Fact Sheet: Nursing Home Projects

Medicare QIO Nursing Home Projects Medicare Quality Improvement Organizations have been working since 1999 to improve the quality of care in nursing homes in 26 states. In 2002, QIOs will begin offer quality improvement technical assistance to nursing homes across the nation. Current projects include: Prevention/Treatment of Pressure Sores : Falls Prevention Pain Management : Improving Rehabilitation Services Improving Diabetes Outcomes : Immunization Projects Prevention/Treatment of Pressure Sores:QIOs in Arkansas, New Jersey, Puerto Rico, and Texas are testing interventions to improve the prevention and treatment of pressure sores. The Arkansas Foundation for Medical Care (AFMC) has been working with the Arkansas Medical Directors Association and the National Pressure Ulcer Advisory Committee to develop model interventions to prevent pressure ulcers. AFMC also has held educational workshops and focus group sessions at nursing homes with pressure ulcer prevalence above the state average. For more information, contact Krissa Thompson at 501-649-8501. The Peer Review Organization of New Jersey is conducting a project to improve processes of initial assessments, care plans, and preventive interventions for nursing home residents at high risk for pressure ulcers. Currently, 11 facilities have attended workshops and training sessions and are implementing interventions to address problem areas. Results show significant reductions in the rate of new pressure ulcers at most facilities. For more information, contact Cari Miller at 732-238-5570. QIPRO in Puerto Rico has held pressure ulcer treatment seminars at all skilled nursing facilities on the island. QIPRO has distributed a tool for data abstraction and reporting on pressure ulcers and is developing a brochure for relatives of patients with ulcers. Contact Brenda Agosto at 787-641-1240. TMF Health Quality Institute is working with more than 40 nursing facilities to increase the use of a protocol for the prevention and treatment of pressure ulcers. The protocol uses risk assessment techniques and addresses a range of treatments for patients at different levels of risk. For more information, contact: Debora Orrick at 512-329-6610. Falls Prevention: Approximately half of all residents in nursing homes experience a fall each year and many of them sustain fractures. QIOs in Alabama and Missouri are conducting pilot projects with skilled nursing facilities to implement programs reducing the incidence of new falls without increased use of physical restraints. The Alabama Quality Assurance Foundation has undertaken interventions that include adoption of the Vanderbilt Fall Prevention Program and use of team building and root cause analysis at a number of nursing homes. Fall rates have improved for almost all participating skilled nursing facilities. For more information, contact Bill Hawkins at 205-970-1600. The Missouri Patient Care Review Foundation (MPCRF) estimates that almost 25,000 Medicare beneficiaries in Missouri fall every year, with at least 1,200 sustaining fractures. MPCRF is working with nursing homes to encourage the adoption of care planning that incorporates individual risk assessments and patient exercise programs. Contact Deborah Finley at 573-893-7900. Pain Management: North Dakota’s QIO and nursing homes are testing quality improvement plans to reduce and manage pain, especially during end of life care. North Dakota Health Care Review, Inc. (NDHCRI) is working with 16 nursing homes, representing 30% of the state’s skilled nursing facility residents, on a pain management project. NDHCRI staff conducted on-site visits at participating facilities to better understand organizational structures, quality improvement experience, the status of pain management activities, and special barriers. These assessments revealed common struggles with high staff turnover, inadequate resources, and the need for education on pain management and continuous quality improvement. NDHCRI is developing quality indicators to evaluate the prevalence of pain, to determine how often residents are screened for pain, to see if identified pain is being appropriately assessed, and to check if pain management guidelines are followed. Contact Barbara Groutt at 701-852-4231. Improving Rehabilitation Services: Nursing homes are expanding their role in providing rehabilitation services. Successful rehab programs are associated with functional improvement and discharge to less restrictive settings. Four QIOs are working jointly on a pilot project to develop quality improvement measures for rehab services. Colorado Foundation for Medical Care (CFMC), Carolinas Center for Medical Excellence, Health Services Advisory Group (HSAG) of Arizona, and Delmarva Foundation for Medical Care of Maryland have partnered with fiscal intermediaries, state survey agencies and trade associations to test the validity of data that can be used to measure the quality of rehab services. Specifically the organizations are looking at patient discharge rates within 30 days and improvement in Activities of Daily Living rates. The project involves assessment and refinement of data and the development of quality improvement interventions. For more information, contact Kam Valentine (Colorado) at 303-695-3300; Patricia Dubick (Arizona) at 602-264-6382; Nicki Shugart (Maryland) at 410-822-0697; Peg O’Connell (North Carolina) at 919-851-2955. Improving Diabetes Outcomes: Nearly one-out-of-five nursing home residents suffers from diabetes. QIOs in Alaska, Indiana, South Carolina, and South Dakota are collaborating with skilled nursing facilities to improve monitoring and care for residents with this disease. In Indiana, Health Care Excel has implemented a local project to monitor and improve the rate for hemoglobin A1c (HbA1c) blood testing for nursing home residents with diabetes. The HbA1c test measures average blood glucose control and is used to improve control and prevent the complication of diabetes. Health Care Excel collaborated with the Indiana Association of Homes and Services for the Aging in which nursing facilities, provider groups, and government agencies came together to look at diabetes care. The project resulted in representatives from nursing facilities across the state meeting on a regular basis to review best practices and to develop and disseminate a conceptual model for quality improvement related to diabetes management. For more information, contact Karin Kennedy at 812-234-1499. PRO-West is launching a project in Alaska to determine the need for better preventative care by identifying the need for improving the rate of annual HbA1c testing among diabetic nursing home residents. For more information, contact Evan Stults at 206-364-9700. Immunization Projects: QIOs in Alaska, Arizona, the District of Columbia, Florida, Hawaii, Kentucky, Massachusetts, Minnesota, Mississippi, Montana, New Mexico, Oregon, Washington, and Wyoming have teamed with skilled nursing facilities in a range of innovative projects designed to increase the number of Medicare beneficiaries who receive flu/pneumococcal vaccinations. Some examples: In Arizona, a project by Health Services Advisory Group has demonstrated that a collaborative community approach can make a difference in the pneumococcal polyvalent vaccine (PPV) rates in nursing homes. HSAG designed the project in partnership with the Arizona Health Care Cost Containment System—the state Medicaid agency. The project has just completed its second re-measurement—with 127 nursing facilities participating—that shows 71.6% of all beneficiaries residing in nursing facilities were immunized for pneumococcal pneumonia, compared to 52.5% at baseline. One-quarter of the facilities had PPV immunization rates that met or exceeded the Healthy People 2010 goal of 90%. For more information, contact Patricia Dubick at 602-263-6382. In Massachusetts, MassPRO is conducting a project designed to promote the implementation of procedures for routine screening and immunization of all new nursing home residents at the time of admission; to promote annual screening and vaccination of staff and patients; and to promote institution-wide baseline reviews of immunization records for needed vaccinations. The project is conducting informational campaigns, distribution of immunization kits, educational workshops, and technical assistance designed to reach all of the state’s 500 nursing homes. Nearly one-quarter of participating facilities indicate making system changes to implement standing orders for influenza and pneumococcal immunizations. For more information, contact Sue Kelman at 781-890-0011. In Mississippi, Information and Quality Healthcare is participating in a CMS/CDC-sponsored project to evaluate factors associated with success or failure to implement standing orders programs, including (1) presence and characteristics of current standing orders policies, practices, and quality assurance programs; (2) state legal and regulatory requirements; and (3) certification status, facility size and type, drug services, and location (rural/urban). At baseline and follow-up, coverage with pneumococcal and influenza vaccines among current residents of the participating nursing homes will be measured. For more information, contact Carole Kelly at 601-957-1575. In Alaska, PRO-West conducted a project in 1998 to increase pneumococcal vaccinations in 26 long-term care facilities. Vaccination rates improved from 53% of Medicare beneficiaries vaccinated to 74% at the end of the action period. PRO-West is currently conducting a project that includes influenza as well as pneumococcal vaccination. The project has increased vaccination rates and resulted in several facilities instituting a standing order policy for vaccinations. In Washington, PRO-West is collaborating with the Department of Health on a project to increase the number of residents in long-term care facilities who receive the pneumococcal vaccine and to promote the implementation of vaccination standing orders. Contact Evan Stults at 206-364-9700. In Montana, the Mountain-Pacific Quality Health Foundation (MPQHF) is collaborating with the Montana Department of Public Health and Human Services (MT DPHHS) to compile influenza and pneumococcal immunization data and to increase rates of influenza and pneumococcal immunizations in long-term care facilities (LTCF). MPQHF and MT DPHHS have received self-reported survey data from nursing homes for 1998, 1999 and 2000. Of the 101 Montana LTCF, about 70% have returned the surveys annually. For more information, contact Ruth A. Swenson at 406-443-4020 ext. 253.