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 Study hypotheses are presented schematically in Figure 1. This figure is not intended to contemplate all possible relationships among study variables, but rather the relationships that are the focus of the present study, with QI implementation being the central variable. In testing these hypotheses, we focused on a single clinical outcome as a general indicator of quality of care, pressure ulcer development. Pressure ulcers are common in nursing homes, are associated with considerable morbidity and mortality, and are often preventable through the provision of appropriate interventions that require the coordinated care efforts of multiple providers (Berlowitz and Wilking 1993). Best practices related to pressure ulcer care have been widely disseminated through clinical practice guidelines published by the Agency for Healthcare Research and Quality (AHRQ formerly Agency for Health Care Policy and Research) (Panel for the Prediction and Prevention of Pressure Ulcers in Adults 1992). There is a general consensus that pressure ulcers are related to quality of care, and those nursing homes with high rates of pressure ulcer development may be more likely to have problems with other quality measures and with deficiency citations during state inspections (Rudman et al. 1993; Mukamel 1997). Moreover, information on pressure ulcer development is available from VA databases, and risk-adjustment models for this outcome have been developed and extensively tested (Berlowitz et al. 1996; Berlowitz, Young, Brandeis et al. 2001). Thus, pressure ulcers may be an ideal measure in assessing nursing home quality. Interventions: The 11-item Asthma Symptom Utility Index (ASUI). This Note discusses the causes of recent growth in nursing home litigation and its effects on nursing home residents, providers and government. Specific attention is devoted to Florida for demographic and legislative reasons. Complementing its large elderly population, Florida has one of the broadest private rights of action for nursing home residents. Consequently, other states use Florida''s statute as a model.(11) Part II of this Note examines the national nursing home environment, reflecting on the status of the industry and relevant legislation. Part III explores current federal nursing home legislation and discusses recent reform efforts. Part IV examines Florida''s nursing home industry and raises concern about particular state legislation widening nursing home liability. Through its residents'' rights statute, Florida has witnessed a tremendous growth in nursing home litigation and corresponding jury verdicts. Part V describes the actual and potential effects of Florida''s rapid growth in nursing home litigation on providers and residents. Part VI discusses the state''s reform efforts and powerful political lobbies'' countermeasures. Finally, Part VII suggests possible state regulation reforms to preserve the industry before excessive private litigation reaches devastating levels. With Doctor-Finder.biz you can find and compare docotor's in your area! Check it out!
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