A Practice Improvement Education Program Using a Mentored Approach to Improve Nursing Facility Depression Care-Preliminary Data.
Depression is common in nursing facility residents. Depression data obtained using the Minimum Data Set (MDS) 3.0 offer opportunities for improving diagnostic accuracy and care quality. How best to integrate MDS 3.0 and other data into quality improvement (QI) activity is untested. The objective was to increase nursing home (NH) capability in using QI processes and to improve depression assessment and management through focused mentorship and team building. This was a 6-month intervention with five components: facilitated collection of MDS 3.0 nine-item Patient Health Questionnaire (PHQ-9) and medication data for diagnostic interpretation; education and modeling on QI approaches, team building, and nonpharmacological depression care; mentored team meetings; educational webinars; and technical assistance. PHQ-9 and medication data were collected at baseline and 6 and 9 months. Progress was measured using team participation measures, attitude and care process self-appraisal, mentor assessments, and resident depression outcomes. Five NHs established interprofessional teams that included nursing (44.1%), social work (20.6%), physicians (8.8%), and other disciplines (26.5%). Members participated in 61% of eight offered educational meetings (three onsite mentored team meetings and five webinars). Competency self-ratings improved on four depression care measures (P = .05 to <.001). Mentors observed improvement in team process and enthusiasm during team meetings. For 336 residents with PHQ-9 and medication data, depression scores did not change while medication use declined, from 37.2% of residents at baseline to 31.0% at 9 months (P < .001). This structured mentoring program improved care processes, achieved medication reductions, and was well received. Application to other NH-prevalent syndromes is possible.
Veterans Affairs Greater Los Angeles Health System, Los Angeles, California.|University of California at Los Angeles, Los Angeles, California.|Division of Geriatric Medicine and Palliative Care, School of Medicine, New York University, New York, New York.
Joshua
J
Chodosh
University of California at Los Angeles, Los Angeles, California.
Rachel M
RM
Price
University of California at Los Angeles, Los Angeles, California.
Mary P
MP
Cadogan
University of California at Los Angeles, Los Angeles, California.
JoAnn
J
Damron-Rodriguez
University of California at Los Angeles, Los Angeles, California.|California Association of Long Term Care Medicine, Los Angeles, California.
Dan
D
Osterweil
Lawson & Associates, Sacramento, California.
Alfredo
A
Czerwinski
University of California at Los Angeles, Los Angeles, California.
Zaldy S
ZS
Tan
University of California at Los Angeles, Los Angeles, California.
Sharon S
SS
Merkin
University of California at Los Angeles, Los Angeles, California.
Daphna
D
Gans
University of California at Los Angeles, Los Angeles, California.
Janet C
JC
Frank
D000368:Aged; D003863:Depression / Q000628:therapy*; D006282:Health Personnel / Q000193:education; D006707:Homes for the Aged; D006801:Humans; D008611:Mentors; D009735:Nursing Homes; D058996:Quality Improvement
MDS 3.0; antidepressants; depression; nursing home; quality improvement