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| Conducted the statewide study of longitudinal "Show-me QI Reports" and educational support for quality improvement for nursing homes in Missouri (MO DHSS-funded) |
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This effectiveness study, conducted from 1996-1999, determined whether simply providing comparative quality indicator information will facilitate improved clinical practices in nursing homes or if a stronger intervention, such as expert consultation with nursing home staff, is needed to affect resident outcomes. Using a randomized design, we implemented and evaluated the effectiveness of providing to nursing facilities MDS QI feedback reports that were designed in Missouri to that show how they compare to other facilities in the state. Additionally, we evaluated the effectiveness of providing on-site clinical consultation with an advanced practice nurse about ways to improve care practices.
The study began with 120 homes randomly assigned to three groups. Using a quality improvement approach, employees from homes in Groups 1 and 2 attended workshops to learn to interpret their MDS data and understand how they compare to other homes in the state. We encouraged them to initiate quality improvement efforts specific to their facility and gave them bibliographic information about ways to improve care practices. Group 2 homes had access to on-site consultation from an advanced practice nurse to facilitate their quality improvement efforts and provide further clinical information about improving care practices. Group 3 were control homes. In mid 1999, all homes in the state received information, education, and support. We had almost 1000 nursing home staff participate in statewide training. Division of Aging staff also received education about QIs and quality improvement to facilitate providing quality improvement support to all facilities in the state. Resident outcomes are being monitored using quarterly MDS data to determine if providing comparative reports of MDS quality indicator data and support for quality improvement efforts does improve resident outcomes in Missouri nursing homes. This study had the support and full cooperation of the Missouri Department of Health and Senior Services and both nursing home associations in the state. Results indicated efforts to support quality improvement in nursing facilities helps the staff and helps the residents. This study is the foundation for developing a systematic way to provide QI support to facilities that is effective. We have used the principles learned in this study for the pilot of the Quality Improvement Program for Missouri in progress at this time for facilities in the state. Rantz, M.J., Popejoy, L, Petroski, G.F., Madsen, R.W., Mehr, D.R., Zwygart-Stauffacher, M., Hicks, L.L., Grando, V., Wipke-Tevis, D.D., Bostick, J., Porter, R., Conn, V., & Maas, M. (2001). Randomized clinical trial of a quality improvement intervention in nursing homes. The Gerontologist, 41(4):525-538 Popejoy, L.L., Rantz, M.J., Conn, V., Wipke-Tevis, D., Grando, V., & Porter, R. (2000). Improving quality of care in nursing facilities: The gerontological clinical nurse specialist as a research nurse and consultant. Journal of Gerontological Nursing, 26(4), 6-13. |