Clinical practice guidelines, process improvement teams, and performance on a quality indicator for urinary...

Area of Science:

• Gerontology
• Healthcare Quality Improvement
• Nursing Home Care

Background:

• Urinary incontinence (UI) is prevalent in nursing facilities but often not prioritized.
• Interventions for UI in nursing facilities are frequently not individualized or poorly implemented.
• Facility characteristics may influence care processes more than individual staff capabilities.

Purpose of the Study:

• To test the hypothesis that better facility performance on a quality indicator (QI) for continence care (toileting) is associated with a more systematic approach to continence care.

Main Methods:

• A descriptive study of 34 for-profit nursing facilities (NFs) within the AMDA Foundation Long-Term Care (AMDA-F LTC) Research Network.
• Facilities were categorized as good or poor performers based on a 1-year percentile ranking for the toileting QI.
• Comparison of characteristics between good and poor performing facilities.

Main Results:

• No significant differences in occupancy, turnover, other QIs, or continence product costs between good and poor performers.
• Pharmacotherapy prevalence for UI was similar (7-8%) in both groups.
• Good performers were more likely to have a process improvement team (PIT) for UI (53% vs. 18%) and to use a clinical practice guideline (CPG) with a UI PIT (47% vs. 6%).

Conclusions:

• Facilities excelling in toileting care quality indicators are more likely to implement a process improvement team for UI.
• Optimal toileting performance is strongly linked to the combined use of a PIT and a CPG for UI.