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Rantz M, Martin N, Zaniletti I, Mueller J, Galambos C, Vogelsmeier A, Popejoy LL, Thompson RA, Crecelius C. Longitudinal Evaluation of a Statewide Quality Improvement Program for Nursing Homes. J Am Med Dir Assoc 2024; 25:904-911.e1. [PMID: 38309303 DOI: 10.1016/j.jamda.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 02/05/2024]
Abstract
OBJECTIVES The National Academies of Sciences, Engineering, and Medicine (NASEM) Nursing Home Quality report recommends that states "develop and operate state-based…technical assistance programs…to help nursing homes…improve care and…operations." The Quality Improvement Program for Missouri (QIPMO) is one such program. This longitudinal evaluation examined and compared differences in quality measures (QMs) and nursing home (NH) characteristics based on intensity of QIPMO services used. DESIGN A descriptive study compared key QMs of clinical care, facility-level characteristics, and differing QIPMO service intensity use. QIPMO services include on-site clinical consultation by expert nurses; evidence-based practice information; teaching NHs use of quality improvement (QI) methods; and guiding their use of Centers for Medicare and Medicaid Services (CMS)-prepared QM comparative feedback reports to improve care. SETTING AND PARTICIPANTS All Missouri NHs (n = 510) have access to QIPMO services at no charge. All used some level of service during the study, 2020-2022. METHODS QM data were drawn from CMS's publicly available website (Refresh April 2023) and NH characteristics data from other public websites. Service intensity was calculated using data from facility contacts (on-site visits, phone calls, texts, emails, webinars). NHs were divided into quartiles based on service intensity. RESULTS All groups had different beginning QM scores and improved ending scores. Group 2, moderate resource intensity use, started with "worse" overall score and improved to best performing by the end. Group 4, most resource intensity use, improved least but required highest service intensity. CONCLUSIONS AND IMPLICATIONS This longitudinal evaluation of QIPMO, a statewide QI technical assistance and support program, provides evidence of programmatic stimulation of statewide NH quality improvements. It provides insight into intensity of services needed to help facilities improve. Other states should consider QIPMO success and develop their own programs, as recommended by the NASEM report so their NHs can embrace QI and "initiate fundamental change" for better care for our nation's older adults.
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Affiliation(s)
- Marilyn Rantz
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA.
| | - Nicky Martin
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | | | - Jessica Mueller
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Colleen Galambos
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Amy Vogelsmeier
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Lori L Popejoy
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Roy A Thompson
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
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Tevik K, Helvik AS, Stensvik GT, Nordberg MS, Nakrem S. Nursing-sensitive quality indicators for quality improvement in Norwegian nursing homes - a modified Delphi study. BMC Health Serv Res 2023; 23:1068. [PMID: 37803376 PMCID: PMC10557356 DOI: 10.1186/s12913-023-10088-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Use of nursing-sensitive quality indicators (QIs) is one way to monitor the quality of care in nursing homes (NHs). The aim of this study was to develop a consensus list of nursing-sensitive QIs for Norwegian NHs. METHODS A narrative literature review followed by a non-in-person, two-round, six-step modified Delphi survey was conducted. A five-member project group was established to draw up a list of nursing-sensitive QIs from a preliminary list of 24 QIs selected from Minimum Data Set (2.0) (MDS) and the international Resident Assessment Instrument for Long-Term Care Facilities (interRAI LTCF). We included scientific experts (researchers), clinical experts (healthcare professionals in NHs), and experts of experience (next-of-kin of NH residents). The experts rated nursing-sensitive QIs in two rounds on a seven-point Likert scale. Consensus was based on median value and level of dispersion. Analyses were conducted for four groups: 1) all experts, 2) scientific experts, 3) clinical experts, and 4) experts of experience. RESULTS The project group drew up a list of 20 nursing-sensitive QIs. Nineteen QIs were selected from MDS/interRAI LTCF and one ('systematic medication review') from the Norwegian quality assessment system IPLOS ('Statistics linked to individual needs of care'). In the first and second Delphi round, 44 experts (13 researchers, 17 healthcare professionals, 14 next-of-kin) and 28 experts (8 researchers, 10 healthcare professionals, 10 next-of-kin) participated, respectively. The final consensus list consisted of 16 nursing-sensitive QIs, which were ranked in this order by the 'all expert group': 1) systematic medication review, 2) pressure ulcers, 3) behavioral symptoms, 4) pain, 5) dehydration, 6) oral/dental health problems, 7) urinary tract infection, 8) fecal impaction, 9) depression, 10) use of aids that inhibit freedom of movement, 11) participation in activities of interest, 12) participation in social activities, 13) decline in activities of daily living, 14) weight loss, 15) falls, and 16) hearing loss without the use of hearing aids. CONCLUSIONS Multidisciplinary experts were able to reach consensus on 16 nursing-sensitive QIs. The results from this study can be used to implement QIs in Norwegian NHs, which can improve the quality of care.
