The percentage of residents in the study nursing homes with complex problems such as incontinence, ADL decline, and worsening locomotion are consistent with other studies using nationally reported QMs. Residents with these kinds of complex issues are at greater risk for skin integrity problems and the development of pressure ulcers. Advocates for greater IT implementation in nursing home settings have indicated that improvements in quality, and thus QMs, could be realized with more highly sophisticated technologies that use clinical decision support, integrate portable computing devices, and maintain connections between internal and external stakeholders.
In the past, technology in nursing homes has been used primarily for administrative functions and less for resident care management and clinical support functions (Abbott & Brocht, 2001
). In this sample of nursing homes, more sophisticated technologies are being used in resident care management. These include technologies for reporting laboratory results, pharmaceutical management, and physician order entry. Furthermore, these kinds of technologies are not only being implemented more often; they are also being integrated more often across other external and internal entities, as reflected in the score for the resident care management integrated subscale.
Technologies used in clinical support functions, such as information systems incorporating physical therapy or occupational therapy notes, increased use of wireless communication devices, and technologies for incident reporting, are less common in these facilities. However, our research indicates there is evidence that clinical support technologies are beginning to be used to a greater extent to support resident care.
Attempting to correlate IT sophistication with improved quality is important, to determine whether IT implementation provides clinical benefits to residents. In this study's homes, greater IT sophistication was related to improved detection of ADL decline in residents across all but one of the IT sophistication sub-scales. The strongest relationships between IT sophistication score and ADL QMs existed when technologies were used for resident care management and clinical support.
Additionally, greater IT sophistication in the clinical support domain appears to be negatively related to the detection of residents with incontinence. Both of these relationships make intuitive sense. Sophisticated technologies that enable more complete documentation by all disciplines involved in resident care also provide better communication across disciplines so that ADL decline is detected and documented more frequently, potentially raising awareness of ADL decline in facilities. Similarly, as more staff, including certified nursing assistants, are integrated into documentation systems, findings of incontinence will more than likely negatively affect the QM because of increased recordings of residents experiencing incontinence. However, better documentation should lead to earlier interventions and decreased risk of altered skin integrity for residents.