Members of the Statewide Committee for Improving MDS Assessment and Use and QIPMO have developed educational materials to assist long-term care facilities with the Resident Assessment Instrument (RAI) processes, such as the Minimum Data Set (MDS). Quality Indicators (QIs) derived from the MDS were developed as a way of providing feedback to facilities about their quality of care and provide one way of using the MDS data for quality monitoring and improvement. The MDS team has found that facilities that use their QI reports and on-site clinical consultations with gerontological nursing specialists from the MDS team’s Quality Improvement Program for Missouri (QIPMO) program improve the quality of care they deliver and improve resident outcomes.

Longitudinal analysis of aging in place at TigerPlace: Resident function and well-being

Published On: 05-01-2022

Written By: Popejoy, L., Zaniletti, I., Lane, K., Anderson, L., Miller, S., & Rantz, M.

This paper reports on a longitudinal eight-year analysis (2011-2019) of trajectory of function and well-being residents of TigerPlace Aging in Place (AIP) model of care. Residents were routinely assessed using standard health assessment instruments. Average scores from each measure...

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Value propositions for health information exchange toward improving nursing home hospital readmission rates

Published On: 01-01-2022

Written By: Alexander, G.L., Galambos, C., Rantz, M., Shumate, S., Vogelsmeier, A., Popejoy, L., & Crecelius, C.

The importance of health information technology use in nursing home (NH) care delivery is a major topic in research exploring methods to improve resident care. Topics of interest include how technology investments, infrastructure, and workforce development lead to better...

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A call to address RN, social work, and advanced practice registered nurses in nursing homes

Published On: 11-10-2021

Written By: Popejoy, L.L., Vogelsmeier, A.A., Canada, K.E., Kist, S., Miller, S.J., Galambos, C., Alexander, G.L., Crecelius, C., & Rantz, M.

Background: US nursing homes (NHs) have struggled to overcome a historic pandemic that laid bare limitations in the number and clinical expertise of NH staff. Problem: For nurse staffing, current regulations require only one registered nurse (RN) on duty...

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Longitudinal impact of APRNs on nursing home quality measures in the Missouri Quality Initiative

Published On: 10-04-2021

Written By: Rantz, M., Petroski, G.F., Popejoy, L.L., Vogelsmeier, A.A., Canada, K.E., Galambos, C.L., Alexander, G.L., & Crecelius, C.

OBJECTIVES: To measure the impact of advanced practice nurses (APRNs) on quality measures (QM) scores of nursing homes (NHs) in the CMS funded Missouri Quality Initiative (MOQI) that was designed to reduce avoidable hospitalizations of NH residents, improve quality...

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Financial and work-flow benefits of reducing avoidable hospitalizations of nursing home residents

Published On: 07-02-2021

Written By: Rantz, M., Vogelsmeier, A., Popejoy, L., Canada, K., Galambos, C., Crecelius, C., & Alexander, G.L.

Objectives: 1) Explain the financial benefit of potential revenue recapture (PRR) for non-billable days due to hospitalizations of nursing home (NH) residents using a six-year longitudinal analysis of 11 of 16 NHs participating in the Missouri Quality Initiative (MOQI);...

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Examining social networks in text messages about nursing home resident health status

Published On: 07-01-2021

Written By: Powell, K.R., Popescu, M., & Alexander, G.L.

Social network analysis (SNA) uses quantitative methods to analyze relationships between people. In the current study, SNA was applied in two nursing homes (NHs) to describe how health care teams interact via text messages. Two data sources were used:...

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Advanced practice registered nurses help reduce hospitalizations from nursing home residents

Published On: 03-03-2021

Written By: Consiglio, Brian

Advanced practice registered nurses help reduce hospitalizations from nursing home residents MU study examines effectiveness of $35 million program designed to improve quality of care in nursing homes. Marilyn Rantz still remembers the day she got the call that...