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Affiliation(s)
- Kjerstin Tevik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.
| | - Anne-Sofie Helvik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Geir-Tore Stensvik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Marion S Nordberg
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Geriatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sigrid Nakrem
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- National Ageing Research Institute, Royal Melbourne Hospital, 34-54 Poplar Road, Victoria, 3050, Australia
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Rantz M, Ersek M. Care Delivery, Quality Measurement, and Quality Improvement in Nursing Homes: Issues and Recommendations from the National Academies' Report on the Quality of Care in Nursing Homes. J Am Geriatr Soc 2023; 71:329-334. [PMID: 36795629 DOI: 10.1111/jgs.18275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 01/26/2023] [Indexed: 02/17/2023]
Affiliation(s)
- Marilyn Rantz
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA
| | - Mary Ersek
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute and School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Mueller CA, Alexander GL, Ersek M, Ferrell BR, Rantz MJ, Travers JL. Calling all nurses-Now is the time to take action on improving the quality of care in nursing homes. Nurs Outlook 2023; 71:101897. [PMID: 36621418 DOI: 10.1016/j.outlook.2022.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/18/2022] [Accepted: 11/08/2022] [Indexed: 01/09/2023]
Abstract
For a number of decades, nurses have raised concerns about nursing-related issues in nursing homes (NH) such as inadequate registered nurse (RN) staffing, insufficient RN and advanced practice registered nurse (APRN) gerontological expertise, and lack of RN leadership competencies. The NASEM Committee on the Quality of Care in Nursing Homes illuminated the long-standing issues and concerns affecting the quality of care in nursing homes and proposed seven goals and associated recommendations intended to achieve the Committee's vision: Nursing home residents receive care in a safe environment that honors their values and preferences, addresses goals of care, promotes equity, and assesses the benefits and risks of care and treatments. This paper outlines concrete and specific actions nurses and nursing organizations can take to ensure the recommendations are implemented.
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Affiliation(s)
| | | | - Mary Ersek
- Veteran Experience Center, University of Pennsylvania Schools of Nursing and Medicine, Department of Veterans Affairs, Philadelphia, PA
| | - Betty R Ferrell
- City of Hope National Medical Center, Division of Nursing Research & Education, Duarte, CA
| | - Marilyn J Rantz
- University of Missouri, Sinclair School of Nursing, Columbia, MO
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Martin N, Frank B, Farrell D, Brady C, Dixon-Hall J, Mueller J, Rantz M. Sharing Lessons From Successes: Long-term Care Facilities That Weathered the Storm of COVID-19 and Staffing Crises. J Nurs Care Qual 2023; 38:19-25. [PMID: 36166657 PMCID: PMC9678394 DOI: 10.1097/ncq.0000000000000662] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To identify leadership styles and staffing strategies in Missouri long-term care (LTC) facilities that stood out among their peers as "positive deviants" with regard to COVID-19 infections and staffing shortages. METHODS Statewide survey of all LTC facilities to identify exemplar facilities with stable staffing and low rates of COVID-19. Interviews with senior leaders were conducted in 10 facilities in the state to understand the strategies employed that led to these "positive outliers." A result-based educational program was designed to describe their actions and staff reactions. RESULTS Exemplar leaders used transformational leadership style. Top reasons for their success were as follows: (1) trusting and supportive staff relationships; (2) positive presence and communication; and (3) use of consistent staffing assignments. Strong statewide participation was noted in the educational programs.
