Challenges of Using Quality Improvement Methods in Nursing Homes that "Need Improvement"
Challenges of Using Quality Improvement Methods in Nursing Homes that "Need Improvement"
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DOI：
10.1016/j.jamda.2012.07.008
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发表时间：
2012-10-01
影响因子：
7.6
通讯作者：
Minner, Donna
中科院分区：
文献类型：
--
作者：
Rantz, Marilyn J.;Zwygart-Stauffacher, Mary;Minner, Donna
目标：定性描述参与一项旨在提高“需要改进”疗养院护理质量的研究的干预设施所采取的策略和遇到的挑战。描述工作人员如何使用联邦质量指标/质量测量 (QI/QM) 分数和报告、质量改进方法和活动，以及工作人员如何支持和维持质量改进团队建议的变革。 设计/设置/参与者：使用随机、两组、重复测量设计来测试为期 2 年的干预措施，以提高“需要改进”设施中的护理质量和住院医师结果。干预组 (n = 29) 接受了旨在帮助他们的实验性多层次干预：(1) 使用质量改进方法，(2) 使用团队和小组流程进行直接护理决策，(3) 专注于完成护理的基础知识，以及 (4) 保持更加一致的护理和行政领导，致力于沟通和工作人员积极参与决策。结果：定性分析显示，有可能继续进行质量改进活动的家庭亚组以及可能改善的家庭准备指标：(1)领导团队（疗养院管理员、护士长）有兴趣学习如何使用联邦 QI/QM 报告作为改善住院医师护理和结果的基础； (2) 一位领导者成为“变革倡导者”，并确保一致地打印当前的 QI/QM 报告并每月与每个护理单位共享； (3) 领导者愿意让设施中的所有员工参与教育活动，以了解 QI/QM 流程以及显示其设施与州和国家其他设施相比情况的报告； (4) 领导者愿意计划并持续教育新员工有关 MDS 和联邦 QI/QM 报告以及如何开展质量改进活动； (5) 领导者愿意让所有员工持续参与质量改进委员会和团队活动，以便他们“拥有”流程并负责变革。结论：这种定性分析的结果可以帮助将专家护士的时间分配到实际准备改进的设施上。广泛采用这种干预措施是可行的，并且可以通过疗养院医疗主任与高级执业护士的合作实践来实现。版权所有 (C) 2012 - 美国医疗主任协会，Inc.
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. Copyright (C) 2012 - American Medical Directors Association, Inc.