The MU MDS and Quality Research Team, which began work in 1993, is an interdisciplinary group committed to conducting research that will help nursing homes in Missouri deliver high quality services to its residents. The team specifically focuses on the use of the MDS data for quality improvement and monitoring resident outcomes of care. The MDS team has made extensive use of information contained in Minimum Data Set (MDS) assessment forms to improve resident care. The MDS data provides a wealth of information about each resident’s needs and outcomes of care can also be interpreted from the data.

Quality measurement in nursing: Where are we now?

Written By: Rantz, M. J.

The American Nurses’ Association commissioned a review of the nursing quality measurement literature to understand the state of the art of nursing quality measurement and to influence policy makers to include nurse-sensitive quality measures in health care reform legislation....

Read More

Assessing contributors to cost of care in nursing homes

Written By: Hicks, L.L., Rantz, M. J., Petroski, G.F., Madsen, R.W., Conn, V.S., Mehr, D., & Porter, R.

In 1994 12.7% of the population was 65 and over, while 10.6% were 85 and over. Expenditures for nursing homes reached $72.3 billion in 1994 (much of which is tax-supported) accounting for 8.7% of all personal health money spent....

Read More

Setting thresholds for quality indicators derived from MDS data for nursing home quality improvement reports: An update

Written By: Rantz, M. J., Petroski, G., Madsen, R., Mehr, D., Popejoy, L., Hicks, L., Porter, R., Zwygart-Stauffacher, M. & Grando, V

Determining meaningful thresholds to reinforce excellent performance and flag potential problem areas in nursing home care is critical for preparing reports for nursing homes to use in their quality improvement programs. This article builds on the work of an...

Read More

Setting thresholds for MDS quality indicators for nursing home quality improvement reports

Written By: Rantz, M. J., Petroski, G.F., Madsen, R.W., Scott, J., Mehr, D., Popejoy, L., Hicks, L., Porter, R., Zwygart-Stauffacher, M., & Grando, V.

An important area of inquiry in quality measurement when using quality indicators (QIs) lies in determining what thresholds indicate good and poor resident outcomes. In July 1996, a cross-section of 13 clinical care personnel from nursing homes participated on...

Read More

Verifying nursing home care quality using minimum data set quality indicators and other quality measures

Written By: Rantz, M. J., Popejoy, L., Mehr, D., Zwygart-Stauffacher, M., Hicks, L., Grando, V., Conn, V., Porter, R., Scott, J., & Maas, M.

Researchers, providers and government agencies have devoted time and resources to the development of a set of Quality Indicators derived from Minimum Data Set (MDS) data. Little effort has been directed toward verifying that Quality Indicators derived from MDS...

Read More

Minimum data set and resident assessment instrument: Can using standardized assessment improve clinical practice and outcomes of care?

Written By: Rantz, M.J., Popejoy, L., Zwygart-Stauffacher, M., Wipke-Tevis, D.D., & Grando, V.T.

Regulating and standardizing the assessment of residents was envisioned by the 1986 Committee on Nursing Home Reform to have many advantages for facility management, government regulatory agencies, and clinical staff to evaluate changes in resident status and adjust the...

Read More

Initial field-testing of an instrument to measure “Observable indicators of nursing home care quality

Written By: Rantz, M.J., Mehr,D.R., Petroksi, G.F., Madsen, R.W., Popejoy, L., Hicks, L.L., Conn, V.S., Grando, V.T., Wipke-Tevis, D.D., Bostick, J., Porter, R., Zwygart-Stauffacher, M., & Maas, M.

The “Observable Indicators of Nursing Home Care Quality” instrument was developed as a new measure of nursing home care quality. The instrument is based on a theoretical model of quality nursing home care grounded in data from provider and...

Read More

Improving quality of care in nursing facilities: The gerontological clinical nurse specialist as research nurse consultant

Written By: Popejoy, L.L., Rantz, M.J., Conn, V., Wipke-Tevis, D., Grando, V., & Porter, R.

It is becoming increasingly common for nursing facilities to use Quality Indicators (Ql) derived from Minimum Data Set (MDS) data for quality improvement initiatives within their facilities. It is not known how much support facilities need to effectively review...

Read More

Lower respiratory infections in nursing home resident with dementia: A tale of two countries

Written By: Mehr, D.R., van der Steen, J.T., Kruse, R.L., Ooms, M.E., Rantz, M., & Ribbe, M.W.

