Nursing Home Quality

Article PDF:

JAMDA - Challenges in NHs Needing Improvement 13(8) 2012.pdf

Abstract:

Objectives: Qualitatively describe the adoption of strategies and challenges experienced by intervention
facilities participating in a study targeted to improve quality of care in nursing homes “in need of
improvement”. To describe how staff use federal quality indicator/quality measure (QI/QM) scores and
reports, quality improvement methods and activities, and how staff supported and sustained the changes
recommended by their quality improvement teams.

Design/setting/participants: A randomized, two-group, repeated-measures design was used to test
a 2-year intervention for improving quality of care and resident outcomes in facilities in “need of
improvement”. Intervention group (n ¼ 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.

Results: A qualitative analysis revealed a subgroup of homes likely to continue quality improvement
activities and readiness indicators of homes likely to improve: (1) a leadership team (nursing home
administrator, director of nurses) interested in learning how to use their federal QI/QM reports as
a foundation for improving resident care and outcomes; (2) one of the leaders to be a “change champion”
and make sure that current QI/QM reports are consistently printed and shared monthly with each
nursing unit; (3) leaders willing to involve all staff in the facility in educational activities to learn about
the QI/QM process and the reports that show how their facility compares with others in the state and
nation; (4) leaders willing to plan and continuously educate new staff about the MDS and federal QI/QM
reports and how to do quality improvement activities; (5) leaders willing to continuously involve all staff
in quality improvement committee and team activities so they “own” the process and are responsible for
change.

Conclusions: Results of this qualitative analysis can help allocate expert nurse time to facilities that are
actually ready to improve. Wide-spread adoption of this intervention is feasible and could be enabled by
nursing home medical directors in collaborative practice with advanced practice nurses.

Article PDF:

NE - Cost of Care in NH 15(4) 1997.pdf

Abstract:

In 1994 12.7% of the population was 65 and over, while 10.6% were 85 and over. Expenditures for nursing homes reached $72.3 billion in 1994 (much of which is tax-supported) accounting for 8.7% of all personal health money spent. Data from the 1993 Missouri Medicaid cost reports for 403 nursing homes were reviewed to determine differences in costs per resident day (PRD) and discover which factors most influenced these differences. Mid-sized facilities with 60-120 beds reported the lowest resident-related PRD costs. PRD expenses for aides and orderlies were higher in tax-exempt facilities, which was thought to be related to their "more altruistic" mission. Investor-owned facilities showed significantly greater administrative costs PRD, which may relate to higher administrative salaries and fancier offices. The authors suggest further study that would incorporate location, occupancy rate, quality of care, case mix, and payer mix data.

Abstract:

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) a leadership team (NHA, DON) interested in learning how to use their federal QI/QM reports as a foundation for improving resident care and outcomes; 2) one of the leaders to be a “change champion” and make sure that current QI/QM reports are consistently printed and shared monthly with each nursing unit; 3) leaders willing to involve all staff in the facility in educational activities to learn about the QI/QM process and the reports that show how their facility compares with others in the state and nation; 4) leaders willing to plan and continuously educate new staff about the MDS and federal QI/QM reports and how to do quality improvement activities; 5) leaders willing to continuously involve all staff in quality improvement committee and team activities so they “own” the process and are responsible for change.

Key words: quality improvement, readiness indicators, nursing homes, randomized clinical trial, qualitative analysis

Article PDF:

JNCQ - OIQ NH 20(4) 2005.pdf

Abstract:

Over the past 12 years, members of the Minimum Data Set (MDS) and Quality Research Team at the University of Missouri-Columbia have been working with the Missouri Department of Health and Senior Services to improve care in Missouri nursing homes. The team conducted initial qualitative studies that explored the multidimensional aspects of quality of nursing home care. Using grounded theory methods, dimensions important to consumers and overlapping dimensions important to providers, healthcare professionals, and regulators were identified. The quality dimensions were operationalized in a theoretical model of quality of nursing home care. We learned from the studies that quality of care in nursing homes is a concept that encompasses broad dimensions of not only technical care provided but also the context or environment in which the care is delivered.

Abstract:

It is becoming increasingly common for nursing facilities to use Quality Indicators (QI) derived from Minimum Data Set (MDS) data for quality improvement initiatives within their facilities. It is not known how much support facilities need to effectively review QI reports, investigate problem areas, and implement practice changes to improve care. In Missouri, the University of Missouri-Columbia MDS and Nursing Home Quality Research Team has undertaken a Quality Improvement Intervention Study using a gerontological clinical nurse specialist (GCNS) to support quality improvement activites in nursing homes. Nursing facilities have responded positively to the availability of a GCNS to assist them in improving nursing facility care quality.