|
In this study, we seek to improve the outcomes of residents by transforming poorly performing nursing homes staffs into good ones — a task of pressing national importance. We propose to accomplish this by bundling the best clinical and management approaches gleaned from our preliminary work and a formerly fragmented set of studies by others. Our intervention will be comprehensive as well as the first to work at multiple levels: We will firmly guide direct-care staff at poor nursing homes to adopt excellent care systems and practices. We will also foster a professional and inclusive nursing management style and an organizational culture that systematically carry quality-improvement practices forward. Based on our recently completed NINR-funded study, “Nursing Care Processes, Outcomes and Cost in Nursing Homes” (1998-2003, Rantz, PI), we have designed a randomized, two-group, repeated-measures design to test a two-year experimental intervention for improving quality of care and subsequently improving resident outcomes in nursing homes. Facilities with resident outcomes in need of improvement will receive an experimental multilevel intervention that helps staff (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. The multilevel intervention will involve all levels of nursing home staff; that is, owners, administrators and direct care staff at 64 facilities in three states. Our design calls for both qualitative and quantitative methods in measuring the effectiveness of the intervention. An attention control group will receive information about aging and physical assessment of elders. We will measure resident outcomes with selected quality indicators (QIs) from nursing home Minimum Data Set (MDS) resident assessment information: bladder and bowel incontinence, weight loss, pressure ulcers and decline in activities of daily living (ADL). We will measure staff retention, direct care costs and total costs, staffing and staff mix, and employees’ views of selected organizational attributes before, during and after the intervention. Similarly, we will observe processes of care delivery before, during and after the multilevel intervention to determine the degree to which intervention facilities adopt the intervention’s care systems.
|
