Objectives: A comprehensive multilevel intervention was tested to build organizational capacity to create and sustain improvement in quality of care and subsequently improve resident outcomes in nursing homes in need of improvement.

Design/Setting/Participants: Intervention facilities (N ¼ 29) received a 2-year multilevel intervention with monthly on-site consultation from expert nurses with graduate education in gerontological nursing. Attention control facilities (N ¼ 29) that also needed to improve resident outcomes received monthly information about aging and physical assessment of elders.

Intervention: The authors conducted a randomized clinical trial of nursing homes in need of improving resident outcomes of bladder and bowel incontinence, weight loss, pressure ulcers, and decline in activities of daily living. It was hypothesized that following the intervention, experimental facilities would have higher quality of care, better resident outcomes, more organizational attributes of improved working conditions than control facilities, higher staff retention, similar staffing and staff mix, and lower total and direct care costs.

Rantz, M.J., Zwygart-Stauffacher, M., Hicks, L., Mehr, D., Flesner, M., Petroski, G.F., Madsen, R.W., & Scott-Cawiezell, J. (2012). Randomized multilevel intervention to improve outcomes of residents in nursing homes in need of improvementJournal of the American Medical Directors Association, 13(1), 60-68.