A Randomized Trial of Quality Assurance in Nursing Homes

Sixty nursing homes were randomly allocated to receive or not to receive a quality assurance intervention. The experimental intervention included the use of predeveloped quality assurance packages, the services of a quality assurance consultant, and the process of working through the quality assuran...

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Bibliographic Details
Published in:Medical care 1988-06, Vol.26 (6), p.554-565
Main Authors: Mohide, E. Ann, Tugwell, Peter X., Caulfield, Patricia A., Chambers, Larry W., Dunnett, Charles W., Baptiste, Susan, Bayne, J. Ronald, Patterson, Christopher, Rudnick, K. Vincent, Pill, Miriam
Format: Article
Language:English
Subjects:
Accidental Falls - prevention & control
Aged
Aged, 80 and over
Constipation
Constipation - therapy
Experimentation
Health hazards
Health outcomes
Humans
Medical conditions
Medical specialists
Methods
Nursing homes
Nursing Homes - standards
Ontario
Outcome and Process Assessment (Health Care)
Peer groups
Quality assurance
Quality Assurance, Health Care
Random Allocation
Registered nurses
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Summary:Sixty nursing homes were randomly allocated to receive or not to receive a quality assurance intervention. The experimental intervention included the use of predeveloped quality assurance packages, the services of a quality assurance consultant, and the process of working through the quality assurance cycle with one of two principal indicator conditions. Two prevalent health problems, hazardous mobility and constipation, were selected as the principal indicator conditions. To detect co-intervention, one of two hidden secondary indicator conditions (potential skin breakdown and urinary incontinence) was assessed in each facility. In the control nursing homes, both the principal and secondary indicator conditions were hidden from staff. The care for 1,525 residents was examined before and after the intervention using a retrospective record review initiated for the study purposes. Improvement in management of the principal conditions, hazardous mobility and constipation, was greater in the experimental group (P < 0.03 and P < 0.005, respectively). Neither group changed its management of the hidden conditions. Behavior change was achieved using quality assurance-linked interventions. Further research should focus on refining quality assurance interventions that provide staff education and motivational strategies.
ISSN:0025-7079
1537-1948
DOI:10.1097/00005650-198806000-00004