Resident Vignettes for Assessing Care Quality in Nursing Homes.
Cathleen S Colón-Emeric, Kirsten N Corazzini, Eleanor S McConnell and 9 others
PMID 29174560WHAT IT FOUND
In 16 nursing homes, staff vignettes about fall prevention matched resident recurrent falls better than chart checks, especially environmental changes and comorbidity management.
They may offer a quicker quality measure, but not all fall care areas worked.
Key findings
01Vignette measures for environmental modification and comorbidity management explained 7-10% of variation in recurrent fall rates, compared with 2-6% for chart abstraction.
02Combining all vignette measures explained 3.9% of variation in fall outcomes, while combining all chart abstraction measures explained 0%.
03Responses from unlicensed staff explained 8.3% of variance for environmental modification and 8.9% for comorbidity management.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
Only 16 nursing homes were studied, all in one geographic region, so the results may not apply to other facilities. The study could not test whether vignette scores improve when fall care improves, because fall rates did not change after the quality improvement program. The study could not be confident the relationships between chart abstraction and vignettes were not due to chance because only 16 facilities were studied. Medical and pharmacy providers were not included, although they can influence fall prevention activities such as medication reduction. Staff role strongly affected vignette responses, so results depend on who completes the measure. Participation varied widely between facilities, from 29.3% to 70.2% of eligible staff. Not all fall prevention process measures were associated with fall rates, including psychoactive medication reduction and exercise/rehabilitation.
Declared interests
The supplied text lists NIH extramural research support. No author conflicts of interest are stated in the supplied text.
The easy way to misread this
Do not conclude that clinical vignettes are proven to improve fall prevention or that they can replace chart abstraction. The study found only associations, it could not rule out chance for the relationships between chart abstraction and vignettes, and it could not test whether vignette scores changed when fall rates changed.