Meehan Thomas P, Qazi Daniel J, Van Hoof Thomas J, Ho Shih-Yieh, Eckenrode Sheila, Spenard Ann, Pandolfi Michelle, Johnson Florence, Quetti Deborah
Qualidigm, Wethersfield, CT; Department of Health Sciences, Frank H. Netter MD School of Medicine, North Haven, CT.
Qualidigm, Wethersfield, CT.
J Am Med Dir Assoc. 2015 Aug 1;16(8):648-53. doi: 10.1016/j.jamda.2015.02.015. Epub 2015 Mar 29.
To describe and evaluate the impact of quality improvement (QI) support provided to skilled nursing facilities (SNFs) by a Quality Improvement Organization (QIO).
Retrospective, mixed-method, process evaluation of a QI project intended to decrease preventable hospital readmissions from SNFs.
Five SNFs in Connecticut.
SNF Administrators, Directors of Nursing, Assistant Directors of Nursing, Admissions Coordinators, Registered Nurses, Certified Nursing Assistants, Receptionists, QIO Quality Improvement Consultant.
QIO staff provided training and technical assistance to SNF administrative and clinical staff to establish or enhance QI infrastructure and implement an established set of QI tools [Interventions to Reduce Acute Care Transfers (INTERACT) tools].
Baseline SNF demographic, staffing, and hospital readmission data; baseline and follow-up SNF QI structure (QI Committee), processes (general and use of INTERACT tools), and outcome (30-day all-cause hospital readmission rates); details of QIO-provided training and technical assistance; QIO-perceived barriers to quality improvement; SNF leadership-perceived barriers, accomplishments, and suggestions for improvement of QIO support.
Success occurred in establishing QI Committees and targeting preventable hospital readmissions, as well as implementing INTERACT tools in all SNFs; however, hospital readmission rates decreased in only 2 facilities. QIO staff and SNF leaders noted the ongoing challenge of engaging already busy SNF staff and leadership in QI activities. SNF leaders reported that they appreciated the training and technical assistance that their institutions received, although most noted that additional support was needed to bring about improvement in readmission rates.
This process evaluation documented mixed clinical results but successfully identified opportunities to improve recruitment of and provision of technical support to participating SNFs. Recommendations are offered for others who wish to conduct similar projects.
描述并评估质量改进组织（QIO）向专业护理机构（SNF）提供的质量改进（QI）支持的影响。
对旨在降低SNF可预防的医院再入院率的QI项目进行回顾性、混合方法的过程评估。
康涅狄格州的五家SNF。
SNF管理人员、护理主任、助理护理主任、入院协调员、注册护士、认证护理助理、接待员、QIO质量改进顾问。
QIO工作人员向SNF行政和临床工作人员提供培训和技术援助，以建立或加强QI基础设施，并实施一套既定的QI工具[减少急性护理转移干预措施（INTERACT）工具]。
SNF的基线人口统计学、人员配备和医院再入院数据；基线和随访时SNF的QI结构（QI委员会）、流程（一般流程和INTERACT工具的使用）以及结果（30天全因医院再入院率）；QIO提供的培训和技术援助的详细信息；QIO认为的质量改进障碍；SNF领导层认为的障碍、成就以及对QIO支持改进的建议。
在建立QI委员会、针对可预防的医院再入院以及在所有SNF中实施INTERACT工具方面取得了成功；然而，只有两家机构的医院再入院率有所下降。QIO工作人员和SNF领导层指出，让已经忙碌的SNF工作人员和领导层参与QI活动是一项持续的挑战。SNF领导层报告称，他们感谢其机构获得的培训和技术援助，尽管大多数人指出，需要更多支持才能使再入院率得到改善。
该过程评估记录了喜忧参半的临床结果，但成功识别出了改善参与SNF的招募和技术支持提供方面的机会。为希望开展类似项目的其他人提供了建议。
