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
Sinclair School of Nursing, University of Missouri-Columbia, Columbia, MO 65211, USA.
Gerontologist. 2001 Aug;41(4):525-38. doi: 10.1093/geront/41.4.525.
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.
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.
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).
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.
本研究的目的是确定仅向护理机构提供质量绩效比较信息和质量改进教育是否会改善临床实践，进而改善居民结局，或者是否需要更强有力的干预措施，即与护理机构工作人员进行专家临床咨询。
将113家护理机构随机分为三组：仅参加研讨会和接收反馈报告组、参加研讨会和接收反馈报告并接受临床咨询组以及对照组。编写了《最低数据集》（MDS）质量指标（QI）反馈报告，并在一年中每季度发送给干预组中的每个机构。为第二组中的机构提供了老年临床护理专家（GCNS）的临床咨询服务。
除MDS QI 27（活动很少或没有活动）外，各护理机构组之间在居民评估指标上未发现显著差异。然而，实际利用了GCNS临床咨询服务的养老院居民的结局显示，在衡量跌倒、行为症状、活动很少或没有活动以及压疮（总体及低风险居民）的质量指标方面有改善趋势。
仅提供绩效比较反馈不足以改善居民结局。似乎只有那些寻求GCNS额外强化支持的养老院才能在临床实践中实现足够的改变，从而显著改善居民结局。
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