Quality improvement in nursing homes in Texas: results from a pressure ulcer prevention project.
BACKGROUND
Pressure ulcer prevalence, cost, associated mortality, and potential for litigation are major clinical problems in nursing homes despite guidelines for prevention and treatment.


OBJECTIVE
To improve the use of pressure ulcer prevention procedures at nursing homes in Texas through implementation of process of care system changes in collaboration with a state quality improvement organization (QIO).


METHODS
Preintervention and postintervention measurement of performance for process of care quality indicators and of pressure ulcer incidence rates.


METHODS
Twenty nursing homes in Texas.


METHODS
Quality improvement teams at participating nursing homes.


METHODS
Data were abstracted from medical records on performance measures (quality indicators) and pressure ulcer incidence rates between November 2000 and August 2002. Descriptive and inferential statistics were used.


METHODS
Process of care system changes consisting of tools and education to prevent pressure ulcers were introduced to participating nursing homes.


RESULTS
Participating nursing homes showed statistically significant improvement in 8 out of 12 quality indicators. Pressure ulcer incidence rates also decreased, although not quite significantly. Furthermore, facilities with the greatest improvement in quality indicator scores had significantly lower pressure ulcer incidence rates than the facilities with the least improvement in quality indicator scores (S = 131.0, P = .03). This suggests that the interventions positively affected not only the process of care but also led to a decrease in pressure ulcer incidences.


CONCLUSIONS
These results show that nursing homes in a collaborative effort with a QIO were able to improve their processes of care. Although significant improvement was noted on most of the quality indicators, opportunity remains for further improvement. Furthermore, these results suggest that implementation of process of care system changes by nursing homes in a collaborative relationship with a QIO may yield improvements in measures of patient outcome (eg, pressure ulcer incidence).
Abel
Robert L
RL
Texas Medical Foundation, Austin, TX 78746, USA. babel@txqio.sdps.org
Warren
Kevin
K
Bean
Gloria
G
Gabbard
Bethany
B
Lyder
Courtney H
CH
Bing
Mark
M
McCauley
Carol
C
D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006707:Homes for the Aged / Q000592:standards* / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D009735:Nursing Homes / Q000592:standards* / Q000639:trends; D003668:Pressure Ulcer / Q000453:epidemiology* / Q000517:prevention & control* / Q000628:therapy; D011322:Primary Prevention / Q000458:organization & administration*; D015397:Program Evaluation; D019984:Quality Indicators, Health Care / Q000592:standards*; D018570:Risk Assessment; D015996:Survival Rate; D013781:Texas / Q000453:epidemiology; D017749:Total Quality Management