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Full-time nurse program cuts ED visits, saves $31 million for MO nursing homes

Published On: 03-01-2020

Written By: Lasek, Alicia

Medicare should scrap billing restrictions for direct care services provided by advanced practice nurses in nursing homes, say researchers from the University of Missouri’s Sinclair School of Nursing, citing results of a long-term study. Investigators followed a six-year quality...

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Take it to the resident: A model for engaging longterm stay residents in advance care planning

Published On: 02-11-2021

Written By: Pritchett, A., Canada, K.E., Galambos, C., Rollin, L., & Rantz, M.

Advance care planning involves a meaningful conversation about residents’ end of life goals with the health-care team and documenting these wishes in advance directives; however, these conversations are not taking place early enough or with strategies that allow nursing...

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Enhancing physician relationships, communication, and engagement to reduce nursing home residents hospitalizations

Published On: 02-01-2021

Written By: Galambos, C., Vogelsmeier, A., Popejoy, L., Crecelius, C., Canada, K., Alexander, G., Rollin, L., & Rantz, M.

Recently, there have been numerous policy and program responses to reducing potentially avoidable hospitalizations from skilled nursing facilities (SNFs). It is estimated that approximately 25% of resident discharges to SNFs are readmitted within 30 days of discharge. Medicare spends...

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Results of the Missouri Quality Initiative: six-year trends of reducing unnecessary hospitalizations

Published On: 01-01-2021

Written By: Vogelsmeier, A., Popejoy, L., Canada, K., Galambos, C., Petroski, G., Crecelius, C., Alexander, GL, & Rantz, M.

Objectives: The purpose of this article is to present six-year findings of the Missouri Quality Initiative (MOQI) to reduce unnecessary hospitalizations for long-stay nursing home residents. Design: A CMS funded demonstration project analyzed over 6-years using a single group...

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Advance directives in the nursing home setting: an initiative to increase completion and reduce potentially avoidable hospitalizations

Published On: 01-01-2021

Written By: Galambos, C., Rantz, M., Popejoy, L., Ge, B., & Petroski, G.

Advance directive (AD) completion can improve transitions between hospitals and skilled nursing facilities (SNF’s). One Centers for Medicare and Medicaid Services (CMS) Innovations Demonstration Project, The Missouri Quality Initiative (MOQI), focused on improving AD documentation and use in sixteen...

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To text or not to text? That is the question.

Published On: 11-14-2020

Written By: Alexander G.L., Harrell, R., Shumate, S., Rothert, M., Vogelsmeier, A., Popejoy, L., Crecelius, C., & Rantz, M.

Texting is ubiquitous with a text frequency of 145 billion/day worldwide. This paper provides partial results of the national demonstration project called the Missouri Quality Improvement Initiative (MOQI). MOQI goals were to reduce avoidable hospitalizations using APRNs to infuse...

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Transitions of care: Perspectives of patients living in long-term care

Published On: 07-01-2020

Written By: Canada, K. E., Galambos, C., Pritchett, A., Rollin, L., Popejoy, L., Vogelsmeier, A., & Rantz, M.

Across studies, the risk of hospital transfer for nursing home residents is highest for people without documented advance directives and for people with chronic health conditions (eg, diabetes and congestive heart failure), mental health conditions (eg, depression), and limited...

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Reducing avoidable hospitalizations for nursing home residents: role of the Missouri Quality Initiative intervention support team

Published On: 07-01-2020

Written By: Vogelsmeier, A., Popejoy, L., Kist, S., Shumate, S., Pritchett, A., Mueller, J., & Rantz, M.

Hospitalization for nursing home residents is a national concern. Studies suggest the majority of hospital transfers are avoidable, often resulting from poor care processes such as lack of early illness detection, adverse event occurrences, and poor communication between nursing...

