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Enhancing Quality Improvement Adoption in US Nursing Homes

This report summarizes the research findings from the Institute for Healthcare Improvement's 90-day innovation project to identify key activities to increase adoption of effective quality improvement practices in US nursing homes.

Highlights

  • Driver diagram representing the initial theory of change for factors that drive adoption of QI in nursing homes
  • Research findings: Existing Quality Assurance and Performance Improvement regulations and daily quality management; leadership and culture attributes; developing staff, building community, and emphasizing why QI matters; and health policy impact
  • Recommendations intended to serve as guidance to organizations seeking to work with nursing homes to improve quality

Johnson M, Renton M. Enhancing Quality Improvement Adoption in US Nursing Homes. Boston: Institute for Healthcare Improvement; 2023. (Available at ihi.org)

The COVID-19 pandemic exacerbated and illuminated quality failings in nursing homes, persistent equity issues, and the system- and policy-level factors that contribute to their endurance. To begin seeking ways to address these issues, the Institute for Healthcare Improvement (IHI) conducted a 90-day innovation project to identify key activities to increase adoption of effective quality improvement practices in US nursing homes.

To inform the work, IHI conducted a literature scan focused on quality improvement in US nursing homes and the Quality Assurance and Performance Improvement (QAPI) program; 20+ expert interviews; and a site visit to one high-performing nursing home.

This report summarizes the research findings and presents some recommendations for organizations seeking to work with nursing homes to improve quality.

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