The Use of Data for Process and Quality Improvement in Long-Term Care and Home Care: A Systematic Review of the Literature Anne E. Sales, PhD, RN, Anne-Marie Bostrom, PhD, Tracey Bucknall, PhD, RN, Kellie Draper, BSc, Kimberly Fraser, PhD, RN, Corinne Schalm, MSG, MPA, FCCHSE, and Sharon Warren, PhD Background: Standardized resident or client assess- ments, including the Resident Assessment Instrument (RAI), have been available in long-term care and home care settings (continuing care sector) in many jurisdictions for a number of years. Although using these data can make quality improvement activities more efficient and less costly, there has not been a re- view of the literature reporting quality improvement interventions using standardized data. Objectives: To address 2 questions: (1) How have RAI and other standardized data been used in process or quality improvement activities in the continuing care sector? and (2) Has the use of RAI and similar data re- sulted in improvements to resident or other outcomes? Data sources: Searches using a combination of key- word and controlled vocabulary term searches were conducted in MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, the Cochrane Library, and PsychINFO. Eligibility criteria, participants, and interventions: En- glish language publications from database inception to October 2008 were included. Eligibility criteria in- cluded the following: (1) set in continuing care (long-term care facility or home care), (2) involved some form of intervention designed to improve qual- ity or process of care, and (3) used standardized data in the quality or process improvement intervention. Study appraisal and synthesis methods: After review- ing the articles, we grouped the studies according to the type of intervention used to initiate process im- provement. Four different intervention types were identified. We organized the results and discussion by these 4 intervention types. Results: Key word searches identified 713 articles, of which we excluded 639 on abstract review because they did not meet inclusion criteria. A further 50 arti- cles were excluded on full-text review, leaving a total of 24 articles. Of the 24 studies, 10 used a defined process improvement model, 8 used a combination of interventions (multimodal), 5 implemented new guidelines or protocols, and 1 used an education intervention. Conclusions/Implications: The most frequently cited issues contributing to unsuccessful quality improve- ment interventions were lack of staff, high staff turn- over, and limited time available to train staff in ways that would improve client care. Innovative strategies and supporting research are required to determine how to intervene successfully to improve quality in these settings characterized by low staffing levels and predominantly nonprofessional staff. Research on how to effectively enable practitioners to use data to improve quality of care, and ultimately qual- ity of life, needs to be a priority. (J Am Med Dir Assoc 2011; -: -–-) Key words: Long-term care; quality improvement; process improvement; systematic review; standard- ized data Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada (A.E.S., A.–M.B., K.D., K.F.); Deakin University, Melbourne, Victoria, Australia (T.B.); Shepherd’s Care Foundation, Edmonton, Alberta, Canada (C.S.); Fac- ulty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (S.W.). Funding for this project was provided by the Canadian Health Services Re- search Foundation, and the Alberta Heritage Foundation for Medical Re- search. Neither funder had a role in this review. Dr. Bostrom was funded through a post-doctoral fellowship from the Alberta Heritage Foundation for Medical Research and the Canadian Institutes for Health Research. Address correspondence to Anne Sales, PhD, RN, Faculty of Nursing, Univer- sity of Alberta, 6–10 University Terrace, Edmonton, AB T6G 2T4, Canada. E-mail: anne.sales@ualberta.ca Copyright Ó2011 American Medical Directors Association DOI:10.1016/j.jamda.2011.01.004 REVIEW Sales et al 1