The overall goal of this project is to increase the number of high quality nursing homes in
Massachusetts. The study will evaluate an intervention involving two active treatment arms:
one implementing a CQI program and a second implementing the CQI program and specific
protocol programming. The intervention will be implemented in 24 nursing homes identified
as performing, over multiple quality indicator domains, at a poor or average level across
multiple outcome domains.
Nursing facilities as well as CMS and state governments are under pressure to find
cost-effective methods to improve quality, particularly in poor and average facilities. In
our prior work, we found that better performing facilities make more extensive use of CQI
mechanisms, have more protocol driven problem advanced resolution mechanisms and
systematically address multiple areas Both arms of the study apply the same standardized
approach to CQI, while one arm will include specific best-practice care strategies targeted
at identified problems. The study will evaluate whether the CQI program improves quality
indicator scores in multiple domains, relative to control facilities, and whether
improvement is greater in facilities that also utilize the study's best-practice protocols.
The study consent form describes the MDS assessment (used to evaluate the reliability of the
facility's assessment), including items to be reviewed and how information will be obtained.
The subject is informed that there is no known risk for participating in research, the
purpose of which is to determine if the intervention improves nursing home care in
The outcomes will be reviewed by means of a change in twelve quality indicator scores: ADL
decline, ADL decline following improvement, Mobility change, walking improvement, cognitive
change, communication change, bowel continence change, bladder continence change, depressed
mood change, new insertion of an indwelling urinary catheter, infection prevalence,
- Men and Women
- Residents of long-term care facilities in Massachusetts who have had
- a Minimum Data Set assessment completed by the facility in the last 90 days.