Background
Long-term care institutions are challenged to provide good quality care with increasing complexity and scarce resources. There is a lack of nationally specific practices to consistently and systematically support data-driven quality development in long-term care institutions. Accordingly, the Federal Quality Commission (FQC) commissioned a National Implementation Program (NIP) to ARTISET with the industry association CURAVIVA and senesuisse to strengthen the quality of data collection and the quality of the data collected for quality indicators, as well as to promote data-driven quality development in long-term care institutions.

Objective
The overall objective of NIP-Q-UPGRADE is the data-driven improvement of the quality of care in long-term care institutions. This will be addressed through the following work packages:
(1) Optimising data collection and quality
(2) Further development of quality indicators
(3) Develop and implement quality improvement measures.
In collaboration with the stakeholders, needs for improvement are to be defined and developed in order to then jointly search for solutions to improve data quality at the level of the long-term institutions, the software providers for needs assessment instruments and resident documentation and the Federal Offices of Public Health and Statistics (planned for 2023 - 2024).
In a further step, it will be verified whether the solutions actually improve data quality. The national implementation of the measures is being prepared by the industry association CURAVIVA and senesuisse (planned for 2025 - 2026).
The introduction of the three quality indicators pressure ulcers, advance health care planning and medication review is also being prepared (planned for 2023 - 2024). Together with the long-term care institutions, work is being done on how the three indicators can be introduced and integrated into the existing structures and systems (2024 - 2025). In addition, new quality indicators are to be developed. Finally, the aim is to find out how long-term care institutions can best be supported in improving quality. Together with them, a program will be developed to support them in using quality of care data to further develop their care (planned for 2023 - 2024). Here too, national implementation is being planned by the industry association CURAVIVA and senesuisse. Finally, it will be examined whether the program developed offers an effective solution for the further development of care quality (planned for 2025 - 2026).

Program Design
In principle, approaches from implementation science are used in the implementation of NIP-Q-UPGRADE. This includes working with the EPIS framework with 4 phases of an implementation: from finding the best intervention(s), to context analysis, elaborating intervention(s) and implementation strategies, implementing and evaluating them, and ensuring sustainable implementation. Another framework is Going for Full Scale, which describes the process of scaling up from the development of a package of interventions, including implementation strategies, to replication in all desired settings. The detailed objectives of the work packages are subordinate to these two major processes. For each of the detailed objectives, appropriate methodological approaches are proposed, including quantitative, qualitative and mixed-method approaches, such as a rapid ethnography study for context analysis, case studies of international best practice examples, a validation study to check the quality of data collection, qualitative interviews to describe best practice examples of quality development at home level, workshops with residents and relatives to elicit their perspectives, pilot studies to test the planned programs, and national evaluations of the programs with online surveys and the use of routine data. A participatory approach will also be used to draw a broad arc across all steps, working with a sounding board group and an advisory group, as well as suggesting how residents and relatives can be involved in the development and evaluation of the programs. For the evaluation of the program, suitable methods will be developed in the first months of the program and agreed upon with FQC. Here, lessons learned per detailed objective are planned in the sense of a retrospective, as well as synthesis reports on the three work packages, in which findings from the program are compiled for a possible transfer to other programs and service provider areas.

Expected benefit / relevance
NIP-Q-UPGRADE will contribute to the development of quality of care in long-term care. It increases the data quality of national quality indicators, improves data-driven quality development, and thus has an impact on the quality development of long-term care.