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The Gerontologist 45:576-582 (2005)
© 2005 The Gerontological Society of America

Improving the Quality of Nursing Home Care and Medical-Record Accuracy With Direct Observational Technologies

John F. Schnelle, PhD1,2, Dan Osterweil, MD2 and Sandra F. Simmons, PhD2

Correspondence: Address correspondence to John F. Schnelle, PhD, University of California–Los Angeles, Department of Medicine, Division of Geriatrics, 7150 Tampa Avenue, Reseda, CA 91335. E-mail: jschnell{at}

Nursing home medical-record documentation of daily-care occurrence may be inaccurate, and information is not documented about important quality-of-life domains. The inadequacy of medical record data creates a barrier to improving care quality, because it supports an illusion of care consistent with regulations, which reduces the motivation and ability of providers to identify areas for improvement. Observational protocols designed for use by survey and quality-assurance staff can provide the independent information necessary for improving both medical record accuracy and residents' quality of life. Unfortunately, observational protocols currently used in survey and quality-assurance activities are not designed in a manner that is consistent with the scientific principles that guide observational measurement. The purpose of this article is to describe the steps to develop a standardized and scientifically defensible observational system to assess nursing home care quality.

Key Words: Observations • Nursing home quality assessment • Nursing home survey

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Copyright © 2005 by The Gerontological Society of America.