title: A Model of Regulatory Alignment to Enhance the Long-Term Care Survey Process in a Veterans Health Care Network.
abstract: Regulatory oversight aims to promote quality of care in US nursing homes. A survey of long-term care (LTC) inspection practices in a Veterans Administration network in 2006 revealed great variability in monitoring and reporting processes, with opportunities for improvement. Modern organization theory and the PARIHS Implementation Framework provide a model for process improvement to enhance oversight for LTC facilities. Over a 3-year time frame, 6 facility inspection teams utilized a modified Delphi approach to arrive at and adopt a standardized structured inspection process. In the 2 districts where 10 facility contracts were terminated for quality deficits identified as a result of process improvement, Star Ratings of approved facilities improved (3.2 to 3.3). The 10 facilities terminated had a mean rating of 1.2 (0.48) (t = 3.87, P < .01). Standardization of a structured LTC inspection process enhances organizational oversight and may contribute to improved quality of care.
authors.affiliation: VA Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center, Nashville, TN Vanderbilt University School of Medicine, Nashville, TN James.powers@vanderbilt.edu.
authors.forename: James S
authors.initials: JS
authors.lastname: Powers
authors.affiliation: Social Work Service, VA Medical Center, Johnson City, TN.
authors.forename: Mark
authors.initials: M
authors.lastname: Preshong
authors.affiliation: VA Medical Center, Huntington, WV.
authors.forename: Pamela
authors.initials: P
authors.lastname: Smith
mesh_terms: D033161:Government Regulation; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration / Q000592:standards*; D017146:Models, Organizational; D009735:Nursing Homes / Q000458:organization & administration / Q000592:standards; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration / Q000592:standards; D011795:Surveys and Questionnaires; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration* / Q000592:standards
keywords: geriatrics; long-term care; survey process; veterans