A cross-sectional survey to investigate the quality of care in Tuscan (Italy) nursing homes: the structural, process and outcome indicators of nutritional care
Identifieur interne : 001078 ( Pmc/Checkpoint ); précédent : 001077; suivant : 001079A cross-sectional survey to investigate the quality of care in Tuscan (Italy) nursing homes: the structural, process and outcome indicators of nutritional care
Auteurs : Guglielmo Bonaccorsi [Italie] ; Francesca Collini [Italie] ; Mariangela Castagnoli [Italie] ; Mauro Di Bari [Italie] ; Maria Chiara Cavallini [Italie] ; Nicoletta Zaffarana [Italie] ; Pasquale Pepe [Italie] ; Alessandro Mugelli [Italie] ; Ersilia Lucenteforte [Italie] ; Alfredo Vannacci [Italie] ; Chiara Lorini [Italie]Source :
- BMC Health Services Research [ 1472-6963 ] ; 2015.
Abstract
Previous studies have investigated process and structure indicators of nutritional care as well as their use in nursing homes (NHs), but the relative weight of these indicators in predicting the risk of malnutrition remains unclear.
Aims of the present study are to describe the quality indicators of nutritional care in older residents in a sample of NHs in Tuscany, Italy, and to evaluate the predictors of protein-energy malnutrition risk.
A cross-sectional survey was conducted in 67 NHs. Information was collected to evaluate quality indicators of nutritional care and the individual risk factors for malnutrition, which was assessed using the Malnutrition Universal Screening Tool. A multilevel model was used to analyse the association between risk and predictors.
Out of 2395 participants, 23.7 % were at high, 11 % at medium, and 65.3 % at low risk for malnutrition. Forty-two percent of the NHs had only a personal scale to weigh residents; 88 % did not routinely use a screening test/tool for malnutrition; 60 % used some standardized approach for weight measurement; 43 % did not assess the severity of dysphagia; 12 % were not staffed with dietitians.
Patients living in NHs where a chair or platform scale was available had a significantly lower risk of malnutrition (OR = 0.73; 95 % CI = 0.56–0.94). None of the other structural or process quality indicators showed a statistically significant association with malnutrition risk.
Of all the process and structural indicators considered, only the absence of an adequate scale to weigh residents predicted the risk of malnutrition, after adjusting for case mix. These findings prompt the conduction of further investigations on the effectiveness of structural and process indicators that are used to describe quality of nutritional care in NHs.
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DOI: 10.1186/s12913-015-0881-5
PubMed: 26047610
PubMed Central: 4458040
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Department of Experimental and Clinical Medicine, University of Florence-Unit of Geriatric Cardiology and Medicine, Florence, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence-Unit of Geriatric Cardiology and Medicine, Florence</wicri:regionArea><wicri:noRegion>Florence</wicri:noRegion></affiliation></author><author><name sortKey="Pepe, Pasquale" sort="Pepe, Pasquale" uniqKey="Pepe P" first="Pasquale" last="Pepe">Pasquale Pepe</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Regional Health Agency of Tuscany, Tuscany, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Regional Health Agency of Tuscany, Tuscany</wicri:regionArea><wicri:noRegion>Tuscany</wicri:noRegion></affiliation></author><author><name sortKey="Mugelli, Alessandro" sort="Mugelli, Alessandro" uniqKey="Mugelli A" first="Alessandro" last="Mugelli">Alessandro Mugelli</name><affiliation wicri:level="1"><nlm:aff id="Aff5">Department of Neuroscience, Psychology, Drug Research and Children’s Health, University of Florence, viale Pieraccini 6, 50139 Florence, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Neuroscience, Psychology, Drug Research and Children’s Health, University of Florence, viale Pieraccini 6, 50139 Florence</wicri:regionArea><wicri:noRegion>50139 Florence</wicri:noRegion></affiliation></author><author><name sortKey="Lucenteforte, Ersilia" sort="Lucenteforte, Ersilia" uniqKey="Lucenteforte E" first="Ersilia" last="Lucenteforte">Ersilia Lucenteforte</name><affiliation wicri:level="1"><nlm:aff id="Aff5">Department of Neuroscience, Psychology, Drug Research and Children’s Health, University of Florence, viale Pieraccini 6, 50139 Florence, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Neuroscience, Psychology, Drug Research and Children’s Health, University of Florence, viale Pieraccini 6, 50139 Florence</wicri:regionArea><wicri:noRegion>50139 Florence</wicri:noRegion></affiliation></author><author><name sortKey="Vannacci, Alfredo" sort="Vannacci, Alfredo" uniqKey="Vannacci A" first="Alfredo" last="Vannacci">Alfredo