Challenges of Using Quality Improvement Methods in Nursing Homes that ¡°Need Improvement¡±

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• 作者：Marilyn J. Rantz ; PhD ; RN ; FAAN^a ; ^{RantzM@missouri.edu} ; Mary Zwygart-Stauffacher ; PhD ; RN ; FAAN^b ; Marcia Flesner ; PhD ; RN^a ; Lanis Hicks ; PhD^c ; David Mehr ; MD ; MS^c ; Teresa Russell ; PhD ; RN ; CNE^d ; Donna Minner ; RN ; BSN^a
• 关键词：Quality improvement ; readiness indicators ; nursing homes ; randomized clinical trial ; qualitative analysis
• 刊名：Journal of the American Medical Directors Association
• 出版年：2012
• 出版时间：October, 2012
• 年：2012
• 卷：13
• 期：8
• 页码：732-738
• 全文大小：155 K

文摘

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?= 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.