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A coordinated response to the COVID-19 pandemic in Missouri nursing homes

Published On: 07-01-2020

Written By: Popejoy, L., Vogelsmeier, A., Boren, W., Martin, N., Kist, S, Canada, S., Miller, S.J., & Rantz, M.

In the United States, the first case of the novel coronavirus 2019 (COVID-19) was detected in January 2020 in the state of Washington. By February 2020, COVID-19 was linked to 167 confirmed cases of staff and residents within a...

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Analyzing hospital transfers using INTERACT Acute Care Transfer tools: Lessons from MOQI

Published On: 06-12-2019

Written By: Popejoy, L.L., Vogelsmeier, A.A., Alexander, G.A., Galambos, C.M., Crecelius, C., Ge, B., Flesner, M., Canada, K., & Rantz, M.

OBJECTIVES: We explored the differences in potentially avoidable/unavoidable hospital transfers in a retrospective analysis of Interventions to Reduce Acute Care Transfers (INTERACT) Acute Transfer Tools (ACTs) completed by advanced practice registered nurses (APRNs) working in the Missouri Quality Improvement...

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Avoiding nursing home to hospital transfers: rethinking avoidability

Published On: 05-01-2019

Written By: Vogelsmeier, A., Popejoy, L., Kist, S., Harrell, R., Alexander, G., & Rantz, M.

Studies describing avoidable hospital transfers for nursing home (NH) residents sug-gest rates vary between 30% and 70%, often citing poor communication, limited resources, patient/family preference, and adverse events as underlying causes.1-3Adverse events, defined as harm resulting from the delivery...

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Advanced practice registered nurses’ quality improvement efforts to reduce antipsychotic use in nursing homes

Published On: 01-01-2019

Written By: Flesner, M., Lueckenotte, A., Vogelsmeier, A., Popejoy, L., Canada, K., Minner, D., Galambos, C., & Rantz, M.

In 2011, the Office of Inspector General (OIG) of the Department of Health and Human Services released the report Medicare Atypical Antipsychotics Drug Claims for Elderly Nursing Homes Residents. This report was prompted by a legislator’s concern about the...

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An Interdisciplinary Approach to Promote Older Adult Health

Published On: 11-12-18

Written By: WebsEdgeHealth

An Interdisciplinary Approach to Promote Older Adult Health Over twenty years ago, the University of Missouri formed a broad interdisciplinary team to revolutionize older adult care. Over the years, this team consisted of engineering, nursing, and social work researchers,...

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An Interdisciplinary Approach to Promote Older Adult Health (GSA video)

Published On: 11-12-2018

Over twenty years ago, the University of Missouri formed a broad interdisciplinary team to revolutionize older adult care. Over the years, this team consisted of engineering, nursing, and social work researchers, among other valuable members. From this team came...

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Impact of Survey Readiness Training on Nursing Home Quality of Care

Published On: 11-01-2018

Written By: Phillips, L.J., Oyewusi, C., Martin, C., Youse, E., & Rantz, M.J.

Due to their role overseeing administrative, operational, and clinical services in nursing homes (NHs), licensed nursing home administrators (LNHAs) are responsible for quality of care and correcting deficiencies identified during the annual certification and survey process. State regulations vary...

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

Published On: 07-19-2018

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...

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Impact of advanced practice registered nurses on quality measures: The Missouri Quality Initiative experience

Published On: 06-01-2018

Written By: Rantz, M.J., Popejoy, L., Vogelsmeier, A., Galambos, C., Alexander, G., Flesner, M., Murray, C., Crecelius, C., Ge, B., & Petroski, G.

Purpose: The purpose of this article is to review the impact of advanced practice registered nurses (APRNs) on the quality measure (QM) scores of the 16 participating nursing homes of the Missouri Quality Initiative (MOQI) intervention. The MOQI was...

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Involvement of Advanced Practice Nurse in the management of geriatric conditions: examples from different countries

Published On: 01-30-2018

Written By: Fougère, B., Lagourdette, C., Abele, P., Resnick, B., Rantz, M., Kam Yuk Lai, C., Chen, Q., Moyle, W., Vellas, B., & Morley, J.E.

