State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. QMWeb/Development of Best Practices


QMWeb is an internet site ( is a training resource of evidence-based practices meant to help long-term care facilities to be able to "do the right thing in the right way at the right time for the right person in order to achieve the best possible outcome."11 The state's goal is to help facilities "achieve optimal resident outcomes through the consistent application of evidence-based resident care planning and care practices." QMWeb presents information to help facilities achieve that goal with respect to selected issues in nursing home care.

QMWeb includes the following:

  • Selected presentations from DHS provider trainings.

  • Clinical literature reviews: There are comprehensive literature reviews for Restraint Use in Long-Term Care, Medical Direction and Staff Bylaws in Long-Term Care, The Role and Implementation of Ethics Committees in Long-Term Care Facilities, Interventions for Behavioral Symptoms in the Cognitively Impaired, and Congestive Heart Failure in Elderly Nursing Home Residents.

  • Calendar listings for long-term care educational events, including those sponsored by DHS and those sponsored by other organizations that requested that information be included on QMWeb.

  • E-mail addresses and phone numbers for key staff in the state's Medical Quality Assurance department.

  • A list of the top ten deficiencies in Texas nursing and assisted living facilities.

  • Quality Matter alerts (e.g., recommendations to nursing facilities concerning the West Nile Virus.)

  • A set of problem-oriented best practices that address topics such as end-of-life care, medical futility, ethics committees, group disparities in health outcomes (e.g., based on age, race, or gender), restraint reduction, palliative care, and tube feeding. For each of these topics, bibliographies of relevant clinical literature and links to external web resources are provided.

  • Web links to government agencies, clinical professionals, online journals, patient and family resources, and problem-oriented resources.

  • Selected presentations from DHS provider trainings, including written materials and streaming media.

  • A report that describes the pilot test of an innovative quality improvement project.

  • Several White Papers that were prepared by DHS staff related to long-term or other health care issues.

Information is prepared by DHS staff and subjected to outside peer review before publication. The web site is evolving as more information is assembled. At present, it includes substantial information on topics that are the current focus of the Quality Monitor Program such as incontinence care and restraint use.

One example of the way in which the website provides information for providers is the "resident-centered evaluation and care planning for restraint-free environments" section. This provides background information on the use of restraints in Texas from the 2000 Statewide Assessment, links to resources regarding approaches to reducing restraint use, information regarding best practices regarding restraint use derived from a detailed review of the literature, and a copy of the structured assessment form used in the Quality Monitor Program to assess appropriate restraint use in facilities. As explained above, Texas commissioned a detailed review of the literature in order to develop an evidence-based best practice protocol regarding restraint use (similar efforts are underway or planned regarding other care practices for which no evidence-based best practice guidelines exist). QMWeb contains a 23-page summary of key empirical studies and a 36-minute online streaming media presentation in which Dr. Cortes discusses the literature review and development of the best practice protocol regarding restraint use.

QMWeb is managed in-house as part of the regular duties of DHS staff and is not a separate budget line item. Appendix D and Appendix Eshow some of the information that is available through QM web--Appendix D shows the state's Problem Oriented Best Practices and Appendix E shows the state's conference calendar.

11. Source: QM web site (

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®