Annals of Long Term Care

Translating Evidence-Based Falls Prevention into Clinical Practice in Nursing Facilities: Results and Lessons from a Quality Improvement Collaborative
Cathleen Colón-Emeric, MD, MHSc, Anna Schenck, PhD, Joel Gorospe, RN, MSN, Jill McArdle, RN, MSPH, Lee Dobson, MPA, Cindy DePorter, MSW, and Eleanor McConnell, RN, PhD, APRN, BC

OBJECTIVES: To describe the changes in process of care before and after an evidence-based fall reduction quality improvement collaborative in nursing facilities.

DESIGN: Natural experiment with nonparticipating facilities serving as controls.

SETTING: Community nursing homes.

PARTICIPANTS: Thirty-six participating and 353 nonparticipating nursing facilities in North Carolina.

INTERVENTION: Two in-person learning sessions, monthly teleconferences, and an e-mail discussion list over 9 months. The change package emphasized screening, labeling, and risk-factor reduction.

MEASUREMENTS: Compliance was measured using facility self-report and chart abstraction (n=832) before and after the intervention. Fall rates as measured using the Minimum Data Set (MDS) were compared with those of nonparticipating facilities as an exploratory outcome.

RESULTS: Self-reported compliance with screening, labeling, and risk-factor reduction approached 100%. Chart abstraction revealed only modest improvements in screening (51% to 68%, P<.05), risk-factor reduction (4% to 7%, P=.30), and medication assessment (2% to 6%, P=.34). There was a significant increase in vitamin D prescriptions (40% to 48%, P=.03) and decrease in sedative-hypnotics (19% to 12%, P=.04) but no change in benzodiazepine, neuroleptic, or calcium use. No significant changes in proportions of fallers or fall rates were observed according to chart abstraction (28.6% to 37.5%, P=.17), MDS (18.2% to 15.4%, P=.56), or self-report (6.1–5.6 falls/1,000 bed days, P=.31).

CONCLUSON: Multiple-risk-factor reduction tasks are infrequently implemented, whereas screening tasks appear more easily modifiable in a real-world setting. Substantial differences between self-reported practice and medical record documentation require that additional data sources be used to assess the change-in-care processes resulting from quality improvement programs. Interventions to improve interdisciplinary collaboration need to be developed. J Am Geriatr Soc 2006;54(9):1414-1418.

Satisfaction with End-of-Life Care for Nursing Home Residents with Advanced Dementia
Sharon E. Engel, Dan K. Kiely, MPH, MA, and Susan L. Mitchell, MD, MPH

OBJECTIVES: To identify factors associated with satisfaction with care for healthcare proxies (HCPs) of nursing home (NH) residents with advanced dementia.

DESIGN: Cross-sectional study.

SETTING: Thirteen NHs in Boston.

PARTICIPANTS: One hundred forty-eight NH residents aged 65 and older with advanced dementia and their formally designated HCPs.

MEASUREMENTS: The dependent variable was HCPs' score on the Satisfaction With Care at the End of Life in Dementia (SWC-EOLD) scale (range 10–40; higher scores indicate greater satisfaction). Resident characteristics analyzed as independent variables were demographic information, functional and cognitive status, comfort, tube feeding, and advance care planning. HCP characteristics were demographic information, health status, mood, advance care planning, and communication. Multivariate stepwise linear regression was used to identify factors independently associated with higher SWC-EOLD score.

RESULTS: The mean ages±standard deviation of the 148 residents and HCPs were 85.0±8.1 and 59.1±11.7, respectively. The mean SWC-EOLD score was 31.0±4.2.