Skip to main content

Quality Improvement


Warshaw G. Quality improvement. Annals of Long-Term Care: Clinical Care and Aging. 2013;21(7):8.


Gregg Warshaw, MD; Medical Editor

Historically, nursing homes have had a reputation of being bleak places that provide poor care, but recent legislation is incentivizing good care across care settings by tying compensation to specific clinical benchmarks via pay-for-performance programs. Medicare, Medicaid, and private insurers are all adopting such programs, with some insurers mandating the implementation of quality improvement projects (QIPs). For example, Medicare Advantage organizations must conduct at least one QIP for all non-special needs coordinated care plans offered under a contract.

As healthcare systems continue to move toward incentivized, pay-for-performance models, which increase facility and provider accountability, quality improvement is playing a greater role in the future of nursing home care. To participate in these new models of care and meet the requirements of integrated delivery systems, many nursing homes are encouraging QIPs to improve health outcomes and beneficiary satisfaction at their facilities. However, two major hurdles for facilities have been prioritizing problems to address and finding creative solutions to improve care outcomes. When solutions are found, or even if they fail, there are few venues for sharing the insights gleaned with other facilities.

To address this issue, Annals of Long-Term Care: Clinical Care and Aging® (ALTC) is launching a new Quality Improvement department. The goal of this department is to provide an information-sharing outlet with regard to QIPs. Our hope is that having such a forum will help facilities better identify and develop successful QIPs of their own.

Our first article regarding quality improvement is a Practical Research report titled “A State-Sponsored Approach to Quality Improvement in Nursing Homes: Insights From Providers." In this article, the authors describe the perceptions and concerns of Minnesota nursing home providers who participated in state-sponsored QIPs. The authors found that most QIP participants perceived their projects as positively influencing care, not only in the area that the project specifically targeted, but in other domains as well. They also noted that there are several action items that organizations can address to successfully carry out QIPs, including enlisting top leadership support, increasing staff confidence to participate in QIPs, and thinking broadly when calculating the return on investment for a particular QIP. As the authors note, the goal of a QIP should be to devise strategies that are sustainable at any facility and in any state.

Our second article, “Leadership Collaborative Education Intervention to Enhance the Quality of End-of-Life Care in Nursing Homes: The IMPRESS Project”, launches our Quality Improvement department. In this article, the authors discuss the results of their educational intervention, which included staff from five remotely located nursing homes on the Hawaiian island of Oahu. The staff met quarterly over a 10-month period, during which they received education on evidence-based strategies and tools to improve end-of-life care. A key point is that the tools provided to staff included existing educational resources from local providers and national organizations, which saved the facilities the time and resources that would have been required to develop their own materials. The authors found that these educational sessions resulted in statistically significant changes in the implementation of strategies to improve end-of-life care.

Finally, you will find a Case Report titled “A Case of Purple Urine Bag Syndrome in an Elderly Woman”, which describes the case of an atypical presentation of this rare finding in a nursing home resident, and a Perspectives article, “Visiting Germany in the Winter”, which provides an example of how storytelling can help elderly persons recall notable events of their past and build relationships among old and young physicians when the patient is also a physician.

We welcome your thoughts on the articles in this issue of ALTC. Responses can be sent to our associate editor, Allison Musante, at

If you are involved in a QIP project at your facility, we encourage you to submit an article about your project to our new Quality Improvement department. For more information on article submissions, please refer to our Author Guidelines.

Thank you for reading!

Back to Top