Nursing Home Quality Improvement

Nursing Home Quality improvement has always been a large focus for CHSRA. CHSRA researchers are known for the development of the original Quality Indicator (QI) reporting system which the Center for Medicare and Medicaid Services (CMS) released to states in July 1999. This QI reporting system was developed by CHSRA under a subcontract that was part of a general contract with CMS. The QIs developed by CHSRA researchers are markers that indicate either the presence or absence of potentially poor nursing home care practices or outcomes. QIs represent the first known systematic attempt to longitudinally record the clinical and psychosocial profile of nursing home residents in a standardized, relatively inexpensive and regular manner requiring the expertise of only in-house staff. In 2005 CMS extended the state reporting system to make use of a new set of Quality Indicators/Quality Measures (QI/QMs). The new QI/QMs are based on the original CHSRA QIs with a new numbering system, a new way of adjusting for risk factors for 3 of the QI/QMs and the inclusion of a pain measure and 3 new Post Acute Care (PAC) QI/QMs.

CHSRA researchers continue to work towards quality Improvement in nursing homes through projects such the Clinical Resource Center (CRC) founded in 2007, Antibiotic Stewardship Intervention for Nursing Homes, the Wisconsin ScoreCard project and analysis and research support for monitoring quality of care with the Office of the Inspector General (OIG).

-+ Antibiotic Stewardship: Intervention for Nursing Homes

Project Duration: 09/01/14-08/31/17

Primary Personnel

Principal Investigator: Chris Crnich
Co-Investigator: Barbara Bowers
Co-Investigator: James H. Ford II
Co-Investigator: Meghan Brennan
Co-Investigator: Tosha Wetterneck
David Nace, University of Pittsburgh

Funding Source

AHRQ

Links

AHRQ

Presentations/Publications

  • Ramly E, Ford J, Nace DA, Bahrinian M, Crnich C. Reducing Unnecessary Use of Antibiotics in Nursing Homes with a Complex Multi-Level Intervention: A Study Protocol. Poster session presented at the annual conference of the Agency of Health Care Research and Quality (AHRQ) cohosted with Academy Health. 2015 Oct 4-6. Arlington, VA.
  • Ramly E, Ford J, Nace DA, Bahrinian M, Crnich C. Work System Redesign to Reduce Unnecessary Use of Antibiotics in Nursing Homes: A Mixed-Methods Study. Presented at the YoungOR19 conference of the Operations Research Society. 2015 Sep 22-24. Birmingham, UK. 
  • Crnich C, Nace DA, Ramly E, Ford, J, Wetterneck T. Improving Antibiotic Prescribing in Nursing Homes through Work System Redesign. Presented at the annual conference of AMDA The Society for Post-Acute and Long-Term Care Medicine. 2016 Mar 17-20. Orlando, FL.   

-+ Clinical Resource Center (CRC)

Clinical Resource Center The Clinical Resource Center (CRC) is a website designed to provide key information about clinical care for staff working in skilled nursing facilities (SNFs). The website is a user-friendly resource containing a wealth of information, as well as links to external resources. The website is not intended as an exhaustive listing of all resources but as dynamic tool for providers. The key content identified has been selected by a diverse group of professionals working in long-term care and long-term care quality research. The hope is to provide a dynamic forum for continuing education and sharing of useful information and resources for clinicians caring for those living in Nursing Homes.

The website is always changing and growing; the content is reviewed and updated as new information becomes available. It contains guidelines, tools, regulatory resources, current and upcoming meetings and events and much more. AMDA Clinical practice guides and materials are available on the website to users free of charge through an ongoing contract with AMDA, the Society for Post-Acute and Long-Term Care Medicine. There are Training Modules which can be used for a personal learning or a quick in-service. As well as specific Care Area Modules designed by CHSRA healthcare researchers which are presented in a consistent and easy to use framework including tools, guidelines, related regulations and additional resources for learning. The Care Area Modules include: Challenging Behaviors, Dehydration & Fluid Maintenance, Dementia & Distressed Behaviors, Depression in the Elderly, Diabetes Management, Falls & Fall Risk, Infection, Nutrition, Pain Management, Person-Centered Care, Pressure Ulcer Prevention & Treatment, Restraints, Transitions in Care and Urinary Incontinence.

The website, originally called WCRC (Wisconsin Clinical Resource Center), began as a Civil Money Penalty (CMP) funded research project in 2007, through collaboration between CHSRA and the two Wisconsin Nursing Associations, LeadingAge Wisconsin and Wisconsin Health Care Association (WHCA). Continued funding has been provided by the state of Wisconsin Department of Health Services (Wi-DHS). In 2016 WCRC became CRC and the content was updated to include nationally relevant information and all Wisconsin specific information was moved to special State specific sections, allowing for the possible expansion and inclusion of other states in the CRC project.

The CRC website is a password protected website and access is currently available to staff working in Wisconsin nursing homes and the Wisconsin Department of Health Services (DHS). 2017 marked the beginning of a new pilot project between CHSRA and the Texas Health Care Association (THCA) which will provide CRC access to staff working in 500 SNFs in the state of Texas, this access will be provided by the THCA through CMP funding. Other states or agencies interested in joining or learning more about the CRC project are encouraged to contact the CRC Helpdesk for further information.

