Article 1

Abstract

Christine Mueller, PhD, RN Associate Professor School of Nursing University of Minnesota HISTORICALLY, long-term care nursing facilities focused efforts to address the quality of care provided to residents by using the quality assurance (QA) model. This model tends to focus on structure components (e.g., presence of sprinkler systems, number of nursing staff) and process components (e.g., proper charting of medications), rather than outcomes (e.g., residents who remain continent; absence of pressure ulcers). A common strategy to evaluate quality was gathering data through retrospective chart reviews or observations. Often, these data did not translate into useful information, which otherwise could have been used to improve the quality of care and life for nursing home residents. In the more recent past, nursing facilities have been moving away from the QA model to a quality improvement model. This latter model has been a focus of Minnesota nursing facilities due, in part, to a demonstration project initiated in Minnesota by the Department of Human Services (DHS). The alternative payment system (APS) shifts the role of the DHS as a payer of long-term care services to a purchaser of long-term care services.