Vannacci</name><affiliation wicri:level="1"><nlm:aff id="Aff5">Department of Neuroscience, Psychology, Drug Research and Children’s Health, University of Florence, viale Pieraccini 6, 50139 Florence, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Neuroscience, Psychology, Drug Research and Children’s Health, University of Florence, viale Pieraccini 6, 50139 Florence</wicri:regionArea><wicri:noRegion>50139 Florence</wicri:noRegion></affiliation></author><author><name sortKey="Lorini, Chiara" sort="Lorini, Chiara" uniqKey="Lorini C" first="Chiara" last="Lorini">Chiara Lorini</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Health Science, University of Florence, viale GB Morgagni 48, 50134 Florence, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Health Science, University of Florence, viale GB Morgagni 48, 50134 Florence</wicri:regionArea><wicri:noRegion>50134 Florence</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26047610</idno><idno type="pmc">4458040</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458040</idno><idno type="RBID">PMC:4458040</idno><idno type="doi">10.1186/s12913-015-0881-5</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000B73</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000B73</idno><idno type="wicri:Area/Pmc/Curation">000B73</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000B73</idno><idno type="wicri:Area/Pmc/Checkpoint">001078</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">001078</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">A cross-sectional survey to investigate the quality of care in Tuscan (Italy) nursing homes: the structural, process and outcome indicators of nutritional care</title><author><name sortKey="Bonaccorsi, Guglielmo" sort="Bonaccorsi, Guglielmo" uniqKey="Bonaccorsi G" first="Guglielmo" last="Bonaccorsi">Guglielmo Bonaccorsi</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Health Science, University of Florence, viale GB Morgagni 48, 50134 Florence, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Health Science, University of Florence, viale GB Morgagni 48, 50134 Florence</wicri:regionArea><wicri:noRegion>50134 Florence</wicri:noRegion></affiliation></author><author><name sortKey="Collini, Francesca" sort="Collini, Francesca" uniqKey="Collini F" first="Francesca" last="Collini">Francesca Collini</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Regional Health Agency of Tuscany, Tuscany, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Regional Health Agency of Tuscany, Tuscany</wicri:regionArea><wicri:noRegion>Tuscany</wicri:noRegion></affiliation></author><author><name sortKey="Castagnoli, Mariangela" sort="Castagnoli, Mariangela" uniqKey="Castagnoli M" first="Mariangela" last="Castagnoli">Mariangela Castagnoli</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Regional Health Agency of Tuscany, Tuscany, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Regional Health Agency of Tuscany, Tuscany</wicri:regionArea><wicri:noRegion>Tuscany</wicri:noRegion></affiliation></author><author><name sortKey="Di Bari, Mauro" sort="Di Bari, Mauro" uniqKey="Di Bari M" first="Mauro" last="Di Bari">Mauro Di Bari</name><affiliation wicri:level="1"><nlm:aff id="Aff3">Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence-Unit of Geriatric Cardiology and Medicine, Florence, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence-Unit of Geriatric Cardiology and Medicine, Florence</wicri:regionArea><wicri:noRegion>Florence</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff4">Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence</wicri:regionArea><wicri:noRegion>Florence</wicri:noRegion></affiliation></author><author><name sortKey="Cavallini, Maria Chiara" sort="Cavallini, Maria Chiara" uniqKey="Cavallini M" first="Maria Chiara" last="Cavallini">Maria Chiara Cavallini</name><affiliation wicri:level="1"><nlm:aff id="Aff3">Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence-Unit of Geriatric Cardiology and Medicine, Florence, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence-Unit of Geriatric Cardiology and Medicine, Florence</wicri:regionArea><wicri:noRegion>Florence</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff4">Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence</wicri:regionArea><wicri:noRegion>Florence</wicri:noRegion></affiliation></author><author><name sortKey="Zaffarana, Nicoletta" sort="Zaffarana, Nicoletta" uniqKey="Zaffarana N" first="Nicoletta" last="Zaffarana">Nicoletta Zaffarana</name><affiliation wicri:level="1"><nlm:aff id="Aff3">Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence-Unit of Geriatric Cardiology and Medicine, Florence, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence-Unit of Geriatric Cardiology and