Quality improvement for pressure ulcer care in the nursing home setting: the Northeast Pressure Ulcer Project.
OBJECTIVE
The objectives of this study were to evaluate the impact of a collaborative model of quality improvement in nursing homes on processes of care for the prevention and treatment of pressure ulcers.


METHODS
The study design was experimental.


METHODS
We studied 29 nursing homes in New Jersey, Pennsylvania, and Rhode Island.


METHODS
Participants consisted of pressure ulcer quality improvement teams in 29 nursing homes.


METHODS
Quality improvement teams attended a series of workshops to review clinical guidelines and quality improvement principles and to share best practices, and worked one-on-one with mentors to implement quality improvement techniques and to collect data independently.


METHODS
We calculated process measures based on the Agency for Healthcare Research and Quality (AHRQ) guidelines. Process measures addressed each facility's processes of care for the prevention and treatment of pressure ulcers at baseline and after 12 months of intervention. Prevention measures focused on recent admissions and high-risk residents; treatment measures focused on patients newly diagnosed with pressure ulcers and all patients with pressure ulcers.


RESULTS
Overall, 6 of 8 prevention process measures improved significantly, with percent difference between baseline and follow up ranging from 11.6% to 24.5%. Three of 4 treatment process measures improved significantly, with 5.0%, 8.9%, and 25.9% difference between baseline and follow up. For each process measure, between 5 and 12 facilities demonstrated significant improvement between baseline and follow up, and only 2 or fewer declined for each process measure.


CONCLUSIONS
Improvement in processes of care after the use of a structured collaborative quality improvement approach is possible in the nursing home setting.
Baier
Rosa R
RR
Department of Community Health, Brown University School of Medicine, Providence, Rhode Island, USA.
Gifford
David R
DR
Lyder
Courtney H
CH
Schall
Marie W
MW
Funston-Dillon
Diane L
DL
Lewis
Jennifer M
JM
Ordin
Diana L
DL
D000368:Aged; D019985:Benchmarking; D003299:Cooperative Behavior; D005500:Follow-Up Studies; D006707:Homes for the Aged / Q000458:organization & administration; D006801:Humans; D017146:Models, Organizational; D009515:New Jersey / Q000453:epidemiology; D009735:Nursing Homes / Q000458:organization & administration; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D010067:Ownership / Q000706:statistics & numerical data; D010414:Pennsylvania / Q000453:epidemiology; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D003668:Pressure Ulcer / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011366:Professional Review Organizations / Q000458:organization & administration; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D012237:Rhode Island / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D017749:Total Quality Management / Q000458:organization & administration*