Informing standard development and understanding user needs with omaha system signs and symptoms text entries in community-based care settings.

The Omaha System is one of the most widely used standards for documentation in community-based settings. While researchers have focused upon this extensible classification scheme to understand and summarize structured data, few studies have analyzed the use of associated text. Two years of client records were accessed from two diverse sites utilizing the Omaha System 2005 revision: a skilled homecare, hospice, and palliative care program and a maternal child health home visiting program.

The ReACH Collaborative--improving quality home care.

Research on quality of care has shown that vigorous leadership, clear goals, and compatible incentive systems are critical factors in influencing successful change (Institute of Medicine, 2001). Quality improvement is a complex process, and clinical quality improvement applications are more likely to be effective in organizations that are ready for change and have strong leaders, who are committed to creating and reinforcing a work environment that supports quality goals (Shortell, 1998). Key leadership roles include providing clear and sustained direction, articulating a coherent set of values and incentives to guide group and individual activities, aligning and integrating improvement efforts into organizational priorities, obtaining or freeing up resources to implement improvement activities, and creating a culture of "continuous improvement" that encourages and rewards the pursuit and achievement of shared quality aims (Institute of Medicine, 2001, 70-71).