Medicine, Florence</wicri:regionArea><wicri:noRegion>Florence</wicri:noRegion></affiliation></author><author><name sortKey="Pepe, Pasquale" sort="Pepe, Pasquale" uniqKey="Pepe P" first="Pasquale" last="Pepe">Pasquale Pepe</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Regional Health Agency of Tuscany, Tuscany, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Regional Health Agency of Tuscany, Tuscany</wicri:regionArea><wicri:noRegion>Tuscany</wicri:noRegion></affiliation></author><author><name sortKey="Mugelli, Alessandro" sort="Mugelli, Alessandro" uniqKey="Mugelli A" first="Alessandro" last="Mugelli">Alessandro Mugelli</name><affiliation wicri:level="1"><nlm:aff id="Aff5">Department of Neuroscience, Psychology, Drug Research and Children’s Health, University of Florence, viale Pieraccini 6, 50139 Florence, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Neuroscience, Psychology, Drug Research and Children’s Health, University of Florence, viale Pieraccini 6, 50139 Florence</wicri:regionArea><wicri:noRegion>50139 Florence</wicri:noRegion></affiliation></author><author><name sortKey="Lucenteforte, Ersilia" sort="Lucenteforte, Ersilia" uniqKey="Lucenteforte E" first="Ersilia" last="Lucenteforte">Ersilia Lucenteforte</name><affiliation wicri:level="1"><nlm:aff id="Aff5">Department of Neuroscience, Psychology, Drug Research and Children’s Health, University of Florence, viale Pieraccini 6, 50139 Florence, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Neuroscience, Psychology, Drug Research and Children’s Health, University of Florence, viale Pieraccini 6, 50139 Florence</wicri:regionArea><wicri:noRegion>50139 Florence</wicri:noRegion></affiliation></author><author><name sortKey="Vannacci, Alfredo" sort="Vannacci, Alfredo" uniqKey="Vannacci A" first="Alfredo" last="Vannacci">Alfredo Vannacci</name><affiliation wicri:level="1"><nlm:aff id="Aff5">Department of Neuroscience, Psychology, Drug Research and Children’s Health, University of Florence, viale Pieraccini 6, 50139 Florence, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Neuroscience, Psychology, Drug Research and Children’s Health, University of Florence, viale Pieraccini 6, 50139 Florence</wicri:regionArea><wicri:noRegion>50139 Florence</wicri:noRegion></affiliation></author><author><name sortKey="Lorini, Chiara" sort="Lorini, Chiara" uniqKey="Lorini C" first="Chiara" last="Lorini">Chiara Lorini</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Health Science, University of Florence, viale GB Morgagni 48, 50134 Florence, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Health Science, University of Florence, viale GB Morgagni 48, 50134 Florence</wicri:regionArea><wicri:noRegion>50134 Florence</wicri:noRegion></affiliation></author></analytic><series><title level="j">BMC Health Services Research</title><idno type="eISSN">1472-6963</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Previous studies have investigated process and structure indicators of nutritional care as well as their use in nursing homes (NHs), but the relative weight of these indicators in predicting the risk of malnutrition remains unclear.</p><p>Aims of the present study are to describe the quality indicators of nutritional care in older residents in a sample of NHs in Tuscany, Italy, and to evaluate the predictors of protein-energy malnutrition risk.</p></sec><sec><title>Methods</title><p>A cross-sectional survey was conducted in 67 NHs. Information was collected to evaluate quality indicators of nutritional care and the individual risk factors for malnutrition, which was assessed using the Malnutrition Universal Screening Tool. A multilevel model was used to analyse the association between risk and predictors.</p></sec><sec><title>Results</title><p>Out of 2395 participants, 23.7 % were at high, 11 % at medium, and 65.3 % at low risk for malnutrition. Forty-two percent of the NHs had only a personal scale to weigh residents; 88 % did not routinely use a screening test/tool for malnutrition; 60 % used some standardized approach for weight measurement; 43 % did not assess the severity of dysphagia; 12 % were not staffed with dietitians.</p><p>Patients living in NHs where a chair or platform scale was available had a significantly lower risk of malnutrition (OR = 0.73; 95 % CI = 0.56–0.94). None of the other structural or process quality indicators showed a statistically significant association with malnutrition risk.</p></sec><sec><title>Conclusions</title><p>Of all the process and structural indicators considered, only the absence of an adequate scale to weigh residents predicted the risk of malnutrition, after adjusting for case mix. These findings prompt the conduction of further investigations on the effectiveness of structural and process indicators that are used to describe quality of nutritional care in NHs.