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Affiliation(s)
- Nicky Martin
- Sinclair School of Nursing, University of Missouri, Columbia (Mss Martin, Dixon-Hall, and Mueller and Dr Rantz); B&F Consulting, Warren, Rhode Island (Ms Frank); Alameda County Public Health Department, Oakland, California (Mr Farrell); and B&F Consulting, Charlestown, Rhode Island (Ms Brady)
| | - Barbara Frank
- Sinclair School of Nursing, University of Missouri, Columbia (Mss Martin, Dixon-Hall, and Mueller and Dr Rantz); B&F Consulting, Warren, Rhode Island (Ms Frank); Alameda County Public Health Department, Oakland, California (Mr Farrell); and B&F Consulting, Charlestown, Rhode Island (Ms Brady)
| | - David Farrell
- Sinclair School of Nursing, University of Missouri, Columbia (Mss Martin, Dixon-Hall, and Mueller and Dr Rantz); B&F Consulting, Warren, Rhode Island (Ms Frank); Alameda County Public Health Department, Oakland, California (Mr Farrell); and B&F Consulting, Charlestown, Rhode Island (Ms Brady)
| | - Cathie Brady
- Sinclair School of Nursing, University of Missouri, Columbia (Mss Martin, Dixon-Hall, and Mueller and Dr Rantz); B&F Consulting, Warren, Rhode Island (Ms Frank); Alameda County Public Health Department, Oakland, California (Mr Farrell); and B&F Consulting, Charlestown, Rhode Island (Ms Brady)
| | - Janice Dixon-Hall
- Sinclair School of Nursing, University of Missouri, Columbia (Mss Martin, Dixon-Hall, and Mueller and Dr Rantz); B&F Consulting, Warren, Rhode Island (Ms Frank); Alameda County Public Health Department, Oakland, California (Mr Farrell); and B&F Consulting, Charlestown, Rhode Island (Ms Brady)
| | - Jessica Mueller
- Sinclair School of Nursing, University of Missouri, Columbia (Mss Martin, Dixon-Hall, and Mueller and Dr Rantz); B&F Consulting, Warren, Rhode Island (Ms Frank); Alameda County Public Health Department, Oakland, California (Mr Farrell); and B&F Consulting, Charlestown, Rhode Island (Ms Brady)
| | - Marilyn Rantz
- Sinclair School of Nursing, University of Missouri, Columbia (Mss Martin, Dixon-Hall, and Mueller and Dr Rantz); B&F Consulting, Warren, Rhode Island (Ms Frank); Alameda County Public Health Department, Oakland, California (Mr Farrell); and B&F Consulting, Charlestown, Rhode Island (Ms Brady)
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Mo S, Shi J. The Psychological Consequences of the COVID-19 on Residents and Staff in Nursing Homes. WORK, AGING AND RETIREMENT 2020; 6:254-259. [PMID: 34192005 PMCID: PMC7665707 DOI: 10.1093/workar/waaa021] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
In this commentary, we overview the existing research on psychological consequences caused by COVID-19 for both residents and staff in the nursing homes. We identify loneliness and emotional anxiety as main psychological consequences for nursing home residents, whereas uncertainty, hopelessness, work overload, and role conflicts are the most salient psychological challenges for the staff in the nursing homes during the pandemic. We then summarize the existing strategies and interventions responsive to the above challenges. We suggest that this overview may help nursing home managers understand what are the key psychological challenges and how to deal with them during a crisis period. Finally, we also encourage future research to pay more attention to exploring interventions specifically designed for vulnerable older people, understanding the role of the nursing home leader team in managing emotional and ethical challenges in organizations, and developing community-wide collaboration with multiple external stakeholders.
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Affiliation(s)
| | - Junqi Shi
- Zhejiang University, Hangzhou, China
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Behrens LL, Naylor MD. "We are Alone in This Battle": A Framework for a Coordinated Response to COVID-19 in Nursing Homes. J Aging Soc Policy 2020; 32:316-322. [PMID: 32497467 DOI: 10.1080/08959420.2020.1773190] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
As of May 2020, nursing home residents account for a staggering one-third of the more than 80,000 deaths due to COVID-19 in the U.S. This pandemic has resulted in unprecedented threats to achieving and sustaining care quality even in the best nursing homes, requiring active engagement of nursing home leaders in developing solutions responsive to the unprecedented threats to quality standards of care delivery during the pandemic. This perspective offers a framework, designed with the input of nursing home leaders, to facilitate internal and external decision-making and collective action to address these threats. Policy options focus on assuring a shared understanding among nursing home leaders and government agencies of changes in the operational status of nursing homes throughout the crisis, improving access to additional essential resources needed to mitigate the crisis' impact, and promoting shared accountability for consistently achieving accepted standards in core quality domains.
