Siobhan S. Sharkey

The National Pressure Ulcer Long-Term Care Study: Pressure ulcer development in long-term care residents

Objectives: To identify resident, treatment, and facility characteristics associated with pressure ulcer (PU) development in long‐term care residents.

Description of the National Pressure Ulcer Long-Term Care Study

OBJECTIVES: To describe and provide baseline data from The National Pressure Ulcer Long‐Term Care Study (NPULS).

Frontline Caregiver Daily Practices: A Comparison Study of Traditional Nursing Homes and The Green House Project Sites

OBJECTIVES: To describe differences in frontline caregiver daily practice in two types of skilled nursing facility (SNF) settings, Green House (GH) homes and traditional SNF units, related to overall staffing (nursing and nonnursing departments), direct care and indirect care time per resident day, and staff time interacting with residents.

Exploratory study of nursing home factors associated with successful implementation of clinical decision support tools for pressure ulcer prevention.

PURPOSE: To enhance the learner’s competence with information about a study examining nursing home factors associated with the On-Time Quality Improvement for Pressure Ulcer Prevention program clinical decision support tools. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to: 1. Interpret study components that increase successful implementation of the On-Time program. 2. Apply findings of this study in planning for implementation of a similar program for prevention of pressure ulcers. ABSTRACT&NA; OBJECTIVES: To determine those factors that are associated with nursing homes’ success in implementing the On-Time quality improvement (QI) for pressure ulcer prevention program and integrating health information technology (HIT) tools into practice at the unit level. DESIGN: Observational study with quantitative analysis of nursing home characteristics, team participation levels, and implementation milestones collected as part of a QI program. SETTING: Fourteen nursing homes in Washington, District of Columbia, participating in the On-Time Pressure Ulcer Prevention program. MAIN OUTCOME MEASURES: The nursing home level of implementation was measured by counting the number of implementation milestones achieved after at least 9 months of implementation effort. MAIN RESULTS: After at least 9 months of implementation effort, 36% of the nursing homes achieved level III, a high level of implementation, of the On-Time QI-HIT program. Factors significantly associated with high implementation were high level of involvement from the administrator or director of nursing, high level of nurse manager participation, presence of in-house dietitian, high level of participation of staff educator and QI personnel, presence of an internal champion, and team’s openness to redesign. One factor that was identified as a barrier to high level of implementation was higher numbers of health inspection deficiencies per bed. CONCLUSION: The learning from On-Time QI offers several lessons associated with facility factors that contribute to high level of implementation of a QI-HIT program in a nursing home.

Creating and Supporting a Mixed Methods Health Services Research Team

OBJECTIVE To use the experience from a health services research evaluation to provide guidance in team development for mixed methods research. METHODS The Research Initiative Valuing Eldercare (THRIVE) team was organized by the Robert Wood Johnson Foundation to evaluate The Green House nursing home culture change program. This article describes the development of the research team and provides insights into how funders might engage with mixed methods research teams to maximize the value of the team. RESULTS Like many mixed methods collaborations, the THRIVE team consisted of researchers from diverse disciplines, embracing diverse methodologies, and operating under a framework of nonhierarchical, shared leadership that required new collaborations, engagement, and commitment in the context of finite resources. Strategies to overcome these potential obstacles and achieve success included implementation of a Coordinating Center, dedicated time for planning and collaborating across researchers and methodologies, funded support for in-person meetings, and creative optimization of resources. CONCLUSIONS Challenges are inevitably present in the formation and operation of effective mixed methods research teams. However, funders and research teams can implement strategies to promote success.

