Abstract

Background: In Italy, as in a number of high-income countries, nursing homes were often the focus of Covid-19 outbreaks, particularly in the second half of 2020, when the number of infected people in the general population was very high and a vaccine was not yet available. Many factors are known to influence the ability of a nursing home to prevent and contain a Covid 19 outbreak. The role of an organisation's quality management prior to the pandemic is not yet clear. In the Italian region of Tuscany nursing home performance indicators have been regularly collected since before the pandemic, providing the opportunity to better understand this relationship.

Objectives: We wanted to test if there is a difference in the results achieved by nursing homes in Tuscany on 14 quality management indicators, grouped by severity of Covid-19 outbreaks experienced in the second half of 2020. We also wanted to better understand how these quality management indicators may be related to the ability to control Covid-19 outbreaks, from the perspective of nursing homes.

Methods: We used a mixed methods approach. Data from regional and national databases were used to divide 166 nursing homes in Tuscany into 4 groups by outbreak severity. We tested the significance of the differences between the groups with respect to 14 structure, process and outcome indicators related to quality management. Furthermore, the potential relation of these indicators to Covid-19 outbreaks in nursing homes was discussed with 30 managers and other staff members from 22 different nursing homes through 4 group interviews.

Results: The quantitative analysis did not show statistically significant differences between the groups of nursing homes, with the exception of the indicator on the use of an administrative software. From the perspective of nursing homes, the indicators might not be good at capturing important aspects related to the ability to control Covid 19 outbreaks. For example, while staffing availability is seen as essential, staff-to-bed ratio does not capture turn-over of staff and temporary absences due to positive Covid 19 testing of staff, which considerably influence staff availability and skills.

Conclusions: The relationship between currently measured quality management indicators and the severity of Covid-19 outbreaks in nursing homes does not seem straightforward. Though currently collected indicators are key for overall performance monitoring and improvement, further refinement of the currently collected quality management indicators is needed to clarify the relationship with nursing homes ability to control of Covid 19 outbreaks.