The increasing demand for healthcare services is placing great strain on healthcare systems throughout the world. Although the older population is increasing worldwide, there is a marked deficit in the number of persons trained in geriatrics. It is now...

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APRN-conducted medication reviews for long-stay nursing home residents

Published On: 01-01-2018

Written By: Vogelsmeier, A., Popejoy, L., Crecelius, C., Orique, S., Alexander, G. & Rantz, M.

Objective: As part of the Missouri Quality Initiative (MOQI) to reduce hospitalizations for long-stay nursing home residents, this article describes reasons MOQI advanced practice registered nurses (APRNs) recommended medication order changes as part of their medication review process as...

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Reducing avoidable hospitalizations and improving quality in nursing homes with APRNs and interdisciplinary support: lessons learned

Published On: 01-01-2018

Written By: Rantz, M., Popejoy, L., Vogelsmeier, A., Galambos, C., Alexander, G., Flesner, M., Murray, C., & Crecelius, C.

Reduction in avoidable hospitalizations of nursing home residents is a major concern to health care providers as well as payers. Not only are hospitalizations costly but also hospitalized nursing home residents experience functional and physical decline as a result...

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Successfully reducing hospitalizations of nursing home residents: results of the Missouri Quality Initiative

Published On: 11-01-2017

Written By: Rantz, M. J., Popejoy, L., Vogelsmeier, A., Galambos, C., Alexander, G., Flesner, M., Crecelius, C., Ge, B., & Petroski, G.

Purpose: The goals of the Missouri Quality Initiative (MOQI) for long-stay nursing home residents were to reduce the frequency of avoidable hospital admissions and readmissions, improve resident health outcomes, improve the process of transitioning between inpatient hospitals and nursing...

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Randomized trial of intelligent sensor system for early illness alerts in senior housing

Published On: 10-01-2017

Written By: Rantz, M., Phillips, L.J., Galambos, C., Lane, K., Alexander, G.L., Despins, L., Koopman, R.J., Skubic, M., Hicks, L., Miller, S., Craver, A., Harris, B., & Deroche, C.B.

Objectives: Measure the clinical effectiveness and cost-effectiveness of using sensor data from an environmentally embedded sensor system for early illness recognition. This sensor system has demonstrated in pilot studies to detect changes in function and in chronic diseases or...

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Call to action: APRNs in US nursing homes to improve care and reduce costs

Published On: 09-01-2017

Written By: Rantz, M.J., Birtley, N.M., Flesner, M., Crecelius, C., & Murray, C.

Background: Centers for Medicare and Medicaid Innovation Center sponsored the initiative to reduce avoidable hospitalizations among nursing facility residents. Purpose: Missouri Quality Initiative (MOQI) designed inter-professional model in nursing homes with advanced practice registered nurses (APRNs). Method: MOQI APRN...

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An integrated review of research using clinical decision support to improve advanced directive documentation

Published On: 08-01-2017

Written By: Folarinde, B. & Alexander, G.L.

The Patient Self-determination Act requires that health care institutions inform patients of their right to make health care preferences known through advance directives. However, actual advance directive documentation remains low. This study’s purpose is to identify and analyze research...

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The APRN role in changing nursing home quality: The Missouri Quality Improvement Initiative

Published On: 07-01-2017

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

The Centers for Medicare & Medicaid Innovations Centers partnered with 7 Enhanced Care and Coordination Provider (ECCP) sites across the United States with the goal to reduce potentially avoidable hospital transfers for nursing home residents. The University of Missouri Sinclair...

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Analysis of advance directive documentation to support palliative care activities in nursing homes

Published On: 11-20-2016

Written By: Galambos, C., Starr, J., Rantz, M., & Petroski, G.

