Fact Sheet: Nursing Home Results

Results of Selected QIO Nursing Home Projects QIOs partnered with nursing homes in more than 30 states from 1999-2002 to implement projects directed at prevention of pressure sores, falls prevention, pain management, development of quality measures for rehabilitation services, improved diabetes outcomes, improved anticoagulant use, reduction in the use of restraints, immunization campaigns, and treatment for depression. Although many of these projects are still under way, a number have shown measurable results. Some examples: Pain Management : Diabetes Management : Falls Prevention Pressure Ulcers : Flu/Pneumonia Immunization Pain Management Quality Partners of Rhode Island worked with more than half of all Rhode Island nursing homes to develop pain policies and procedures, and implement new protocols. All nursing homes that completed the project put into place procedures employing medication management and the use of non-drug interventions. Re-measurement showed that residents with a non-pharmacological treatment for pain had doubled from 40% to more than 80%. Diabetes Management Health Care Excel, an Indiana-based QIO, conducted a project to monitor and improve the rate of hemoglobin A1c (HbA1c) blood testing used to prevent the complication of diabetes. The project regularly convened nursing home staff from across the state to review best practices and develop a conceptual model for quality improvement. Data showed that the aggregate HbA1c rate in participating facilities improved from 57% at baseline in May 2001 to 87% in February 2002. Falls Prevention The Alabama Quality Assurance Foundation began a falls prevention project in 2001 with a focus on the creation of multidisciplinary falls teams knowledgeable about continuous improvement techniques. The teams track and analyze falls and disseminate program information throughout nursing facilities. Within six months, the aggregate fall rate for participating facilities decreased from 7 to 6 per 1000 resident days—the equivalent of an 100-bed facility decreasing its falls by 3 per month. Extrapolated to cover the state’s 25,000 LTCF residents, falls would be reduced by 9,000 per year. Pressure Ulcers Quality Insights of Pennsylvania, worked with 12 nursing homes to test interventions designed to reduce incidence of pressure ulcers. The project showed improvement in two-thirds of the quality indicators used. There was a significant increase in care plans that used cushions to reduce pressure for patients while sitting in chairs (57% vs. 90%) and lifting devices to shift patients in chairs (43 vs. 95%); and the percentage of residents who received better mattresses to reduce pressure ulcers increased from 25% to 58%. Flu/Pneumonia Immunization Health Services Advisory Group conducted a project in 127 Arizona nursing homes that increased resident vaccination for pneumonia from 52% to 75%. The Virginia Health Quality Center conducted a project that increased immunization rates for pneumonia from 26% to 52% in 15 participating nursing homes. Seattle-based Qualis Health improved pneumococcal vaccination rates from 53% to 74% in 26 long-term care facilities in Alaska; increased flu immunization rates from 65% to 73% and pneumococcal vaccination rates from 43% to 58% in Idaho; and increased pneumococcal vaccinations from 47%.to 61% in 300 Washington state facilities.