Facility versus unit level reporting of quality indicators in nursing homes when performance monitoring is the goal

Norton, Peter; Murray, Michael; Doupe, Malcolm; Cummings, Greta G.; Poss, Jeff; Squires, Janet E.; Teare, Gary; Estabrooks, Carole A.

doi:10.1136/bmjopen-2013-004488

Cited by 33 publications

(29 citation statements)

References 18 publications

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“…This is consistent with a focus on the resident care unit in nursing homes as an important focus of quality of care improvement efforts. 61,62 Our models explain much higher levels of variance in CRU compared with IRU.…”

Section: Discussionmentioning

confidence: 94%

The Influence of Organizational Context on Best Practice Use by Care Aides in Residential Long-Term Care Settings

Estabrooks¹,

Squires²,

Hayduk³

et al. 2015

Journal of the American Medical Directors Association

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Section: Discussionmentioning

confidence: 94%

The Influence of Organizational Context on Best Practice Use by Care Aides in Residential Long-Term Care Settings

Estabrooks¹,

Squires²,

Hayduk³

et al. 2015

Journal of the American Medical Directors Association

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“…Then, using logistic regression with improvement as the outcome we will investigate the effects of context (using ACT scales), best practice use, and staff characteristics on improvement. To this end we have developed a reliable classification system for individual control charts [49, 50]. …”

Section: Methodsmentioning

confidence: 99%

“…TREC is an ongoing research program and aims to create actionable performance data to improve performance at the clinical microsystem (care unit) level in nursing homes. The microsystem has rarely been targeted before in performance improvement trials and possesses unique features that make it key to leading care interventions and driving change in these settings [49, 50]. Our previous research demonstrated that members of the clinical microsystem are the best potential target to drive positive change in this field [49, 50].…”

Section: Introductionmentioning

confidence: 99%

“…The microsystem has rarely been targeted before in performance improvement trials and possesses unique features that make it key to leading care interventions and driving change in these settings [49, 50]. Our previous research demonstrated that members of the clinical microsystem are the best potential target to drive positive change in this field [49, 50]. Findings from this investigation will add new insights on how actionable research data on modifiable elements of organizational context (framed as performance data) can be used to improve performance in a complex adaptive system such as a nursing home [51].…”

Section: Introductionmentioning

confidence: 99%

“…We found that the microsystem level explained a significantly higher percentage of variance in work context outcomes (e.g., leadership, culture, evaluation) than did individual (resident/caregiver) or facility levels [49]. Using longitudinal data on three risk-adjusted quality indicators (QIs) from the Resident Assessment Instrument – Minimum Data Set (RAI-MDS) 2.0 [61], we found that facility level reporting masks important inter-unit/intra-facility variation; thus quality improvement interventions should target both facility and microsystem levels [50]. The intervention described here targets the leaders of these clinical microsystems .…”

Section: Introductionmentioning

confidence: 99%

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Improving Nursing Home Care through Feedback On PerfoRMance Data (INFORM): Protocol for a cluster-randomized trial