A focus on palliative care for residents with dementia is much more common in Dutch nursing homes than in the United States. We compared treatment and mortality in U.S. and Dutch nursing home residents with lower respiratory infections (LRI),...

Read More

Hospice and non-hospice nursing home residents

Written By: Parker-Oliver, D., Porock, D., Zweig, S., Rantz, M., & Petroski, G.

Objective: To compare hospice residents in nursing homes with residents who are noted as end-stage, but not in hospice programs. Design: Descriptive comparison of the outcomes reported on Minimum Data Set (MDS) for all residents admitted to Missouri nursing homes in...

Read More

A profile of residents admitted to long-term care facilities for end-of-life care

Written By: Porock, D., Parker-Oliver, D., Zweig, S., Rantz, M., & Petroski, G.

Permanent placement in a Long-Term-Care (LTC) facility following hospitalization or when staying at home is no longer a viable option is the reality for a growing number of Americans. When death is imminent, the specialized knowledge and skill of...

Read More

A statewide strategy to improve quality of care in nursing facilities

Written By: Rantz, M.J., Vogelsmeier, A., Manion, P., Minner, D., Markway, B., Conn, V., Aud, M.A., & Mehr, D.R.

We describe the development of a statewide strategy to improve resident outcomes in nursing facilities, and we present some evaluative data from this strategy. Key components of the strategy include (a) a partnership between the state agency responsible for...

Read More

High-quality nursing home care is more cost effective than low-quality care

Written By: Rantz, M., Hicks, L., Petroski, G.F., Madsen, R.W., Conn, V., Zwygart-Stauffacher, M., & Maas, M.

Two studies of Missouri nursing homes – a random sample of facilities and a larger, statewide analysis – suggest that high-quality LTC actually costs less than poor-quality LTC. The researchers found that larger nursing homes, in particular, can realize...

Read More

Getting the basics right: Critical processes of care delivery in nursing homes that achieve good resident outcomes

Written By: Rantz, M.J., Grando, V., Conn, V.S., Zwygart-Stauffacher, M., Hicks, L., Flesner, M., Scott, J., Manion, P., Minner, D., Porter, R., & Mass, M.

Rantz, M.J., Grando, V., Conn, V.S., Zwygart-Stauffacher, M., Hicks, L., Flesner, M., Scott, J., Manion, P., Minner, D., Porter, R., & Mass, M. (2003). Getting the basics right: Critical processes of care delivery in nursing homes that achieve good...

Read More

Stability and sensitivity of nursing home quality indicators

Written By: Rantz, M.J., Hicks, L. Petroski, G.F., Madsen, R.W., Mehr, D.R., Conn, V., Zwygart-Stauffacher, M., & Mass, M.

The issues of stability and sensitivity of indicators to actually detect differences in quality of care in nursing facilities are not only of concern to researchers, but also to public policy makers, who are reporting indicators to providers and...

Read More

Developing a residential care facility version of the observable indicators of nursing home care quality instrument

Written By: Aud, M.A., Rantz, M.J., Zwygart-Stauffacher, M., & Manion, P.

The last decade has seen a substantial growth in the development of residential care facilities (assisted-living facilities). Evaluation of the quality of care in this service delivery sector has been hampered by the lack of a consensus definition of...

Read More

Nursing home quality, cost, staffing, and staff-mix

Written By: Rantz, M.J., Hicks, L., Grando, V.T., Petroski, G.F., Madsen, R.W., Mehr, D.R., Conn, V., Zwygart-Stauffacher, M., Scott, J., Flesner, M., Bostick, J., Porter, R., & Maas, M.

The purpose of this study was to describe the processes of care, organizational attributes, cost of care, staffing level, and staff mix in a sample of Missouri homes with good, average, and poor resident outcomes. In facilities with good...

Read More

Measuring nursing care quality and using large data sets in non-acute care settings: State of the science

Written By: Rantz, M.J. & Connolly, R.

The general state of the science of nursing quality measurement in nonacute care settings has accelerated in the last several years. Examples of current research using large data sets to measure quality of nursing care in nursing homes, home...

Read More

Back to the fundamentals of care: A road map to improve nursing home care quality

Written By: Rantz, M.J. & Zwygart-Stauffacher, M.

Rantz, M.J., & Zwygart-Stauffacher, M. (2004). Back to the fundamentals of care: A road map to improve nursing home care quality. Journal of Nursing Care Quality, 19(2), 92-94.

