A Randomized Trial of Quality Assurance in Nursing Homes

Mohide, E. Ann; Tugwell, Peter; Caulfield, Patricia; Chambers, Larry W.; Dunnett, Charles W.; Baptiste, Susan; Bayne, J. R. D.; Patterson, Christopher; Rudnick, K. V.; Pill, M.A.J.

doi:10.1097/00005650-198806000-00004

Cited by 28 publications

(15 citation statements)

References 19 publications

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“…9,10 Initial studies that consider this question have found neither an increase nor a decrease in the quality provided for unmeasured conditions. 11,12 Thus, the current evidence, albeit limited, suggests that quality improvement works best when all targeted conditions are measured, as opposed to a limited number of tracer conditions. It is partially with this concern in mind that the EHR, which could potentially allow costeffective automated quality assessment across the entire medical record, has been proposed as a data source for quality assessment and improvement.…”

Section: Introductionmentioning

confidence: 94%

The Challenge of Measuring Quality of Care From the Electronic Health Record

et al. 2009

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The electronic health record (EHR) is seen by many as an ideal vehicle for measuring quality of health care and monitoring ongoing provider performance. It is anticipated that the availability of EHR-extracted data will allow quality assessment without the expensive and time-consuming process of medical record abstraction. A review of the data requirements for the indicators in the Quality Assessment Tools system suggests that only about a third of the indicators would be readily accessible from EHR data. Other factors involving complexity of required data elements, provider documentation habits, and EHR variability make the task of quality measurement more difficult than may be appreciated. Accurately identifying eligible cases for quality assessment and validly scoring those cases with EHR-extracted data will pose significant challenges but could potentially plummet the cost and therefore expand the use of quality assessment.

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Section: Introductionmentioning

confidence: 94%

The Challenge of Measuring Quality of Care From the Electronic Health Record

et al. 2009

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“…41–44 Only two studies in nursing homes have attempted all care systems quality-improvement interventions, and both demonstrated improvements in resident outcomes: mobility and constipation 45 and falls, behavioral symptoms, little or no activity, and pressure ulcers. 43 The first study 45 used narrowly focused clinical conditions of hazardous mobility or constipation and nurse consultants to assist 30 experimental homes to learn quality-assurance methods and improve care.…”

mentioning

confidence: 99%

Randomized Multilevel Intervention to Improve Outcomes of Residents in Nursing Homes in Need of Improvement

Rantz¹,

Zwygart-Stauffacher²,

Hicks³

et al. 2012

Journal of the American Medical Directors Association

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Purpose A comprehensive multilevel intervention was tested to build organizational capacity to create and sustain improvement in quality of care and subsequently improve resident outcomes in nursing homes in need of improvement. Intervention facilities (n=29) received a two-year multilevel intervention with monthly on-site consultation from expert nurses with graduate education in gerontological nursing. Attention control facilities (n=29) that also needed to improve resident outcomes received monthly information about aging and physical assessment of elders. Design and Methods Randomized clinical trial of nursing homes in need of improving resident outcomes of bladder and bowel incontinence, weight loss, pressure ulcers, and decline in activities of daily living (ADL). It was hypothesized that following the intervention, experimental facilities would have better resident outcomes, higher quality of care, higher staff retention, more organizational attributes of improved working conditions than control facilities, similar staffing and staff mix, and lower total and direct care costs. Results The intervention did improve quality of care (p=0.02); there were improvements in pressure ulcers (p=0.05), weight loss (p=0.05). Staff retention, organizational working conditions, staffing, and staff mix and most costs were not affected by the intervention. Leadership turnover was surprisingly excessive in both intervention and control groups. Implications Some facilities that are in need of improving quality of care and resident outcomes are able to build the organizational capacity to improve while not increasing staffing or costs of care. Improvement requires continuous supportive consultation and leadership willing to involve staff and work together to build the systematic improvements in care delivery needed.

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“…If there was any discrepancy between the desired and the actual situation, changes were implemented. The results of one controlled study 23 showed that there was a decrease in the occurrence of a number of adverse outcomes (constipation and hazardous mobility), but for other outcome measures (urinary incontinence and potential skin breakdown) the prevalence of adverse outcomes was the same as in the control group. Another controlled study 22 showed that the assessment method helped to detect problems and that many process improvements would not occur without external review.…”

Section: Areasmentioning

confidence: 99%

“…Controlled studies described: (1) the eVectiveness of specific educational programmes 20 21 ; (2) the eVectiveness of two diVerent facility and resident assessment processes on the overall quality of care and the detection of problems 22 ; and (3) the impact of working with quality assurance cycles. 23 In 10 studies the researchers used a pre-test/ post-test design with no control groups in which the interval between the pre-test and the post-test period was less than 1 year. 5 24-32 There were two longitudinal studies in nursing homes with a follow up of several years, 33 34 and four studies with a post-test design only.…”

Section: Research Design Of the Selected Studiesmentioning

confidence: 99%

The effectiveness of quality systems in nursing homes: a review

Wagner¹

2001

Quality in Health Care

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The design of most of the studies meant that it was not possible to attribute the results entirely to the newly implemented quality system. As it is difficult in practice to design a randomised controlled study, future research into the effectiveness of quality systems should not only focus on selected correlates of quality, but should also include a qualitative and quantitative (multivariate and multilevel) approach. The methods used to measure quality need to be improved.

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A Randomized Trial of Quality Assurance in Nursing Homes

Cited by 28 publications

References 19 publications

The Challenge of Measuring Quality of Care From the Electronic Health Record

The Challenge of Measuring Quality of Care From the Electronic Health Record

Randomized Multilevel Intervention to Improve Outcomes of Residents in Nursing Homes in Need of Improvement

The effectiveness of quality systems in nursing homes: a review

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