As part of an intervention to improve health care in nursing homes with the goal of reducing potentially avoidable hospital admissions, 1,877 resident records were reviewed for advance directive (AD) documentation. At the initial phases of the intervention, 50...

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Exploring health information exchange implementation using qualitative assessments of nursing home leaders

Published On: 09-01-2016

Written By: Alexander, G., Popejoy, L., Lyons, V., Shumate, S., Mueller, J., Galambos, C., Vogelsmeier, A., Rantz, M., & Flesner, M.

Objectives: Limited research exists on nursing home information technologies, such as health information exchange (HIE) systems. Capturing the experiences of early HIE adopters provides vital information about how these systems are used. In this study, we conduct a secondary...

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Development and implementation of the advanced practice nurse worldwide with an interest in geriatric care

Published On: 09-01-2016

Written By: Fougère, B., Morley, J.E., Decavela, F., Nourhashémi, F., Abele, P., Resnick, B., Rantz, M., Kam Yuk Lai, C., Moyle, W., Pédra, M., Chicoulaa, B., Escourrou, E., Oustric, S., & Vellas, B.

Many countries are seeking to improve health care delivery by reviewing the roles of health professionals, including nurses. Developing new and more advanced roles for nurses could improve access to care in the face of a limited or diminishing...

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Aging in Place: Critical for Seniors to Remain Independent

Published On: 05-25-2016

Written By: Rice, Sheena

EXPERT AVAILABLE: Aging in Place Critical for Seniors to Remain Independent MU Professor Marilyn Rantz credits advanced nurses, technology and coordinated care as means for improving patient care and lowering health care costs COLUMBIA, Mo. – Quality of care...

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Better care, better quality: reducing avoidable hospitalizations of nursing home residents

Published On: 10-01-2015

Written By: Rantz, M.J., Flesner, M.K., Franklin, J., Galambos, C., Pudlowski, J., Pritchett, A., Alexander, G., & Lueckenotte, A.

The MOQI Intervention Model illustrates the key components of the intervention. An APRN guides the intervention delivering care to the residents and training the facility staff to improve their skills. An MOQI intervention team assists with medical care, care...

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Are older persons willing to accept and use amplifiers to better understand speech?

Published On: 07-01-2015

Written By: Lane, K., Rantz, M., Rawn, C., & Bien, A.

Hearing loss, the partial or total inability to perceive sound (Bance, 2007), is the third leading chronic illness in older adults, exceeded only by hypertension and arthritis (Hannula, 2011). In nursing homes, the prevalence of hearing loss is staggering, with reports...

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Preparing nursing homes for the future of health information exchange

Published On: 04-15-2015

Written By: Alexander, G.L., Rantz, M., Galambos, C. Vogelsmeier, A., Flesner, M., Popejoy, L.L., Mueller, J., Shumate, S., & Elvin, M.

Objective: Our purpose was to describe how we prepared 16 nursing homes (NHs) for health information exchange (HIE) implementation. Background: NH HIE connecting internal and external stakeholders are in their infancy. U.S. initiatives are demonstrating HIE use to increase...

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

Published On: 04-01-2015

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....

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Staff perceptions of social work student contributions to home health care services at an independent living facility

Published On: 04-01-2015

Written By: Galambos, C., Starr, J., Musterman, K., & Rantz, M.

This exploratory qualitative study examined staff perceptions of social work student contributions to client services, family and client communication, and staff workload in an independent living setting for older adults. Ten employees who had contact with the students, clients...

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Certified nurse aide scope of practice

Published On: 01-01-2015

Written By: Siem, C. & Rantz, M.

Editorial Siem, C. & Rantz, M. (2015). Certified nurse aide scope of practice. Journal of the American Medical Directors Association, 16(1), 6.

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Health Outcomes Improved in States Where Nurse Practitioners Independently Provide Primary Care (video)

Published On: 11-01-2014

Written By: Oliver, G.M., Pennington, L., Revelle, S., & Rantz, M.