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Affiliation(s)
- Liza L Behrens
- Postdoctoral Research Fellow, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania, USA
| | - Mary D Naylor
- Marian S. Ware Professor in Gerontology, Director of the NewCourtland Center for Transitions and Health, University of Pennsylvania , Philadelphia, Pennsylvania, USA
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Cacchione PZ. Innovative care models across settings: Providing nursing care to older adults. Geriatr Nurs 2020; 41:16-20. [DOI: 10.1016/j.gerinurse.2020.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Lorini C, Porchia BR, Pieralli F, Bonaccorsi G. Process, structural, and outcome quality indicators of nutritional care in nursing homes: a systematic review. BMC Health Serv Res 2018; 18:43. [PMID: 29373962 PMCID: PMC5787252 DOI: 10.1186/s12913-018-2828-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 01/03/2018] [Indexed: 11/17/2022] Open
Abstract
Background The quality of nursing homes (NHs) has attracted a lot of interest in recent years and is one of the most challenging issues for policy-makers. Nutritional care should be considered an important variable to be measured from the perspective of quality management. The aim of this systematic review is to describe the use of structural, process, and outcome indicators of nutritional care in NHs and the relationship among them. Methods The literature search was carried out in Pubmed, Embase, Scopus, and Web of Science. A temporal filter was applied in order to select papers published in the last 10 years. All types of studies were included, with the exception of reviews, conference proceedings, editorials, and letters to the editor. Papers published in languages other than English, Italian, and Spanish were excluded. Results From the database search, 1063 potentially relevant studies were obtained. Of these, 19 full-text articles were considered eligible for the final synthesis. Most of the studies adopted an observational cross-sectional design. They generally assessed the quality of nutritional care using several indicators, usually including a mixture of many different structural, process, and outcome indicators. Only one of the 19 studies described the quality of care by comparing the results with the threshold values. Nine papers assessed the relationship between indicators and six of them described some significant associations—in the NHs that have a policy related to nutritional risk assessment or a suitable scale to weigh the residents, the prevalence or risk of malnutrition is lower. Finally, only four papers of these nine included risk adjustment. This could limit the comparability of the results. Conclusion Our findings show that a consensus must be reached for defining a set of indicators and standards to improve quality in NHs. Establishing the relationship between structural, process, and outcome indicators is a challenge. There are grounds for investigating this theme by means of prospective longitudinal studies that take the risk adjustment into account.
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Affiliation(s)
- Chiara Lorini
- Department of Health Science, University of Florence, viale GB Morgagni 48, 50134, Florence, Italy.
| | - Barbara Rita Porchia
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, viale GB Morgagni 48, Florence, Italy
| | - Francesca Pieralli
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, viale GB Morgagni 48, Florence, Italy
| | - Gugliemo Bonaccorsi
- Department of Health Science, University of Florence, viale GB Morgagni 48, 50134, Florence, Italy
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Initiative to Test a Multidisciplinary Model With Advanced Practice Nurses to Reduce Avoidable Hospitalizations Among Nursing Facility Residents. J Nurs Care Qual 2014; 29:1-8. [DOI: 10.1097/ncq.0000000000000033] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Li Y, Spector WD, Glance LG, Mukamel DB. State "technical assistance programs" for nursing home quality improvement: variations and potential implications. J Aging Soc Policy 2013; 24:349-67. [PMID: 23216345 DOI: 10.1080/08959420.2012.735157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To improve nursing home quality, many states have developed "technical assistance programs" that provide on-site consultation and training for nursing facility staff. We conducted a national survey on these state programs to collect data on program design, operations, financing, and perceived effectiveness. As of 2010, 17 states had developed such programs. Compared to existing state nursing home quality regulations, these programs represent a collaborative, rather than enforcement-oriented, approach to quality. However, existing programs vary substantially in key structural features such as staffing patterns, funding levels, and relationship with state survey and certification agencies. Perceived effectiveness by program officials on quality was high, although few states have performed formal evaluations. Perceived barriers to program effectiveness included lack of appropriate staff and funding, among others. In conclusion, state technical assistance programs for nursing homes vary in program design and perceived effectiveness. Future comparative evaluations are needed to inform evidence-based quality initiatives.
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Affiliation(s)
- Yue Li
- Department of Public Health Sciences, Division of Health Policy and Outcomes Research, University of Rochester Medical Center, Rochester, New York 14642, USA.
