To improve nursing home quality, many states have developed "technical assistance programs" that provide on-site consultation and training for nursing facility staff. We conducted a national survey on these state programs to collect data on program design, operations, financing, and perceived effectiveness. As of 2010, 17 states had developed such programs. Compared to existing state nursing home quality regulations, these programs represent a collaborative, rather than enforcement-oriented, approach to quality. However, existing programs vary substantially in key structural features such as staffing patterns, funding levels, and relationship with state survey and certification agencies. Perceived effectiveness by program officials on quality was high, although few states have performed formal evaluations. Perceived barriers to program effectiveness included lack of appropriate staff and funding, among others. In conclusion, state technical assistance programs for nursing homes vary in program design and perceived effectiveness. Future comparative evaluations are needed to inform evidence-based quality initiatives.
"measuring quality of care in nursing home facilities, including difficulties for staff in understanding and interpreting the CMS quality measures and also in how to apply them for quality improvement (QI).  Li and colleagues  developed a program to provide onsite consultation and training to nursing home staff to improve compliance with federal and state regulations related to quality and also to improve nursing home clinical practice. In a national survey to examine the effectiveness of their program, they reported barriers to QI, including a lack of appropriate staff and funding to initiate and sustain the quality programs. "
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