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Werner RM, Konetzka RT. Advancing nursing home quality through quality improvement itself. Health affairs (Project Hope). 2010 Jan 1; 29(1):81-6.
The traditional approaches to improving the quality of care at U.S. nursing homes--regulation, inspection, and accountability through public reporting--have produced modest results. Greater progress could be made by focusing incentives on broader processes related to improving quality. This could foster a culture of upstream identification and solving of problems that would supplement existing downstream requirements to meet specific safety and care standards.