A randomized, two-group, repeated-measures design was used to test a two year intervention for improving quality of care and resident outcomes in facilities in “need of improvement”. Intervention group (n=29) received an experimental multilevel intervention designed to help them (1) use quality-improvement methods, (2) use team and group process for direct-care decision-making, (3) focus on accomplishing the basics of care, and (4) maintain more consistent nursing and administrative leadership committed to communication and active participation of staff in decision-making. A qualitative analysis revealed a subgroup of homes likely to continue quality improvement activities and readiness indicators of homes likely to improve 1) leadership team (NHA, DON) who are interested in learning to use their federal Quality Indicator/Quality Measure (QI/QM) reports to improve resident care and outcomes; 2) one leader who will be the “change champion” and others make sure that current QI/QM reports are consistently shared on each nursing unit; 3) willingness to involve all staff in educational activities to learn about the QI/QM process and federal reports that compare the home with others in the state and nation; 4) plan and continuously educate new staff about the QI/QM process and how to do quality improvement; 5) continuously involve all staff in quality improvement committee and team activities so they “own” the process and are responsible for change.

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One hundred and five couples with unexplained infertility and 43 couples whose infertility was thought to be due to reduced sperm motility were recruited. The median duration of infertility was 36 months (range 12-168). Couples were randomly allocated to either using Clearplan home ovulation detection kits for 3 cycles or were advised about the optimal time during their menstrual cycle to achieve a pregnancy. The clinical details of the 2 groups were similar. In couples with unexplained infertility over the study period 10 (20.4%) in the Clearplan group and 9 (16%) in the control group conceived with 58% of pregnancies occurring in the first cycle. In couples with reduced sperm motility, the results were disappointing with only 2 (8%) pregnancies in the Clearplan group and 2 (11.1%) in the controls. Assisted reproduction technology may not be justified as the first line of management in patients with unexplained infertility.