title: Randomized clinical trial of a quality improvement intervention in nursing homes.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Sinclair School of Nursing, University of Missouri-Columbia, Columbia, MO 65211, USA. RantzM@health.missouri.edu
authors.forename: M J
authors.initials: MJ
authors.lastname: Rantz
authors.forename: L
authors.initials: L
authors.lastname: Popejoy
authors.forename: G F
authors.initials: GF
authors.lastname: Petroski
authors.forename: R W
authors.initials: RW
authors.lastname: Madsen
authors.forename: D R
authors.initials: DR
authors.lastname: Mehr
authors.forename: M
authors.initials: M
authors.lastname: Zwygart-Stauffacher
authors.forename: L L
authors.initials: LL
authors.lastname: Hicks
authors.forename: V
authors.initials: V
authors.lastname: Grando
authors.forename: D D
authors.initials: DD
authors.lastname: Wipke-Tevis
authors.forename: J
authors.initials: J
authors.lastname: Bostick
authors.forename: R
authors.initials: R
authors.lastname: Porter
authors.forename: V S
authors.initials: VS
authors.lastname: Conn
authors.forename: M
authors.initials: M
authors.lastname: Maas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003253:Consultants; D004493:Education; D005246:Feedback; D006707:Homes for the Aged; D006801:Humans; D009735:Nursing Homes; D010043:Outcome and Process Assessment, Health Care; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D017749:Total Quality Management