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Rahman AN, Applebaum RA, Schnelle JF, Simmons SF. Translating research into practice in nursing homes: can we close the gap? THE GERONTOLOGIST 2012; 52:597-606. [PMID: 22394494 PMCID: PMC3463418 DOI: 10.1093/geront/gnr157] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 12/05/2011] [Indexed: 11/14/2022] Open
Abstract
PURPOSE A gap between research and practice in many nursing home (NH) care areas persists despite efforts by researchers, policy makers, advocacy groups, and NHs themselves to close it. The reasons are many, but two factors that have received scant attention are the dissemination process itself and the work of the disseminators or change agents. This review article examines these two elements through the conceptual lens of Roger's innovation dissemination model. DESIGN AND METHODS The application of general principles of innovation dissemination suggests that NHs are characteristically slow to innovate and thus may need more time as well as more contact with outside change agents to adopt improved practices. RESULTS A review of the translation strategies used by NH change agents to promote adoption of evidence-based practice in NHs suggests that their strategies inconsistently reflect lessons learned from the broader dissemination literature. IMPLICATIONS NH-related research, policy, and practice recommendations for improving dissemination strategies are presented. If we can make better use of the resources currently devoted to disseminating best practices to NHs, we may be able to speed NHs' adoption of these practices.
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Affiliation(s)
- Anna N Rahman
- Davis School of Gerontology, University of Southern California, 3715 McClintock Ave., Los Angeles, CA 90089-0191, USA.
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Rantz MJ, Zwygart-Stauffacher M, Flesner M, Hicks L, Mehr D, Russell T, Minner D. Challenges of using quality improvement methods in nursing homes that "need improvement". J Am Med Dir Assoc 2012; 13:732-8. [PMID: 22926322 DOI: 10.1016/j.jamda.2012.07.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 07/06/2012] [Accepted: 07/09/2012] [Indexed: 11/26/2022]
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 = 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.
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Affiliation(s)
- Marilyn J Rantz
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA.
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Thresholds for Minimum Data Set Quality Indicators Developed and Applied in Icelandic Nursing Homes. J Nurs Care Qual 2012; 27:266-76. [DOI: 10.1097/ncq.0b013e3182493646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rantz MJ, Zwygart-Stauffacher M, Hicks L, Mehr D, Flesner M, Petroski GF, Madsen RW, Scott-Cawiezell J. Randomized multilevel intervention to improve outcomes of residents in nursing homes in need of improvement. J Am Med Dir Assoc 2012; 13:60-8. [PMID: 21816681 PMCID: PMC3379965 DOI: 10.1016/j.jamda.2011.06.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 06/24/2011] [Accepted: 06/24/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVES 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. DESIGN/SETTING/PARTICIPANTS Intervention facilities (N = 29) received a 2-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. INTERVENTION The authors conducted a 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. It was hypothesized that following the intervention, experimental facilities would have higher quality of care, better resident outcomes, more organizational attributes of improved working conditions than control facilities, higher staff retention, similar staffing and staff mix, and lower total and direct care costs. RESULTS The intervention did improve quality of care (P = .02); there were improvements in pressure ulcers (P = .05) and weight loss (P = .05). Organizational working conditions, staff retention, staffing, and staff mix and most costs were not affected by the intervention. Leadership turnover was surprisingly excessive in both intervention and control groups. CONCLUSION AND 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. Medical directors in collaborative practice with advanced practice nurses are ideally positioned to implement this low-cost, effective intervention nationwide.
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Affiliation(s)
- Marilyn J Rantz
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri 65211, USA.
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Rahman AN, Simmons SF, Applebaum R, Lindabury K, Schnelle JF. The coach is in: improving nutritional care in nursing homes. THE GERONTOLOGIST 2011; 52:571-80. [PMID: 22048808 DOI: 10.1093/geront/gnr111] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE This article describes and evaluates a long distance coaching course aimed at improving nutritional care in nursing homes (NHs). The course was structured to provide more support than traditional training programs offer. METHODS In a series of 6 monthly teleconferences led by an expert in NH nutritional care, participating NH staff received step-by-step instructions for implementing an evidence-based nutritional management program. After each session, participants were asked to implement the care step they had just learned. Coaching calls helped facilitate implementation. Staff in 18 NHs in 12 states completed the course. Evaluation data were collected using a resident data form, pre- and post-training quizzes, a participant course evaluation survey, and a supervisor's report. RESULTS NH staff attended an average of 4.8 teleconferences, with 5 staff members typically attending each teleconference. Average quiz scores increased 30% (p < .0001) from pre- to post-training. A majority of course participants (N = 35) said they would participate in a similar course (82.9%) and would recommend the course (80%). Just under half preferred the coaching course to a more traditional 1- to 2-day conference. Nine of 12 reporting supervisors said their facility planned to continue the new nutritional care program. The 10 NHs that submitted resident data assessed an average of 5 residents using the recommended protocols. IMPLICATIONS We recommend the coaching course format. Dissemination outcomes may improve if resources currently used for short-duration training activities are used instead on coaching activities that support NHs over extended periods.
