State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. 4.2 Best Practice Dissemination Programs


As discussed in section 3.2, study states varied in terms of what each described and promoted as "best practices" and how these practices are incorporated into their quality improvement/technical assistance programs. In addition to best practice dissemination through the TA program, many of the study states also initiated additional activities to recognize and disseminate information about best practices in nursing homes in their state.

  • The state of Missouri has a best practices program, that is separate from its quality improvement/technical assistance program, and is implemented by Central Missouri State University. A statewide committee, comprised of provider representatives and Ombudsmen, reviews applications from facilities that believe they offer a "best practice" program. The committee selects those facilities that meet certain criteria. The facilities and their practices that are selected are published and disseminated by the University.

  • Maine disseminates best practices developed by experts as well as those developed at the facility level through a series of educational workshops for facilities mandated by the legislature. In one day long workshop, for example, an expert LTC surveyor educated participants on the current regulations in the morning session, and a panel of facility representatives discussed their innovative ideas in the afternoon session. Ideas were solicited from every facility in the state on the clinical topic area chosen for the session. Nursing home providers praised the program as providing a regulatory update, and providing "real-life examples" through facility participation.

  • In Iowa, facilities are encouraged to share best practices with the survey agency during the annual certification process. The state survey agency reviews facility-advanced practices and acceptance of a best practice leads to its posting on the website--there were over 300 postings. Although facilities were pleased with any positive recognition, several concerns were noted. Some critics felt the practices posted do not always represent exemplary care. Consumer advocates were fearful that the posting of a best practice gives the impression that the facility is performing well in all care areas on a consistent basis. And some in the state do not approve of regulatory agency involvement, however limited, in the recognition and approval process--saying it brings the regulatory agency too close to entities they are supposed to be regulating. In response to several instances where facilities recognized for a best practice were later involved in compliance problems, the state has changed the emphasis of its Best Practice program to recognize facility practice, not the facility itself.

  • Texas has developed an internet site, QMWeb, that contains the best practice protocols used in the TA program and links to other sources of information to help practitioners improve the quality of nursing home care and better understand key elements of the TA program. Every best practice included on the website has been submitted to one or more clinical peer reviewers for comment. Topics are grouped as ethical issues, geriatric syndromes, organization and administrative practices, prescribing practices, and preventive practices. The website includes detailed background information on best practice topics, resident assessment/evaluation guides, step-by-step guides for care implementation, listings of state and federal licensure and certification tags, on-line presentations for viewing, additional resources and an extensive bibliography. For example, the "resident-centered evaluation and care planning for restraint-free environments" section provides background information on the use of restraints in Texas from the 2000 Statewide Assessment, links to resources regarding approaches to reducing restraint use, and information regarding best practices regarding restraint use derived from a detailed review of the literature. It also contains a copy of the structured assessment form used in the Quality Monitor Program to assess appropriate restraint use in facilities as well as a 23 page summary of key empirical studies and a 36 minute online streaming media presentation in which the literature review and development of the best practice protocol is discussed.

View full report


"statenh.pdf" (pdf, 822.35Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®