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Cited by 162Geriatric Care and Nursing HomesHealthcare Quality and ManagementHospital Admissions and Outcomes

Randomized Clinical Trial of a Quality Improvement Intervention in Nursing Homes

Rantz, Marilyn J., Popejoy, Lori, Petroski, Gregory F., Madsen, Richard W., Mehr, David R., Zwygart-Stauffacher, Mary, Hicks, Lanis L., Grando, Victoria +5 more·2001·The Gerontologist
DOI 10.1093/geront/41.4.525
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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.

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  1. CHSRA. (1995). Quality indicators for implementation. QI Version 6.1 MDS 2.0. University of Wisconsin-Madison: Center for Health Sys- tems Research and Analysis. Committee on Nursing Home Regulation, Institute of Medicine. (1986). Improving the quality of care in nursing homes (IOM-85-10). Wash- ington, DC: National Academy Press. Committee on the Adequacy of Nurse Staffing in Hospitals and Nursing Homes, Institute of Medicine. (1996). Nursing staff in hospitals and nursing homes. Washington, DC: National Academy Press.
  2. Dennik-Champion, G., Mareno, S., & Carlson, J. M. (1994). Transform- ing quality assurance activities to a quality improvement program. In T. V. Miller & M. J. Rantz (Eds.), Quality assurance in long-term care (pp. 120-125). Gaithersburg, MD: Aspen.
  3. Feldman, A. (2001). New approaches for the treatment of heart failure in the future: A story of mice and men. Heart Failure Society News, 3(1), 10.
  4. Levine, J. M., Marchello, V., & Totolos, E. (1995). Progress toward a re- straint-free environment in a large academic nursing facility. Journal of the American Geriatrics Society, 43, 914-918.
  5. Pear, R. (2000, July 23). US recommending strict new rules at nursing homes. New York Times, pp. 1, 15.
  6. Ryther, B. J., Zimmerman, D., & Kelly-Powell, M. (1994). Using resident assessment data in quality monitoring. In T. V. Miller & M. J. Rantz (Eds.), Quality assurance in long-term care (pp. I126-I128). Gaithers- burg, MD: Aspen.
  7. Ryther, B. J., Zimmerman, D., & Kelly-Powell, M. (1995). Update on us- ing resident assessment data in quality monitoring. In T. V. Miller & M. J. Rantz (Eds.), Quality assurance in long-term care (pp. I126- I128). Gaithersburg, MD: Aspen.
  8. Specht, J., & Lyons, S. (in press). Patterns of incontinence and continence maintenance on SCUs. Journal of Gerontological Nursing.
  9. Thomson O'Brien, M. A., Oxman, A. D., Davis, D. A., Haynes, R. B., Freemantle, N., & Harvey, E. L. (2000a). Audit and feedback: Effects on professional practice and health care outcomes (Cochrane Review). In: The Cochrane Library, 3 (pp. 1-12). Oxford: Update Software.

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Authors
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. S., & Maas, M.
Affiliations
  • University of Missouri (US)
  • University of Wisconsin–Eau Claire (US)
  • Arizona State University (US)
  • University of Iowa (US)
Corresponding author
Rantz, Marilyn J.
ORCID
Venue
The Gerontologist
Publisher
Oxford University Press (OUP)
Published
2001-06-01
Volume
41
Issue
4
Pages
525-538
ISSN
  • 0016-9013 (ISSN-L)
  • 1758-5341
DOI
10.1093/geront/41.4.525
OpenAlex
W2114697893
Cited by
162
References
67
Citations by year
2026: 2 · 2025: 1 · 2024: 3 · 2023: 1 · 2022: 4 · 2021: 3 · 2020: 4 · 2019: 3 · 2018: 3 · 2017: 3 · 2016: 2 · 2015: 4 · 2014: 2 · 2013: 8 · 2012: 10
FWCI
21.15
Type
journal article
Language
en
Open access
closed
Locations
  • The Gerontologist (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • University of Missouri
  • School of Medicine, University of Missouri
Topics
  • Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
  • Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
  • Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
Keywords
nursing homes, quality improvement intervention, medical consultation, resident outcomes, falls, behavioral symptoms, pressure ulcers, quality of care
MeSH terms
Aged, Aged, 80 and over, Consultants, Education, Feedback, Homes for the Aged, Humans, Nursing Homes, Outcome and Process Assessment, Health Care, Quality Assurance, Health Care, Total Quality Management, Quality Indicators, Health Care

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