2002 AJN Table of Contents
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Washington Watch
American Journal of Nursing -
June, 2002 - Volume 102, Issue 6
Quality Improvement Initiative in Nursing Homes
The quality of care in the nation’s nursing homes may get a boost from a new public reporting quality improvement initiative developed by the Centers for Medicare and Medicaid Services (CMS), formerly known as the Health Care Financing Administration. Tüe project is the CMS’s initial response to the Department of Health and Human Services’s stronger focus on patient care quality. The initiative is designed to provide Medicare and Medicaid beneficiaries and their families with easy-to-understand, comparative information to help them choose high-quality nursing homes, hospitals, and other sources of health care.
NURSING HOME PILOT PROJECT
As the first part of the nursing home quality improvement initiative, CMS established a demonstration project in January 2002 to identify, collect, and publish nursing home quality-of-care information in Colorado, Florida, Maryland, Ohio, Rhode Island, and Washington. In these six states, data on nine quality measures is now available for consumers, clinicians, and discharge planners.
The nine measures are in two categories: six measures for “chronic residents” (pressure ulcers, use of restraints, decline in activities of daily living, pain, weight loss, and infections) and three for “post–acute care residents” (delirium, pain, and improved ability to walk). To allow for fair comparisons from facility to facility, these measures have been validated, are based on current research, and are statistically risk-adjusted for individual resident characteristics and differences in vulnerability for certain patient outcomes. Eight of the nine measures report on a condition that is undesirable. For these, a nursing home should score below the state average. Improved ability to walk is the one measure that should be positive, with nursing homes scoring above the state average.
Nursing homes routinely collect assessment data for all residents at specified intervals; this is the Minimum Data Set (MDS), on which the CMS based its quality measures. The MDS is a nationally recognized assessment survey used to establish quality standards and Medicare and Medicaid payment.
The pilot project is expected to begin including public reporting of information about nursing home quality from all states in October. The final set of quality measures to be reported nationally has not yet been determined but may include none, some, or all of the nine measures from the six-state demonstration project. The CMS asserts that a national reporting system will create powerful incentives for improving quality and allow consumers to compare the performance of their local nursing homes. The program is voluntary, and participation does not change the current federal survey system for nursing facilities.
ROLE OF QUALITY IMPROVEMENT ORGANIZATIONS
To help nursing home operators understand the publicly reported quality measures and how they can use this information to improve quality of care, the CMS has enlisted the aid of the Medicare Quality Improvement Organizations (QIOs, formerly known as Peer Review Organizations). The QIOs are a national network of private organizations in every state that work with health care providers to improve the quality of care they deliver by encouraging rapid identification and resolution of problems in the quality of care, facilitating collection and analysis of data, and sharing resources and “best practices” with providers. During the pilot project, the QIOs provide information using the quality measures, educational programs and materials, and online resource manuals for health care providers. They also are working with a small group of volunteer nursing homes in each state to pilot test the development and implementation of specific quality improvement projects, starting with pressure ulcers and pain management.
The ANA will represent nursing’s interests in this initiative as part of an advisory council that has been established to share information on the project as it progresses, identify concerns, and provide input on how the QIOs can best assist nursing homes. Also, the ANA will help in developing a staffing guidebook for use in assessing and improving nursing home quality issues related to staffing.
More information is available at the CMS Nursing Home Compare Web site: go to www.medicare.gov and click on “Nursing Home Compare.” Or call (800) Medicare for more information.
Sheila Abood is an associate director of the ANA’s Department of Government Affairs.
The ANA acts in an advisory role.
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