Rantz Marilyn J, Cheshire Debra, Flesner Marcia, Petroski Gregory F, Hicks Lanis, Alexander Greg, Aud Myra A, Siem Carol, Nguyen Katy, Boland Clara, Thomas Sharon
Sinclair School of Nursing and Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA.
Geriatr Nurs. 2009 Jul-Aug;30(4):238-49. doi: 10.1016/j.gerinurse.2008.09.003. Epub 2009 Apr 25.
The Quality Improvement Program for Missouri (QIPMO), a state school of nursing project to improve quality of care and resident outcomes in nursing homes, has a special focus to help nursing homes identified as "at risk" for quality concerns. In fiscal year 2006, 92 of 492 Medicaid-certified facilities were identified as "at risk" using quality indicators (QIs) derived from Minimum Data Set (MDS) data. Sixty of the 92 facilities accepted offered on-site clinical consultations by gerontological expert nurses with graduate nursing education. Content of consultations include quality improvement, MDS, care planning, evidence-based practice, and effective teamwork. The 60 "at-risk" facilities improved scores 4%-41% for 5 QIs: pressure ulcers (overall and high risk), weight loss, bedfast residents, and falls; other facilities in the state did not. Estimated cost savings (based on prior cost research) for 444 residents who avoided developing these clinical problems in participating "at-risk" facilities was more than $1.5 million for fiscal year 2006. These are similar to estimated savings of $1.6 million for fiscal year 2005 when 439 residents in "at-risk" facilities avoided clinical problems. Estimated savings exceed the total program cost by more than $1 million annually. QI improvements demonstrate the clinical effectiveness of on-site clinical consultation by gerontological expert nurses with graduate nursing education.
密苏里州质量改进计划（QIPMO）是一所州立护理学院开展的项目，旨在提高养老院的护理质量和居民护理效果，特别关注帮助那些被认定存在质量问题“风险”的养老院。在2006财年，利用从最低数据集（MDS）数据得出的质量指标（QIs），在492家获得医疗补助认证的机构中，有92家被认定为“有风险”。这92家机构中有60家接受了具有护理学研究生学历的老年护理专家护士提供的现场临床咨询。咨询内容包括质量改进、MDS、护理计划、循证实践和有效的团队协作。这60家“有风险”的机构在5项质量指标上的得分提高了4% - 41%，这些指标包括压疮（总体和高风险）、体重减轻、卧床居民以及跌倒；该州的其他机构则没有。据估计，2006财年，参与项目的“有风险”机构中444名居民避免出现这些临床问题所节省的费用（基于之前的成本研究）超过150万美元。这与2005财年的估计节省金额160万美元相似，当时“有风险”机构中的439名居民避免了临床问题。估计节省的费用每年超过项目总成本100多万美元。质量改进证明了具有护理学研究生学历的老年护理专家护士进行现场临床咨询的临床有效性。