Beyond CMS Quality Measure Adjustments: Identifying Key Resident and Nursing Home Facility Factors Associated With Quality Measures

OBJECTIVE This quality improvement (QI) project was initiated to understand what differentiates nursing homes (NHs) that perform well on publicly reported Centers for Medicare and Medicaid Services (CMS) Quality Measures (QMs). The intent was to assist NH staff to direct QI efforts to positively impact QM rates. A key step was to determine if any resident or facility characteristics might account for some of the variability in QMs of high-risk pressure ulcers (HRPrUs), low-risk incontinence (LRI), and Activities of Daily Living (ADL) decline, beyond those already adjusted for by CMS. DESIGN Observational Study. SETTING AND PARTICIPANTS The setting was 147 NHs across 12 northeast states owned by 1 for-profit, multifacility organization in 2006 and 2007. INTERVENTION None MEASUREMENTS Minimum Data Set (MDS), patient admission information, facility staffing metrics, and CMS QM data. RESULTS Relationships of facility and resident characteristics to QMs were evaluated using regression analyses performed separately for 2006 and 2007. Among factors found consistently to be significant (P < or = .05) for HRPrUs were percent admissions with pressure ulcers and percent residents with end-stage disease. For LRI, there was significant association with percent residents readmitted and percent incontinent of bladder on admission. ADL decline showed significant associations with licensed nurse turnover and facilities in specific states. CONCLUSION Several resident and facility factors were associated with QMs beyond those previously adjusted for by CMS. With introduction of MDS 3.0, we suggest further exploration of resident and facility factors identified in this study.

Leveraging certified nursing assistant documentation and knowledge to improve clinical decision making: the on-time quality improvement program to prevent pressure ulcers.

PURPOSE:To enhance the learners competence in facilitating a pressure ulcer (PrU) prevention program in long-term-care facilities. TARGET AUDIENCE:This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES:After participating in this educational activity, the participant should be better able to:Analyze how the certified nursing assistant can contribute significantly to the prevention of PrUs.Implement an On-Time Quality Improvement Program using the concepts and start-up processes described. ABSTRACTThe goal of this article was to enhance understanding of the On-Time Quality Improvement for Long-term Care Program, a practical approach to embed health information technology into quality improvement in nursing homes that leverages certified nursing assistant documentation and knowledge, supports frontline clinical decision making, and establishes proactive intervention for pressure ulcer prevention.

The effects of the Green House nursing home model on ADL function trajectory: A retrospective longitudinal study.

BACKGROUND Growing attention in the past few decades has focused on improving care quality and quality of life for nursing home residents. Many traditional nursing homes have attempted to transform themselves to become more homelike emphasizing individualized care. This trend is referred to as nursing home culture change in the U.S. A promising culture change nursing home model, the Green House nursing home model, has shown positive psychological outcomes. However, little is known about whether the Green House nursing home model has positive effects on physical function compared to traditional nursing homes. OBJECTIVES To examine the longitudinal effects of the Green House nursing home model by comparing change patterns of activities of daily living function over time between Green House home residents and traditional nursing home residents. DESIGN A retrospective longitudinal study. SETTINGS Four Green House organizations (nine Green House units and four traditional units). PARTICIPANTS A total of 242 residents (93 Green House residents and 149 traditional home residents) who had stayed in the nursing home at least 6 months from admission. METHODS The outcome was activities of daily living function, and the main independent variable was the facility type in which the resident stayed: a Green House or traditional unit. Age, gender, comorbidity score, cognitive function, and depressive symptoms at baseline were controlled. All of these measures were from a minimum dataset. Growth curve modeling and growth mixture modeling were employed in this study for longitudinal analyses. RESULTS The mean activities of daily living function showed deterioration over time, and the rates of deterioration between Green House and traditional home residents were not different over time. Four different activities of daily living function trajectories were identified for 18 months, but there was no statistical difference in the likelihood of being in one of the four trajectory classes between the two groups. CONCLUSIONS Although Green House nursing homes are considered to represent an innovative model changing the nursing home environment into more person-centered, this study did not demonstrate significant differences in activities of daily living function changes for residents in the Green House nursing homes compared to traditional nursing homes. Given that the Green House model continues to evolve as it is being implemented and variations within and across Green House homes are identified, large-scale longitudinal studies are needed to provide further relevant information on the effects of the Green House model.