Hoben

Norton

Ginsburg

et al. 2017

Trials

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BackgroundAudit and feedback is effective in improving the quality of care. However, methods and results of international studies are heterogeneous, and studies have been criticized for a lack of systematic use of theory. In TREC (Translating Research in Elder Care), a longitudinal health services research program, we collect comprehensive data from care providers and residents in Canadian nursing homes to improve quality of care and life of residents, and quality of worklife of caregivers. The study aims are to a) systematically feed back TREC research data to nursing home care units, and b) compare the effectiveness of three different theory-based feedback strategies in improving performance within care units.MethodsINFORM (Improving Nursing Home Care through Feedback On PerfoRMance Data) is a 3.5-year pragmatic, three-arm, parallel, cluster-randomized trial. We will randomize 67 Western Canadian nursing homes with 203 care units to the three study arms, a standard feedback strategy and two assisted and goal-directed feedback strategies. Interventions will target care unit managerial teams. They are based on theory and evidence related to audit and feedback, goal setting, complex adaptive systems, and empirical work on feeding back research results. The primary outcome is the increased number of formal interactions (e.g., resident rounds or family conferences) involving care aides – non-registered caregivers providing up to 80% of direct care. Secondary outcomes are a) other modifiable features of care unit context (improved feedback, social capital, slack time) b) care aides’ quality of worklife (improved psychological empowerment, job satisfaction), c) more use of best practices, and d) resident outcomes based on the Resident Assessment Instrument – Minimum Data Set 2.0. Outcomes will be assessed at baseline, immediately after the 12-month intervention period, and 18 months post intervention.DiscussionINFORM is the first study to systematically assess the effectiveness of different strategies to feed back research data to nursing home care units in order to improve their performance. Results of this study will enable development of a practical, sustainable, effective, and cost-effective feedback strategy for routine use by managers, policy makers and researchers. The results may also be generalizable to care settings other than nursing homes.Trial registrationClinicalTrials.gov Identifier: NCT02695836. Date of registration: 24 February 2016Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1748-8) contains supplementary material, which is available to authorized users.

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Effect of Promoting High-Quality Staff Interactions on Fall Prevention in Nursing Homes

et al. 2017

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IMPORTANCE New approaches are needed to enhance implementation of complex interventions for geriatric syndromes such as falls.OBJECTIVE To test whether a complexity science-based staff training intervention (CONNECT) promoting high-quality staff interactions improves the impact of an evidence-based falls quality improvement program (FALLS). DESIGN, SETTING, AND PARTICIPANTSCluster-randomized trial in 24 nursing homes receiving either CONNECT followed by FALLS (intervention), or FALLS alone (control). Nursing home staff in all positions were asked to complete surveys at baseline, 3, 6, and 9 months. Medical records of residents with at least 1 fall in the 6-month pre-and postintervention windows (n = 1794) were abstracted for fall risk reduction measures, falls, and injurious falls.INTERVENTIONS CONNECT taught staff to improve their connections with coworkers, increase information flow, and use cognitive diversity in problem solving. Intervention components included 2 classroom sessions, relationship mapping, and self-monitoring. FALLS provided instruction in the Agency for Healthcare Research and Quality's Falls Management Program.MAIN OUTCOMES AND MEASURES Primary outcomes were (1) mean number of fall risk reduction activities documented within 30 days of falls and (2) median fall rates among residents with at least 1 fall during the study period. In addition, validated scales measured staff communication quality, frequency, timeliness, and safety climate. RESULTS Surveys were completed by 1545 staff members, representing 734 (37%) and 811 (44%) of eligible staff in intervention and control facilities, respectively; 511 (33%) respondents were hands-on care workers. Neither the CONNECT nor the FALLS-only facilities improved the mean count of fall risk reduction activities following FALLS (3.3 [1.6] vs 3.2 [1.5] of 10); furthermore, adjusted median recurrent fall rates did not differ between the groups (4.06 [interquartile range {IQR}, 2.03-8.11] vs 4.06 [IQR,] falls/resident/y). A modest improvement in staff communication measures was observed overall (mean, 0.03 [SE, 0.01] points on a 5-point scale; P = .03) and for communication timeliness (mean, 0.8 [SE, 0.03] points on a 5-point scale; P = .02). There was wide variation across facilities in intervention penetration. CONCLUSIONS AND RELEVANCEAn intervention targeting gaps in staff communication and coordination did not improve the impact of a falls quality improvement program. New approaches to implementing evidence-based care for complex conditions in the nursing home are urgently needed. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00636675

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Facility versus unit level reporting of quality indicators in nursing homes when performance monitoring is the goal

Cited by 33 publications

References 18 publications

The Influence of Organizational Context on Best Practice Use by Care Aides in Residential Long-Term Care Settings

The Influence of Organizational Context on Best Practice Use by Care Aides in Residential Long-Term Care Settings

Improving Nursing Home Care through Feedback On PerfoRMance Data (INFORM): Protocol for a cluster-randomized trial

Effect of Promoting High-Quality Staff Interactions on Fall Prevention in Nursing Homes

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