HHS launches national nursing home QI

Launch follows six-state pilot project

The Department of Health and Human Services (HHS) Secretary Tommy G. Thompson has launched the national Nursing Home Quality Initiative in an effort to improve the quality of care given to the millions of long-term care residents. The initiative combines new information for consumers about the quality of care provided in individual nursing homes with important resources available to nursing homes to improve the quality of care in their facilities.

The April 2002 pilot project launch follows the successful six-state pilot project, which involved nursing homes serving Medicare and Medicaid beneficiaries in Colorado, Florida, Maryland, Ohio, Rhode Island, and Washington.

Good for consumer — and nursing home

"The pilot demonstrated that these measures aren’t just good for consumers — they’re good for nursing homes as well," Thompson said in a press conference.

"More than half of the nursing homes in the six pilot states requested technical assistance to help them improve their care, and that is exactly the type of collaborative effort we envisioned — and what we want to continue to see happen," he pointed out.

The complete quality data are available at Medicare’s consumer web site, www.medicare.gov. Tom Scully, administrator for the Centers for Medicare & Medicaid (CMS), explains that the National Nursing Home Quality Initiative is a four-pronged effort, consisting of CMS’ continuing regulatory and enforcement efforts conducted by state survey agencies; improved consumer information on the quality of care in nursing homes; continual community-based quality improvement programs offered to nursing homes by Medicare’s Quality Improvement Organizations (QIOs); and collaboration and partnership to leverage knowledge and resources.

"We know nursing homes are just as interested in improving the high-quality care they already give to their residents as we are," Scully says. "By making this information available to the nursing homes and consumers, we are seeing a collaborative effort to do even more to raise the bar on quality."

In support of the HHS effort, a National Quality Forum (NQF) steering committee recommended that nursing homes focus on 10 quality measures, six for chronic care patients (long-term stay residents) and four for post-acute care patients (short-term patients).

The six measures for long-stay residents are:

  • percentage of residents with loss of ability in basic daily activities;
  • percentage of residents with infections;
  • percentage of residents with pain;
  • percentage of residents with pressure sores;
  • percentage of residents with pressure sores (with additional facility-level risk adjustment);
  • percentage of residents in physical restraints.

The four measures for short-stay residents are:

  • percentage of short-stay residents with delirium;
  • percentage of short-stay residents with delirium (with additional facility-level risk adjustment);
  • percentage of short-stay residents who walk as well or better;
  • percentage of short-stay residents with pain.

Another key component of the initiative is the assistance that every QIO has available to improve quality of care in local nursing home facilities. QIOs are CMS contractors that have offered improvement assistance to hospitals, physician offices, and in some states, nursing homes over the past decade.

As part of the Quality Initiative, the QIOs are expanding their scope by providing information and consultation to skilled nursing facilities in all states. In addition, QIOs and state and local long-term care ombudsmen will use the new data, along with other information and personal visits, to help families make informed decisions about placement in nursing homes.

The ombudsmen primarily are volunteers who help nursing home residents and their families on a daily basis and are trained and funded through HHS’ Administration on Aging.