Reducing Pain For Nursing Home Residents: Facilities Working Closely With QIOs Show Largest Gains

Washington, D.C. — Data released today by the Centers for Medicare & Medicaid Services ( CMS ) shows that Medicare’s Nursing Home Quality Initiative (NHQI) is paying off for residents of long-term care facilities across the nation.

The data shows that the two-year old initiative has improved chronic pain management in nursing homes in every state. The 2,500 nursing homes that worked closely with Quality Improvement Organizations (QIOs) showed even greater improvement on pain control and in reducing the use of physical restraints. Multi-facility nursing home chains that worked with QIOs in a related initiative also made significant progress in the treatment of resident pain.

The initiative combines public reporting on quality of care by all Medicare and Medicaid certified nursing homes with assistance to nursing homes from QIOs working under contract to CMS . The initiative is intended to complement Medicare’s program of enforcing standards of care in nursing homes. Since launch of the initiative, QIOs have provided all nursing homes in the country with guidance on improving care and worked intensively with 10% to 15% of the homes in each state.

Intensive QIO assistance includes individualized consultation and support as well as collaborative training workshops. Typically, QIOs help leadership introduce changes to improve care, empower staff to drive change, and create effective clinical teams to redesign how care is organized and delivered in specific clinical areas.

Major Gains Against Chronic and Post-Acute Pain

CMS data shows that on average since the initiative began nursing homes have reduced the prevalence of pain in long-term residents by 38%. Homes that worked intensively with QIOs on any clinical improvement project showed an overall 49% decrease in chronic pain. The average home reduced post-acute pain for short stay residents by about 11%. Those working intensively with QIOs reduced post acute pain by 18%.

“There’s a powerful message in this data,” said David Schulke , Executive Vice President of the American Health Quality Association, which represents the national network of QIOs. “The more closely nursing homes and QIOs worked together to improve care, the better the results. We’ve seen strong improvement in a short period of time, which makes life better for residents and almost certainly increases job satisfaction for the staff who care for them. Nursing homes participating in the initiative have demonstrated a real commitment to improving care and deserve recognition.”

“We, along with our state affiliate organizations, have partnered with QIOs on the national and state levels since the beginning of the NHQI,” noted Hal Daub, CEO of the American Health Care Association, the largest organization representing both for-profit and non-profit long-term care facilities. “QIOs are in the forefront, and on the frontlines, of efforts to focus on continuous quality improvements in care and to positively impact the quality of life for patients and residents.”

Improvement Seen In Every Region

Nursing homes in every state showed improvement in reducing pain for residents, with some outstanding individual results. A few examples of homes that worked closely with QIOs:

• Providence Rest Nursing Home in New York City cut pain among short stay residents from 26% to 4% and reduced chronic pain to just 1% of its residents.
• The percentage of residents suffering chronic pain at The Cedars’ home in Kansas was reduced from 20% to about 2%.
• Horizon Health and Subacute Center in Fresno , California , now consistently treats 100% of its residents for pain in a timely manner, compared to 65% before the Initiative. Resident satisfaction scores rose from 13% to 100%.
• A group of 68 nursing homes in Minnesota demonstrated more than 45% improvement in chronic pain and almost 20% improvement in post-acute care pain.

In addition, in a closely related initiative, some of the nation’s largest nursing home companies participated in a QIO project that produced a 45% improvement in their chronic pain management performance. Led by the Colorado Foundation for Medical Care and Quality Partners of Rhode Island, the QIOs for Colorado and Rhode Island respectively, the project initially involved 163 nursing homes across the country with total potential resident population of more than 19,000. Companies participating included Beverly Health Care, Genesis Health Care, HCR Manor Care, Kindred Healthcare, Mariner Health Care, Sovereign Health Care, SunBridge Healthcare, Inc., and Trans Healthcare, Inc.

Progress On Other Quality Measures

Nursing homes in almost all states also reported a decrease in the use of physical restraints, with the average home showing a 23% decrease since the beginning of the quality initiative. Nursing homes that worked intensively with QIOs showed a 33% reduction in use of restraints. Across the nation, the average home did not make progress reducing pressure ulcers among residents, while those that worked intensively with QIOs showed some improvement.

“We are gratified to see the many positive outcomes that have been demonstrated through the collaborative efforts of QIOs working in partnership to improve quality,” said Larry Minnix, CEO of the American Association of Homes and Services for the Aging. Minnix was one of the first industry leaders to strongly back the government’s quality initiative.

“There’s still plenty of room for improvement,” Schulke said. “Most QIOs and nursing homes made too little progress on pressure ulcers. And even where we succeeded, improvement on specific clinical quality measures doesn’t automatically create a safe, home-like environment. We support Dr. McClellan’s intention to align all CMS operations that affect quality, including quality measurement and improvement, public reporting, inspections and payment.”

During the forthcoming three-year QIO contract cycle with CMS (beginning August 2005), QIOs will continue to work intensively with many nursing homes across the country—helping develop a culture of care focused on improving residents’ quality of life. QIOs will also work intensively with nursing homes to increase staff satisfaction and retention. “As QIOs recruit and engage additional nursing homes, we’re going to see more and more nursing homes transform themselves,” Schulke said.

The American Health Quality Association is dedicated to improving the safety and effectiveness of health care. AHQA represents the national network of Quality Improvement Organizations (QIOs) that work with hospitals, medical practices, health plans, long-term care facilities, home health agencies, and employers to encourage the spread of best clinical practices and improve systems of care delivery.