Sinclair School of Nursing, University of Missouri, Columbia, MO, USA.
J Am Med Dir Assoc. 2012 Oct;13(8):732-8. doi: 10.1016/j.jamda.2012.07.008. Epub 2012 Aug 25.
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.
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.
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.
定性描述参与旨在改善“需要改进”的养老院护理质量的研究的干预设施所采用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/质量衡量标准(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他们的质量改进团队推荐的变革。
设计/环境/参与者：使用随机、两组、重复测量设计来测试一项为期两年的干预措施，以改善“需要改进”的设施中的护理质量和居民结果。干预组(n=29)接受了一项实验性多层次干预措施，旨在帮助他们：(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)专注于完成基本护理；(4)保持更一致的护理和行政领导，致力于沟通和积极参与员工的决策。
定性分析揭示了一个可能继续质量改进活动的住宅亚组和一个可能提高准备就绪指标的住宅亚组：(1)对学习如何使用联邦 QI/QM 报告作为改善居民护理和结果的基础感兴趣的领导团队(养老院管理员、护士长)；(2)其中一位领导人成为“变革冠军”，并确保当前的 QI/QM 报告每月定期打印并分发给每个护理单元；(3)愿意让所有员工参与设施内教育活动，以了解 QI/QM 流程和显示设施在州和全国与其他设施相比情况的报告；(4)愿意计划并持续教育新员工关于 MDS 和联邦 QI/QM 报告以及如何进行质量改进活动的领导；(5)愿意让所有员工持续参与质量改进委员会和团队活动的领导，以便他们“拥有”该过程并对变革负责。
这项定性分析的结果可以帮助将专家护士的时间分配给真正准备改进的设施。这种干预措施的广泛采用是可行的，可以通过与高级实践护士合作的养老院医疗主任来实现。
