Randomized clinical trial of a quality improvement intervention in nursing homes

TitleRandomized clinical trial of a quality improvement intervention in nursing homes
Publication TypeJournal Article
Year of Publication2001
AuthorsRantz 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.S, Maas M.
JournalGerontologist
Volume41
Issue4
Pagination525-38
Date PublishedAug
Accession Number11490051
Keywords*Homes for the Aged, *Nursing Homes, *Quality Assurance, Health Care, *Quality Indicators, Health Care, Aged, Aged, 80 and over, Comparative Study, Consultants, education, Feedback, Human, Outcome and Process Assessment (Health Care), Support, Non-U.S. Gov't, Support, U.S. Gov't, P.H.S., Total Quality Management
Abstract

PURPOSE: The purpose of the study was to determine if simply providing nursing facilities with comparative quality performance information and education about quality improvement would improve clinical practices and subsequently improve resident outcomes, or if a stronger intervention, expert clinical consultation with nursing facility staff, is needed. DESIGN AND METHODS: Nursing facilities (n = 113) were randomly assigned to one of three groups: workshop and feedback reports only, workshop and feedback reports with clinical consultation, and control. Minimum Data Set (MDS) Quality Indicator (QI) feedback reports were prepared and sent quarterly to each facility in intervention groups for a year. Clinical consultation by a gerontological clinical nurse specialist (GCNS) was offered to those in the second group. RESULTS: With the exception of MDS QI 27 (little or no activity), no significant differences in resident assessment measures were detected between the groups of facilities. However, outcomes of residents in nursing homes that actually took advantage of the clinical consultation of the GCNS demonstrated trends in improvements in QIs measuring falls, behavioral symptoms, little or no activity, and pressure ulcers (overall and for low-risk residents). IMPLICATIONS: Simply providing comparative performance feedback is not enough to improve resident outcomes. It appears that only those nursing homes that sought the additional intensive support of the GCNS were able to effect enough change in clinical practice to improve resident outcomes significantly.

Alternate JournalGerontologist