Preventing falls is a top priority in nursing homes, as they often lead to injuries and loss of function and independence. To understand when and why falls happen is key, and validated process measures that correlate with patient outcomes are needed for research and quality improvement. A study in the May issue of the Journal of Post-Acute and Long-Term Care Medicine (JAMDA) shows that clinical vignettes completed by nursing home staff have a greater association with resident recurrent fall rates than traditional chart abstraction process measures and may be useful in quality improvement efforts.

In “Resident Vignettes for Assessing Care Quality in Nursing Homes,” the authors, including Associate Dean for Research Ruth Anderson, PhD, RN, FAAN, compared traditional resident chart abstractions with vignettes to assess fall rates for quality improvement purposes. Staff were asked to complete 2 clinical vignettes before and right after a falls quality improvement intervention, for a maximum of 4 vignettes over 3 months. Vignettes were derived from resident stories constructed by demographic characteristics and the presence or absence of fall-related risk factors, such as prior falls. The authors found that 2 of 4 fall prevention process measures assessed by clinical vignettes, specifically environmental modification and comorbidity management, explained 7-10 percent of the variation in resident- and facility-level recurrent fall rates.

Anderson and her co-authors concluded that clinical vignettes offer a promising alternative to chart abstraction for measuring nursing home quality. Not only were they acceptable to staff, but they were simple to administer and analyze. Conversely, chart abstraction was time-consuming and required considerable resources. Additionally, the vignettes use standardized patient examples, thus eliminating the need to adjust for different risk factors that are necessary for chart abstraction. The authors suggest that vignettes may be especially cost-effective for complex conditions that require multiple process measures and case-mix adjustment.

Further study is needed, the authors conclude. They say, “It would be useful to determine whether vignette measures can distinguish differences in care quality between nursing units within the same facility so that quality improvement efforts can be targeted to those with lowerperformance.” Nonetheless, they note, “We conclude that clinical vignettes completed by nursing home staff were more feasible…than traditional chart abstraction process measures.”

The study was conducted by researchers at the Duke University School of Medicine.

For more information on the findings above and more details about the study, click here. To contact the researchers or JAMDA Editor for interview contact lsharp@paltc.org.

AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PA/LTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more information.

This study was funded by 5R01NR003178-13. CCE is funded in part by 2P30AG028716-06 and K24 AG049077-01A1.

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