Read More

Nursing home quality and pressure ulcer prevention and management strategies

Written By: Wipke-Tevis, D.D., Williams, D.A., Rantz, M.J., Popejoy, L.L., Madsen, R.W., Petroski, G.F., & Vogelsmeier, A.A

OBJECTIVES: To measure pressure ulcer quality indicator (QI) scores and to describe the self-reported skin integrity assessment, pressure ulcer risk assessment, and pressure ulcer prevention and treatment practices in long-term care facilities (LTCFs). DESIGN: Retrospective analysis of a large data set...

Read More

Nursing home costs and quality of care outcomes

Written By: Hicks, L.L., Rantz, M.J., Petroski, G.F., & Mukamel, D.B.

The article focuses on nursing homes costs and quality of care outcomes. Consumers are demanding mechanisms that will allow them to evaluate the quality of care provided in nursing homes. Policymakers, who are responsible for oversight of the public...

Read More

Clinical outcomes of aging in place

Written By: Marek, K., Popejoy, L., Petroski, G., Mehr, D., Rantz, M.J., & Lin, W.

Programs such as Medicaid Home and Community-based Services (HCBS) have provided an alternative to institutionalization through community-based, long-term care services; however, there are limited studies on the clinical outcomes of participants in these programs as compared to nursing home...

Read More

Evidence-based assessment and treatment of persistent pain in the community-dwelling elderly receiving home health hervices: A Pathway

Written By: Minner, D. & Marek, K.

Persistent pain is a problem for a significant portion of the community-dwelling elderly. Many elderly are reluctant to admit to pain because of fears related to areas such as loss of independence and possible addiction. Cognitively impaired elders may...

Read More

Prevalence and characteristics of nursing home residents needing light-care

Written By: Grando, V., Rantz, M., Petroski, G., Maas, M., Popejoy, L., Conn, V., & Wipke-Tevis, D.

Rising nursing home (NH) costs and the poor quality of NH care make it important to recognize elders for whom NH care may be inappropriate. As a first step in developing a method to identify these elders, we examined...

Read More

Preparation of nurse leaders in the 21st century workplace

Written By: Flesner, M.K., Scott-Cawiezell, J., & Rantz, M.J.

Creating work environments in which health care is delivered in a safe manner requires a new type of nursing leader, one who can transform the environment and the culture of a health care organization. This is the concept identified...

Read More

Impact of pain on outcomes in long-term care residents with and without multiple sclerosis

Written By: Newland, P., Wipke-Tevis, D., Williams, D., Rantz, M., & Petroski, G.

This study was to compare long-term care (LTC) residents with and without multiple sclerosis (MS); to compare admission status of pain, physical disability, pressure ulcers, depression, and cognitive performance in LTC residents with and without MS; and to examine...

Read More

Advances in measuring quality of care in nursing homes: a new tool for providers, consumers, regulators, and researchers

Written By: Rantz, M.J., Zwygart-Stauffacher, M., & Flesner, M.

Over the past 12 years, members of the Minimum Data Set (MDS) and Quality Research Team at the University of Missouri-Columbia have been working with the Missouri Department of Health and Senior Services to improve care in Missouri nursing...

Read More

A new reliable tool for nurse administrators, nursing staff, regulators, consumers, and researchers for measuring quality of care in nursing homes

Written By: Rantz, M.J. & Zwygart-Stauffacher, M.

Funding from NINR enabled large-scale field testing of an instrument to measure the observable multidimensional components of the concept of nursing home care quality. Field testing in 3 states was directed by research teams at the University of Missouri-Columbia...

Read More

Nursing home staff’s views on quality improvement interventions: A follow-up study

Written By: Grando, V., Rantz, M.J., & Maas, M.

Ongoing problems with nursing home care mandates understanding nursing home staff’s perspectives on innovative quality improvement programs. This follow-up study used focus groups to examine the experiences of staff who participated in a clinical trial that involved Quality Indicator...

Read More

Measuring quality of care in assisted living: A new tool for providers, consumers, and researchers

Written By: Aud M., Rantz, M.J., Zwygart-Stauffacher M., Flesner M.

The article discusses the initiative to measure the quality improvement efforts in assisted living facilities in the U.S. In 33,000 assisted living centers, there are roughly 800,000 residents who are under their care. However, there are continuing research to...

