Exploratory study of nursing home factors associated with successful implementation of clinical decision support...

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.

Observational study with quantitative analysis of nursing home characteristics, team participation levels, and implementation milestones collected as part of a QI program.

Fourteen nursing homes in Washington, District of Columbia, participating in the On-Time Pressure Ulcer Prevention program.

The nursing home level of implementation was measured by counting the number of implementation milestones achieved after at least 9 months of implementation effort.

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.

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.