Click here for the video! As America’s population ages, life spans lengthen and more individuals enroll in insurance plans under the Affordable Care Act, the need for health care professionals will increase. The Association of American Medical Colleges estimates...

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Impact of nurse practitioners on health outcomes of Medicare and Medicaid patients

Published On: 11-01-2014

Written By: Oliver, G.M., Pennington, L., Revelle, S., & Rantz, M.

Strengthening healthcare overall is essential to the health of our nation and promoting access to healthcare as well as controlling healthcare costs in a quality cost-effective manner. Nurse practitioners have demonstrated in prior research to be effective and cost-effective...

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QIPMO Video

Published On: 06-19-2014

Written By: Strata Commun

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

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

Published On: 02-04-2014

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...

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

Published On: 02-04-2014

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...

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Systematic review of studies of staffing and quality in nursing homes

Published On: 02-04-2014

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...

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

Published On: 01-22-2013

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...

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The influence of teams to sustain quality improvement in nursing homes that “need improvement”

Published On: 01-01-2013

Written By: Rantz, M.J., Zwygart-Stauffacher, M., Flesner, M., Hicks, L., Mehr, D., Russell, T., & Minner, D.

Objectives: Qualitatively describe the use of team and group processes in intervention facilities participating in a study targeted to improve quality of care in nursing homes “in need of improvement.” Design/setting/participants: A randomized, two-group, repeated-measures design was used to...

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Challenges of using quality improvement methods in nursing homes that “need improvement”

Published On: 10-01-2012

Written By: Rantz, M.J., Zwygart-Stauffacher, M., Flesner, M., Hicks, L., Mehr, D., Russell, T., & Minner, D.

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...

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Randomized multilevel intervention to improve outcomes of residents in nursing homes in need of improvement

Published On: 01-01-2012

Written By: Rantz, M.J., Zwygart-Stauffacher, M., Hicks, L., Mehr, D., Flesner, M., Petroski, G.F., Madsen, R.W., & Scott-Cawiezell, J.

Objectives: A comprehensive multilevel intervention was tested to build organizational capacity to create and sustain improvement in quality of care and subsequently improve resident outcomes in nursing homes in need of improvement. Design/Setting/Participants: Intervention facilities (N ¼ 29) received...

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

Published On: 12-01-2010

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...

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

Published On: 09-01-2010

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...

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

Published On: 07-16-2010

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...

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

Published On: 01-01-2010

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...

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Care Improvement Program Saves Nursing Homes Millions

Published On: 05-14-2009

Written By: Medical News Today

Marilyn Rantz, professor in the MU Sinclair School of Nursing completed a three-year analysis of the Quality Improvement Program of Missouri (QIPMO) and found significant improvements in overall care quality of residents in participating facilities. Care Improvement Program Saves...

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Improvements in Missouri Nursing Homes Using QIPMO Services

Published On: 07-01-2008

Written By: Interdisciplinary Center on Aging

Improvements in Missouri Nursing Homes Using QIPMO Services – Interdisciplinary Center on Aging (2008) The Quality Improvement Program for Missouri (QIPMO) is a cooperative service of the University of Missouri Sinclair School of Nursing and the Missouri Department of Health...

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

Published On: 01-01-2008

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...

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

Published On: 07-01-2007

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...

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

Published On: 01-01-2007

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...

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Entrepreneurial program of research and service to improve nursing home care

Published On: 12-01-2006

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

This is a methodological article intended to demonstrate the integration of multiple goals, multiple projects with diverse foci, and multiple funding sources to develop an entrepreneurial program of research and service to directly affect and improve the quality of...

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

Published On: 04-01-2006

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...

