Objectives: Qualitatively describe the adoption of strategies and challenges experienced by intervention facilities participating in a study targeted to improve quality of care in nursing homes "in need of improvement". To describe how staff use federal quality indicator/quality measure (QI/QM) scores and reports, quality improvement methods and activities, and how staff supported and sustained the changes recommended by their quality improvement teams.

Design/setting/participants: A randomized, two-group, repeated-measures design was used to test a 2-year intervention for improving quality of care and resident outcomes in facilities in "need of improvement". Intervention group (n ¼ 29) received an experimental multilevel intervention designed to help them: (1) use quality-improvement methods, (2) use team and group process for direct-care decision-making, (3) focus on accomplishing the basics of care, and (4) maintain more consistent nursing and administrative leadership committed to communication and active participation of staff in decision-making.

Rantz, M.J., Zwygart-Stauffacher, M., Flesner, M., Hicks, L., Mehr, D., Russell, T., & Minner, D. (2012). Challenges of using quality improvement methods in nursing homes that "need improvement". Journal of the American Medical Directors Association, 13(8), 732-738.

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