Read More

Clinical information systems in nursing homes: an evaluation of initial implementation strategies

Written By: Alexander, G., Rantz, M., Flesner, M., Diekemper, M., & Siem, C.

This article presents qualitative results collected 6 months after implementation of a clinical information system in four nursing homes in the Midwestern USA. Researchers explored initial implementation strategies, discussed employee experiences, and analyzed employee satisfaction. Transcript-based analysis and axial...

Read More

Field testing, refinement, and psychometric evaluation of a new measure of quality of care for assisted living

Written By: Rantz, M.J., Aud, M.A., Zwygart-Stauffacher, M., Mehr, D.R., Petroski, G.F., Owen, S.V., Madsen, R.W., Flesner, M., Conn, V., & Maas, M.

Field test results are reported for the Observable Indicators of Nursing Home Care Quality Instrument-Assisted Living Version, an instrument designed to measure the quality of care in assisted living facilities after a brief 30-minute walk-through. The OIQ-AL was tested...

Read More

Nursing home care quality: insights from a Bayesian network approach

Written By: Goodson, J., Jang, W., & Rantz, M.

The purpose of this research is two-fold: (1) to utilize a new methodology (Bayesian networks) for aggregating various quality indicators to measure the overall quality of care in nursing homes and (2) to provide new insight into the relationships...

Read More

A trial of a comprehensive nursing rehabilitation program for nursing home residents post-hospitalization

Written By: Grando, V.T., Buckwalter, K.C., Maas, M.L., Brown, M., Rantz, M., & Conn, V.

This pilot study examined the feasibility of implementing a comprehensive nursing rehabilitation program (CNRP) designed to promote the physical functioning of moderately frail nursing home residents post-hospitalization. The 4-week to 8-week CNRP incorporated three interventions: the Capacity Intervention (improving...

Read More

Helping nursing homes “at risk” for quality problems: a statewide evaluation

Written By: Rantz, M.J., Cheshire, D., Flesner, M., Petroski, G.F., Hicks, L., Alexander, G., Aud, M.A., Siem, C., Nguyen, K., Boland, C., & Thomas, S.

Nearly everyone has some life experiences or opinions based on media about nursing homes and the need for quality improvement. States and federal agencies spend enormous amounts of time regulating and surveying nursing homes, but quality problems persist. In...

Read More

Improving care in nursing homes using quality measures/indicators and complexity science

Written By: Rantz, M.J., Flesner, M.K., Zwygart-Stauffacher, M.

The authors report on a NIH multilevel intervention study (n=58; 29 intervention, 29 control) performed in a Midwestern state over a 2 year time frame. Complexity science was the theoretical model used to analyze the observations made by research...

Read More

Dance-based therapy in a program of all-inclusive care for the elderly: an integrative approach to decrease fall risk

Written By: Krampe, J., Rantz, M.J., Dowell, L., Schamp, R., Skubic, M., & Abbott, C.

Loss of balance and diminished gait are major fall risk factors in older persons. Literature suggests that physical activity based on dance may improve balance and gait. The aim of this pilot study was to determine whether dance-based therapy...

Read More

The relationship of community-based nurse care coordination to costs in the Medicare and Medicaid programs

Written By: Marek, K.D., Adams, S.J., Stetzer, F., Popejoy, L., Petroski, G.F., & Rantz, M.

The purpose of this evaluation was to study the relationship of nurse care coordination (NCC) to the costs of Medicare and Medicaid in a community-based care program called Missouri Care Options (MCO). A retrospective cohort design was used comparing...

Read More

The MDS Mortality Risk Index: The evolution of a method for predicting 6-month mortality in nursing home residents

Written By: Porock, D., Parker Oliver, D., Petroski, G., & Rantz, M

Accurate prognosis is vital to the initiation of advance care planning particularly in a vulnerable, at risk population such as care home residents. The aim of this paper is to report on the revision and simplification of the MDS...

Read More

Cost, staffing, and quality impact of bedside electronic medical record (EMR) in nursing homes

Written By: Rantz, M.J., Hicks, L., Petroski, G.F., Madsen, R.W., Alexander, G., Galambos, C., Conn, V., Scott-Cawiezell, J., Zwygart-Stauffacher, M., & Greenwald, L.

There is growing political pressure for nursing homes to implement the electronic medical record (EMR) but there is little evidence of its impact on resident care. The purpose of this study was to test the unique and combined contributions...

Read More

Pain management in nursing homes: What do quality measures tell us?