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Field testing, refinement and psychometric evaluation of a new measure of nursing home care quality

Published On: 02-17-2006

Written By: Rantz, M., Zwygart-Stauffacher, M., Mehr, D., Petroski, G., Owen, S., & Madsen, R

The primary aim of this NINR-NIH-funded field test in 407 nursing homes in 3 states was to complete the development of and conduct psychometric testing for the Observable Indicators of Nursing Home Care Quality Instrument (Observable Indicators, OIQ). The...

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

Published On: 10-01-2005

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...

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

Published On: 09-01-2005

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...

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Preparation of nurse leaders in the 21st century workplace

Published On: 08-01-2005

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...

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Prevalence and characteristics of nursing home residents needing light-care

Published On: 06-01-2005

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...

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Nursing home costs and quality of care outcomes

Published On: 07-01-2004

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...

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

Published On: 04-01-2004

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.

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Nursing home quality and pressure ulcer prevention and management strategies

Published On: 04-01-2004

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...

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

Published On: 02-01-2004

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...

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

Published On: 02-01-2004

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...

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Quality concerns in assisted living facilities

Published On: 01-01-2004

Written By: Aud, M.A. & Rantz, M.J.

Aud, M.A. & Rantz, M.J. (2004). Quality concerns in assisted living facilities. Journal of Nursing Care Quality, 19(1), 8-9.

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Stability and sensitivity of nursing home quality indicators

Published On: 01-01-2004

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...

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

Published On: 01-01-2004

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...

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

Published On: 11-01-2003

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...

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

Published On: 09-01-2003

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...

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

Published On: 04-01-2003

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),...

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A statewide strategy to improve quality of care in nursing facilities

Published On: 04-01-2003

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...

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Hospice and non-hospice nursing home residents

Published On: 01-01-2003

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...

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

Published On: 01-01-2003

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...

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International field test results of the observable indicators of nursing home care quality instrument

Published On: 12-01-2002

Written By: Rantz, M., Jensdóttir, A.B., Hjaltadóttir, I., Gudmundsdòttir, H., Sigurveig Gudjónsdóttir, J., Brunton, B., & Rook, M

Researchers at the University of Missouri-Columbia developed the Observable Indicators of Nursing Home Care Quality instrument to measure the dimensions of nursing home care quality during a brief on-site visit to a nursing home. The instrument has been translated...

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Randomized clinical trial of a quality improvement intervention in nursing homes

Published On: 08-01-2001

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

Purpose: The purpose of the study was to determine if simply providing nursing facilities with comparative quality performance information and education about quality improvement would improve clinical practices and subsequently improve resident outcomes, or if a stronger intervention, expert clinical...

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

Published On: 04-01-2000

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 (QI) 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...

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

Published On: 04-01-2000

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...

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

Published On: 04-01-2000

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...

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

Published On: 06-01-1999

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...

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Nursing Home Care Quality: A Multidimensional Theoretical Model

Published On: 02-01-1998

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

This exploratory study was undertaken to discover the defining dimensions of nursing home care quality and to propose a conceptual model to guide nursing home quality research and the development of instruments to measure nursing home care quality. Three...

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

Published On: 12-01-1997

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...

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

Published On: 12-01-1997

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...

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

Published On: 11-01-1997

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...

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Assessing contributors to cost of care in nursing homes

Published On: 07-01-1997

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....

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Assessing quality of nursing home care: The foundation for improving resident outcomes

Published On: 07-01-1996

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

Efforts to improve the quality of care and outcomes for nursing home residents are constantly of concern to state and federal regulators, nursing home providers, nursing home advocacy groups, and health policy researchers. The article describes a study that...

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Quality measurement in nursing: Where are we now?

Published On: 09-01-1995

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....

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Quality assurance: Guaranteeing a high level of care

Published On: 08-01-1989

Written By: Rantz, M. J. & Miller, T. V.

Smeltzer defines quality assurance as a means for the nursing profession to assure the patient of a specified degree of excellence of nursing care by continuously, objectively measuring the structural, procedural, and outcome components of nursing against pre-established criteria...

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