Quality Improvement in Nursing Homes: A Call to Action

Are you involved in quality improvement? As a medical director, primary care clinician, or other health professional working in a nursing home, you should be. If you are not, it is time to act. If you are, it is time to expand your activities and make it a priority for your work in the nursing home. Quality improvement initiatives improve patient outcomes and can result in substantial cost avoidance to both long-term care facilities and society. A supplement to this issue of the Journal of the American Medical Directors Association (JAMDA) provides medical directors and other professionals active in nursing homes an overview of quality improvement, as well as strategies, tools, and processes for improving the quality of care for several key clinical conditions frequently encountered in the nursing home population. Its content, useful to the novice as well as the very experienced professional, is based on presentations made at the annual meeting of AMDA’s New York chapter in November 2006. Drs. Dan Osterweil and Len Gelman should be thanked for their foresight in planning the meeting and the supplement based on it. Providing high-quality nursing home care presents considerable challenges. In no other setting do health professionals face such complex medical problems, intertwined with psychosocial issues and family dynamics, often unrealistic expectations of residents and families, high work force turnover, stringent fiscal constraints, a frequently adversarial regulatory process, and heightened legal liability. Despite these challenges, many nursing homes provide excellent care. Nevertheless, the geriatrics and gerontology literature and reports