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Affiliation(s)
- Anna N Rahman
- Davis School of Gerontology, University of Southern California, 519 Stassi Lane, Santa Monica, Los Angeles, CA 90402, USA.
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The Use of Bedside Electronic Medical Record to Improve Quality of Care in Nursing Facilities. Comput Inform Nurs 2011; 29:149-56. [DOI: 10.1097/ncn.0b013e3181f9db79] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reducing perceived barriers to nursing homes data entry in the advancing excellence campaign: the role of LANEs (Local Area Networks for Excellence). J Am Med Dir Assoc 2010; 12:508-17. [PMID: 21450175 DOI: 10.1016/j.jamda.2010.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 03/02/2010] [Accepted: 03/30/2010] [Indexed: 11/23/2022]
Abstract
PURPOSE Advancing Excellence (AE) is a coalition-based campaign concerned with how society cares for its elderly and disabled citizens. The purpose of this project was to work with a small group of volunteer nursing homes and with local quality improvement networks called LANEs (Local Area Networks for Excellence) in 6 states in a learning collaborative. The purpose of the collaborative was to determine effective ways for LANEs to address and mitigate perceived barriers to nursing home data entry in the national Advancing Excellence campaign and to test methods by which local quality improvement networks could support nursing homes as they enter data on the AE Web site. DESIGN AND METHODS A semistructured telephone survey of nursing homes was conducted in 6 states. Participants included LANEs from California, Georgia, Massachusetts, Michigan, Oklahoma, and Washington. Facility characteristics were obtained from a series of questions during the telephone interview. Three states (GA, MA, OK) piloted a new spreadsheet and process for entering data on staff turnover, and 3 states (CA, MI, WA) piloted a new spreadsheet and process for entering data on consistent assignment. RESULTS Many of the nursing homes we contacted had not entered data for organizational goals on the national Web site, but all were able to do so with telephone assistance from the LANE. Eighty-five percent of nursing homes said they would be able to collect information on advance directives if tools (eg, spreadsheets) were provided. Over 40% of nursing homes, including for-profit homes, were willing to have staff and residents/families enter satisfaction data directly on an independent Web site. Nursing homes were able to convey concerns and questions about the process of goal entry, and offer suggestions to the LANEs during semistructured telephone interviews. The 6 LANEs discussed nursing home responses on their regularly scheduled calls, and useful strategies were shared across states. Nursing homes reported that they are using Advancing Excellence target setting and goal entry to improve care, and that they would use new tools such as those for measuring satisfaction, consistent assignment, and advance directives. IMPLICATIONS Having LANE members contact nursing homes directly by telephone engaged the nursing homes in providing valuable feedback on new Advancing Excellence goals and data entry. It also provided an opportunity to clarify issues related to the campaign and ongoing quality improvement efforts, including culture change.
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Rantz MJ, Hicks L, Petroski GF, Madsen RW, Alexander G, Galambos C, Conn V, Scott-Cawiezell J, Zwygart-Stauffacher M, Greenwald L. Cost, Staffing and Quality Impact of Bedside Electronic Medical Record (EMR) in Nursing Homes. J Am Med Dir Assoc 2010; 11:485-93. [DOI: 10.1016/j.jamda.2009.11.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 11/17/2009] [Accepted: 11/17/2009] [Indexed: 10/19/2022]
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Yamamoto-Mitani N, Katakura N, Fujita J, Shinohara Y, Sonoda Y, Hayashi K. Evaluating pressure ulcer care by home healthcare nurses. Int J Older People Nurs 2010; 6:201-15. [DOI: 10.1111/j.1748-3743.2010.00228.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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