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Baier, Rr" uniqKey="Baier R">RR Baier</name></author><author><name sortKey="Butterfield, K" uniqKey="Butterfield K">K Butterfield</name></author><author><name sortKey="Harris, Y" uniqKey="Harris Y">Y Harris</name></author><author><name sortKey="Gravenstein, S" uniqKey="Gravenstein S">S Gravenstein</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Castle, Ng" uniqKey="Castle N">NG Castle</name></author><author><name sortKey="Ferguson, Jc" uniqKey="Ferguson J">JC 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<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Health Serv Res</journal-id><journal-id journal-id-type="iso-abbrev">BMC Health Serv Res</journal-id><journal-title-group><journal-title>BMC Health Services Research</journal-title></journal-title-group><issn pub-type="epub">1472-6963</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26047610</article-id><article-id pub-id-type="pmc">4458040</article-id><article-id pub-id-type="publisher-id">881</article-id><article-id pub-id-type="doi">10.1186/s12913-015-0881-5</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>A cross-sectional survey to investigate the quality of care in Tuscan (Italy) nursing homes: the structural, process and outcome indicators of nutritional care</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Bonaccorsi</surname><given-names>Guglielmo</given-names></name><address><email>guglielmo.bonaccorsi@unifi.it</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Collini</surname><given-names>Francesca</given-names></name><address><email>francesca.collini@ars.toscana.it</email></address><xref ref-type="aff" rid="Aff2"></xref></contrib><contrib contrib-type="author"><name><surname>Castagnoli</surname><given-names>Mariangela</given-names></name><address><email>mariangela.castagnoli@virgilio.it</email></address><xref ref-type="aff" rid="Aff2"></xref></contrib><contrib contrib-type="author"><name><surname>Di Bari</surname><given-names>Mauro</given-names></name><address><email>mauro.dibari@unifi.it</email></address><xref ref-type="aff" rid="Aff3"></xref><xref ref-type="aff" rid="Aff4"></xref></contrib><contrib contrib-type="author"><name><surname>Cavallini</surname><given-names>Maria Chiara</given-names></name><address><email>mariachiara.cavallini@unifi.it</email></address><xref ref-type="aff" rid="Aff3"></xref><xref ref-type="aff" rid="Aff4"></xref></contrib><contrib contrib-type="author"><name><surname>Zaffarana</surname><given-names>Nicoletta</given-names></name><address><email>nicolettazaffarana@alice.it</email></address><xref ref-type="aff" rid="Aff3"></xref></contrib><contrib contrib-type="author"><name><surname>Pepe</surname><given-names>Pasquale</given-names></name><address><email>pasquale_pepe1@virgilio.it</email></address><xref ref-type="aff" rid="Aff2"></xref></contrib><contrib contrib-type="author"><name><surname>Mugelli</surname><given-names>Alessandro</given-names></name><address><email>alessandro.mugelli@unifi.it</email></address><xref ref-type="aff" rid="Aff5"></xref></contrib><contrib contrib-type="author"><name><surname>Lucenteforte</surname><given-names>Ersilia</given-names></name><address><email>ersilia.lucenteforte@unifi.it</email></address><xref ref-type="aff" rid="Aff5"></xref></contrib><contrib contrib-type="author"><name><surname>Vannacci</surname><given-names>Alfredo</given-names></name><address><email>alfredo.vannacci@unifi.it</email></address><xref ref-type="aff" rid="Aff5"></xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Lorini</surname><given-names>Chiara</given-names></name><address><phone>+390552751065</phone><email>chiara.lorini@unifi.it</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><aff id="Aff1"><label></label>Department of Health Science, University of Florence, viale GB Morgagni 48, 50134 Florence, Italy</aff><aff id="Aff2"><label></label>Regional Health Agency of Tuscany, Tuscany, Italy</aff><aff id="Aff3"><label></label>Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence-Unit of Geriatric Cardiology and Medicine, Florence, Italy</aff><aff id="Aff4"><label></label>Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy</aff><aff id="Aff5"><label></label>Department of Neuroscience, Psychology, Drug Research and Children’s Health, University of Florence, viale Pieraccini 6, 50139 Florence, Italy</aff></contrib-group><pub-date pub-type="epub"><day>6</day><month>6</month><year>2015</year></pub-date><pub-date pub-type="pmc-release"><day>6</day><month>6</month><year>2015</year></pub-date><pub-date pub-type="collection"><year>2015</year></pub-date><volume>15</volume><elocation-id>223</elocation-id><history><date date-type="received"><day>30</day><month>10</month><year>2014</year></date><date date-type="accepted"><day>19</day><month>5</month><year>2015</year></date></history><permissions><copyright-statement>© Bonaccorsi et al. 2015</copyright-statement><license license-type="open-access"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0">http://creativecommons.org/licenses/by/4.0</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>) applies to the data made available in this article, unless otherwise stated.