Continuous quality improvement in nursing homes: Public relations or a reality?

A primary characteristic that differentiates CQI from quality assurance is CQI's focus on care process measurement and analysis as opposed to outcome measurement. Current efforts in nursing homes to improve quality primarily use a quality assurance approach in that the emphasis is on outcome measurement; attention is paid to care process measures only after poor outcomes have been detected. Furthermore, even if providers were intent on monitoring process quality in keeping with recommended CQI methods, poor systems are in place to do so. The solutions to these problems are obvious. To achieve true CQI in nursing homes, data about care process implementation that is used primarily for improvement purposes rather than regulatory compliance is needed. It is doubtful that the traditional practice of monitoring care through staff self-reports will generate data useful for quality improvement even if such monitoring is done electronically and protected from regulatory review. Data collected using reliable and valid direct observational protocols are necessary for effective CQI. There is a need to develop more protocols similar to those described in this Journal if CQI is to become a reality rather than an empty program label. © 2007 American Medical Directors Association.