Written By: Russell, T., Madsen, R., Flesner, M.K., & Rantz, M.

Pain management for older adults residing in nursing homes continues to present multifaceted challenges to health care practitioners and researchers. This study, which focuses on improvement in pain assessment and management, is a secondary analysis of data from a...

Read More

Evaluation of aging in place model with home care services and registered nurse care coordination in senior housing

Written By: Rantz, M.J., Phillips, L., Aud, M., Marek, K.D., Hicks, L.L., Zaniletti, I., & Miller, S.J.

A state-sponsored evaluation of aging in place (AIP) as an alternative to assisted living and nursing home has been underway in Missouri. Cost, physical, and mental health assessment data reveal the cost-effectiveness and positive health measures of AIP. Findings...

Read More

Indicators of new depression diagnosis in nursing home residents

Written By: Phillips, L., Rantz, M., & Petroski, G.

Depression affects approximately 30% to 40% of nursing home residents but frequently goes unrecognized. Using the Missouri Minimum Data Set, we aimed to determine whether changes in clinical status, other than mood changes, were associated with new depression diagnosis...

Read More

Management of dementia and depression utilizing in-home passive sensor data

Written By: Galambos, C., Skubic, M., Wang, S., & Rantz, M.

Purpose: This study investigates whether motion density maps based on passive infrared (PIR) motion sensors and the average time out and average density per hour measures of the density map are sensitive enough to detect changes in mental health over...

Read More

Initiative to test a multidisciplinary model with advanced practice nurses to reduce avoidable hospitalizations among nursing facility residents

Written By: Rantz, M., Alexander, G., Galambos, C., Vogelsmeier, A., Popejoy, L., Flesner, M., Lueckenotte, A., Crecelius, C., & Zwygart-Stauffacher, M.

Consider the current reality for Mrs. Florence Jones, a woman of advanced age and mild dementia in a long-term care facility, who insists everyone call her “Flossie”: On May 1, Karen, the nurse aide taking care of Flossie, needs...

Read More

International comparison of quality indicators in the United States, Icelandic and Canadian nursing facilities

Written By: Jensdottir, A.B., Rantz, M.J., Hjaltadottir, I., Guomundsdottir, H., Rook, M., & Grando, V.

We discuss the results of a comparison using minimum data set (MDS)-based quality indicators (QIs) for residents in nursing facilities in three countries (Iceland; Ontario, Canada; and Missouri, United States) together with implications regarding nursing practices and resident outcomes...

Read More

Systematic review of studies of staffing and quality in nursing homes

Written By: Bostick, J.E., Rantz, M.J., Flesner, M.K., & Riggs, C.J.

Numerous studies in the past three decades have explored the relationships between staffing levels in nursing homes and quality of care measures. However, the wide array of studies researching staffing and quality of care, many with conflicting results, make...

Read More


Written By: Strata Commun

Wonder what QIPMO is all about? Click here for a quick and informative video! Strata Commun

Read More

Integrating advanced practice registered nurses into nursing homes: The Missouri Quality Initiative experience

Written By: Vogelsmeier, A., Popejoy, L., Rantz, M., Flesner, M., Lueckenotte, A., & Alexander, G.

There are nearly 1.5 million older adults residing in nursing homes (NH) across the United States. Reducing avoidable hospitalizations among vulnerable NH residents has become a national priority. Estimates suggest more than $14 billion of Medicare funding is spent annually on hospitalizations for this vulnerable population....

Read More

Quantifying care coordination dose using natural language processing and domain specific ontology

Written By: Khalilia, M., Popejoy, L., Popescu, P., Galambos, C., Lyons, V., Rantz, M., Hicks, L., & Stetzer, F.

Objective This research identifies specific care coordination activities used by Aging In Place (AIP) nurse care coordinators and home healthcare nurses when coordinating care for older community-dwelling adults and suggests a method to quantify care coordination. Methods A care coordination ontology...

Read More

An observational study of antipsychotic medication use among long-stay nursing home residents without qualifying diagnoses

Written By: Phillips, L.J., Birtley, N.M., Petroski, G.F., Siem, C., & Rantz, M.

Introduction: Antipsychotic use in nursing homes varies widely across the United States; inadequate staffing, skill mix, and geropsychiatric training impede sustained improvement. Aim: This study identified risk factors of antipsychotic use in long-stay residents lacking qualifying or potentially qualifying...

Read More