</license-p></license></permissions><abstract id="Abs1"><sec><title>Background</title><p>Previous studies have investigated process and structure indicators of nutritional care as well as their use in nursing homes (NHs), but the relative weight of these indicators in predicting the risk of malnutrition remains unclear.</p><p>Aims of the present study are to describe the quality indicators of nutritional care in older residents in a sample of NHs in Tuscany, Italy, and to evaluate the predictors of protein-energy malnutrition risk.</p></sec><sec><title>Methods</title><p>A cross-sectional survey was conducted in 67 NHs. Information was collected to evaluate quality indicators of nutritional care and the individual risk factors for malnutrition, which was assessed using the Malnutrition Universal Screening Tool. A multilevel model was used to analyse the association between risk and predictors.</p></sec><sec><title>Results</title><p>Out of 2395 participants, 23.7 % were at high, 11 % at medium, and 65.3 % at low risk for malnutrition. Forty-two percent of the NHs had only a personal scale to weigh residents; 88 % did not routinely use a screening test/tool for malnutrition; 60 % used some standardized approach for weight measurement; 43 % did not assess the severity of dysphagia; 12 % were not staffed with dietitians.</p><p>Patients living in NHs where a chair or platform scale was available had a significantly lower risk of malnutrition (OR = 0.73; 95 % CI = 0.56–0.94). None of the other structural or process quality indicators showed a statistically significant association with malnutrition risk.</p></sec><sec><title>Conclusions</title><p>Of all the process and structural indicators considered, only the absence of an adequate scale to weigh residents predicted the risk of malnutrition, after adjusting for case mix. These findings prompt the conduction of further investigations on the effectiveness of structural and process indicators that are used to describe quality of nutritional care in NHs.</p></sec></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Quality indicators</kwd><kwd>Nutritional care</kwd><kwd>Nursing home</kwd><kwd>Multilevel analysis</kwd><kwd>Case mix</kwd><kwd>Risk factors</kwd></kwd-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Author(s) 2015</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc><affiliations><list><country><li>Italie</li></country></list><tree><country name="Italie"><noRegion><name sortKey="Bonaccorsi, Guglielmo" sort="Bonaccorsi, Guglielmo" uniqKey="Bonaccorsi G" first="Guglielmo" last="Bonaccorsi">Guglielmo Bonaccorsi</name></noRegion><name sortKey="Castagnoli, Mariangela" sort="Castagnoli, Mariangela" uniqKey="Castagnoli M" first="Mariangela" last="Castagnoli">Mariangela Castagnoli</name><name sortKey="Cavallini, Maria Chiara" sort="Cavallini, Maria Chiara" uniqKey="Cavallini M" first="Maria Chiara" last="Cavallini">Maria Chiara Cavallini</name><name sortKey="Cavallini, Maria Chiara" sort="Cavallini, Maria Chiara" uniqKey="Cavallini M" first="Maria Chiara" last="Cavallini">Maria Chiara Cavallini</name><name sortKey="Collini, Francesca" sort="Collini, Francesca" uniqKey="Collini F" first="Francesca" last="Collini">Francesca Collini</name><name sortKey="Di Bari, Mauro" sort="Di Bari, Mauro" uniqKey="Di Bari M" first="Mauro" last="Di Bari">Mauro Di Bari</name><name sortKey="Di Bari, Mauro" sort="Di Bari, Mauro" uniqKey="Di Bari M" first="Mauro" last="Di Bari">Mauro Di Bari</name><name sortKey="Lorini, Chiara" sort="Lorini, Chiara" uniqKey="Lorini C" first="Chiara" last="Lorini">Chiara Lorini</name><name sortKey="Lucenteforte, Ersilia" sort="Lucenteforte, Ersilia" uniqKey="Lucenteforte E" first="Ersilia" last="Lucenteforte">Ersilia Lucenteforte</name><name sortKey="Mugelli, Alessandro" sort="Mugelli, Alessandro" uniqKey="Mugelli A" first="Alessandro" last="Mugelli">Alessandro Mugelli</name><name sortKey="Pepe, Pasquale" sort="Pepe, Pasquale" uniqKey="Pepe P" first="Pasquale" last="Pepe">Pasquale Pepe</name><name sortKey="Vannacci, Alfredo" sort="Vannacci, Alfredo" uniqKey="Vannacci A" first="Alfredo" last="Vannacci">Alfredo Vannacci</name><name sortKey="Zaffarana, Nicoletta" sort="Zaffarana, Nicoletta" uniqKey="Zaffarana N" first="Nicoletta" last="Zaffarana">Nicoletta Zaffarana</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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