A Practice Improvement Education Program Using a Mentored Approach to Improve Nursing Facility Depression Care—Preliminary Data

Abstract

Depression is common in nursing facility residents. Depression data obtained using the Minimum Data Set (MDS) 3.0 offer opportunities for improving diagnostic accuracy and care quality. How best to integrate MDS 3.0 and other data into quality improvement (QI) activity is untested. The objective was to increase nursing home (NH) capability in using QI processes and to improve depression assessment and management through focused mentorship and team building. This was a 6-month intervention with five components: facilitated collection of MDS 3.0 nine-item Patient Health Questionnaire (PHQ-9) and medication data for diagnostic interpretation; education and modeling on QI approaches, team building, and nonpharmacological depression care; mentored team meetings; educational webinars; and technical assistance. PHQ-9 and medication data were collected at baseline and 6 and 9 months. Progress was measured using team participation measures, attitude and care process self-appraisal, mentor assessments, and resident depression outcomes. Five NHs established interprofessional teams that included nursing (44.1%), social work (20.6%), physicians (8.8%), and other disciplines (26.5%). Members participated in 61% of eight offered educational meetings (three onsite mentored team meetings and five webinars). Competency self-ratings improved on four depression care measures (P = .05 to <.001). Mentors observed improvement in team process and enthusiasm during team meetings. For 336 residents with PHQ-9 and medication data, depression scores did not change while medication use declined, from 37.2% of residents at baseline to 31.0% at 9 months (P < .001). This structured mentoring program improved care processes, achieved medication reductions, and was well received. Application to other NH-prevalent syndromes is possible.

Quality improvement in long-term care settings: a scoping review of effective strategies used in care homes

“…Other studies described components quality improvement, but without specifying a particular strategy. Components included education about clinical conditions or care ( n = 19) [ 28 , 31 , 33 , 36 , 38 , 43 , 46 , 49 , 52 , 55 , 58 , 60 , 65 , 67 – 69 , 83 , 86 , 94 ], care pathway development ( n = 12) [ 31 , 39 , 46 , 55 , 56 , 67 , 73 , 76 , 77 , 85 , 86 , 91 ], audit and feedback ( n = 14) [ 28 , 33 , 37 , 49 , 58 , 61 , 76 , 77 , 81 , 87 , 91 , 93 – 95 ], changes to multidisciplinary team working ( n = 11) [ 28 , 38 , 40 , 41 , 48 , 71 , 79 , 85 – 87 , 95 ], and enabling peers or champions to lead QI initiatives ( n = 10) [ 28 , 36 , 38 , 63 , 65 , 69 , 77 – 79 , 91 ].…”

“…9 of the 14 studies involved nursing staff, and 6 involved care assistants with several other occupational groups involved in many studies. Studies described resident-facing interventions which addressed clinical topics such as falls [ 37 , 44 , 77 ], end-of-life care [ 76 , 94 ], incontinence [ 81 ], depression [ 28 ], and medication [ 33 ]. Staff-level changes reported for audit and feedback included the following: increased self-rated staff competency [ 28 ], improved staff interactions and relationships with residents [ 27 ], improvement in quality indicators [ 49 ].…”

“…Studies described resident-facing interventions which addressed clinical topics such as falls [ 37 , 44 , 77 ], end-of-life care [ 76 , 94 ], incontinence [ 81 ], depression [ 28 ], and medication [ 33 ]. Staff-level changes reported for audit and feedback included the following: increased self-rated staff competency [ 28 ], improved staff interactions and relationships with residents [ 27 ], improvement in quality indicators [ 49 ]. Finally, for studies of audit and feedback, resident outcomes reported include decrease in hospitalisation [ 93 ], decrease in antipsychotic drug prescribing [ 33 ], and improvement in end-of-life care quality measures [ 94 ].…”

Evaluation of quality improvement intervention with nurse training in nursing homes: A systematic review

“…Outer setting mainly involves external cooperation, such as conducting information‐sharing sessions (Baier et al, 2003; Buhr & White, 2006), and expert consultations (Baier et al., 2004; Chodosh et al., 2015).…”

The role of regulation in the care of older people with depression living in long-term care: a systematic scoping review

“…However, they did note that using the RAI was associated with improvements in meeting resident's needs. Chodosh et al [51] argue that the MDS improved opportunities for assessment and examination of nonpharmacological care but conclude in their study that a lack of technical knowledge and awareness of this tool could be a barrier to its effectiveness in LTC.…”