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Implementing Quality Improvement in Nursing Homes: Nurse Practitioner Perspectives on Barriers, Facilitators, and
Anna H Gallion1, Isaac Schlotterbeck, Carole Bartoo
1Author Affiliations: Division of General Internal Medicine and Public Health, Section of Hospital Medicine, Department of Medicine, Vanderbilt University Medical Center, VA Quality Scholars, Veterans Affairs, Vanderbilt University School of Nursing, Nashville, Tennessee (Dr Gallion), Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee (Mr Schlotterbeck), Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Ms Bartoo and Dr Horr), Health Services Research Department, Brown University School of Public Health, Providence, Rhode Island (Ms Weems), Vanderbilt Home Care Services, Nashville, Tennessee (Dr Niehoff), Vanderbilt Center for Quality Aging, Division of Geriatrics, Department of Medicine, Department of Psychology, College of Arts and Science, Vanderbilt University Medical Center, VA Quality Scholars, Veterans Affairs, Nashville, Tennessee (Dr Simmons), and Division of General Internal Medicine and Public Health, Section of Hospital Medicine, Department of Medicine, Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Kripalani).
Background:
Nursing homes (NHs) face persistent challenges implementing evidence-based quality improvement (QI). Many barriers were intensified during the COVID-19 pandemic.
Purpose:
To identify barriers and facilitators to nurse practitioner (NP)-led QI implementation in NHs and share lessons learned.
Methods:
Fifty-six NHs in middle Tennessee were each assigned an NP mentor to support QI efforts during the COVID-19 pandemic. Structured qualitative interviews with project NPs identified barriers and facilitators to QI implementation using the Consolidated Framework for Implementation Research.
Results:
Facilitators included leadership engagement, QI champions, a supportive culture, and evidence strength. Barriers included low prioritization, limited resources, low staff efficacy, and adaptability challenges.
Conclusions:
NP-led QI is feasible in NHs but requires leadership support, adequate staffing, and an organizational culture that values improvement.
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