Links

CRC website
WI Department of Health Services (DHS)
Wisconsin Health Care Association (WHCA/WiCAL)
LeadingAge Wisconsin

-+ Texas CRC

Texas is the second state to join the Clinical Resource Center. In 2017 CHSRA and the THCA entered into an agreement to create Texas state specific pages and content for the CRC website. In July of 2017 up 500 Skilled Nursing Facilities (SNF) in the state of Texas will be given access to the CRC – Texas website through a grant provided by the Texas Health Care Association (THCA) through CMP funding.

In 2016 WCRC became CRC and the content was updated to include nationally relevant information and all Wisconsin specific information was moved to special State specific sections, allowing for the expansion and inclusion of other states in the CRC project.

Other states or agencies interested in joining or learning more about the CRC project are encouraged to contact the CRC Helpdesk for further information.

Project Duration: January, 2017 – December, 2019

Primary Personnel

Principal Investigator: Susan Nordman-Oliveira
Contact: CRC helpdesk

Sponsoring Agency

Texas Health Care Association – Education Foundation

Funding Source

Texas Health Care Association (THCA) through Civil Money Penalty (CMP) grant from the Center for Medicare and Medicaid Services

Links

CRC website
THCA website

-+ Wisconsin CRC

Wisconsin Clinical Resource Center WCRC was renamed to the Clinical Resource Center (CRC) at the beginning of 2016.

The Clinical Resource Center (CRC) project is jointly sponsored by CHSRA, the Wisconsin Department of Health Services (DHS), Wisconsin Health Care Association (WHCA) and LeadingAge Wisconsin, through funding from the Wisconsin DHS. The Wisconsin Clinical Resource Center (WCRC) was originally developed in 2007 with Civil Money Penalty (CMP) funds. The WCRC was renamed to the Clinical Resource Center (CRC) at the beginning of 2016 in order to facilitate growth. Website and content development has been guided by an Advisory Group. This Advisory Group, along with representation from DQA, recommends and reviews content provided in the website modules and trainings. Development and support is provided by staff and consultants from CHSRA.

This project involves the development, continual maintenance and expansion of the CRC website, along with access to and development of companion training materials. AMDA Clinical practice guides and materials are available on the website to users free of charge through an ongoing contract with AMDA, the Society for Post-Acute and Long-Term Care Medicine.

The CRC website is designed as a user-friendly resource to provide key information about fourteen care areas along with access to companion training materials. The care area modules include: challenging behaviors, dehydration & fluid maintenance, dementia & distressed behaviors, depression in the elderly, diabetes management, falls & fall risk, infection, nutrition, pain management, person-centered care, pressure ulcer prevention & treatment, restraints, transitions in care and urinary incontinence. In addition, six companion training programs for staff have been developed: (1) Getting to the Root of the Matter: Review of the Care Process; (2) Identifying Change in Resident Condition: Medical Provider Notification; (3) Resident-Directed Care Planning; (4) Building Relationships Within a Clinical/Cultural Environment; (5) Infection Prevention and Control Within a Clinical/Cultural Environment; and (6) Use of Antipsychotic Drugs. To facilitate ease of use, each care area module is organized using a framework that provides tools, guidelines, related regulations and additional resources for learning.

The website is not intended as an exhaustive listing of all resources but as dynamic tool for providers. The key content identified has been selected by a diverse group of professionals working in long-term care. The hope is to provide a dynamic forum for sharing useful information and resources.

Project Duration: 2007 - present

Primary Personnel

Principal Investigator: David Zimmerman
Co-Investigator & Project Director: Susan Nordman-Oliveira
Contact: CRC helpdesk

Sponsoring Agency

Jointly sponsored by the Wisconsin Department of Health Services (DHS), Wisconsin Health Care Association (WHCA/WiCAL) and LeadingAge Wisconsin

Funding Source

WI Department of Health Services (DHS)

Links

CRC website
WI Department of Health Services (DHS)
Wisconsin Health Care Association (WHCA/WiCAL)
LeadingAge Wisconsin

-+ Wisconsin CRC ScoreCard

In Phase I of this initiative, the Wisconsin Department of Health Services (DHS) engaged the University of Wisconsin Center for Health Systems Research and Analysis (CHSRA), with input from the nursing home associations and other long term care stakeholders, to produce a nursing home quality performance measurement system tested for credibility and ready for statewide implementation.

Phase II involves the recruitment of several Wisconsin nursing homes who are already members of the Clinical Resource Center (CRC) to pilot test the reporting system and associated CRC clinical content. In Phase II these group will assist in selecting which measures are most useful and identifying appropriate resources and protocols to employ to improve or maintain a high level of measured performance. A final report will recommend next steps to make the reporting system available throughout Wisconsin. As with the prior phase, the ultimate outcome of Phase II is to improve clinical outcomes for Wisconsin nursing home residents, which will also improve their quality of life.

The ScoreCard project is available to selected pilot facilities on the CRC website.

Project Duration: 8/1/2015 - 7/31/2016

Primary Personnel

Principal Investigator: Jim Robinson
Contact: CRC helpdesk

Sponsoring Agency

Wisconsin Department of Health Services, LeadingAge Wisconsin, Wisconsin Health Care Association (WHCA)

Funding Source

Wisconsin Department of Health Services (DHS)

Links

CRC website
LeadingAge Wisconsin
Wisconsin Health Care Association (WHCA)
WI Department of Health Services

-+ Analytic and Research Support for Monitoring Quality of Care (OIG)

The purpose of this project is to assist the Office of the Inspector General (OIG) of the Department of Health and Human Services to identify nursing home chains to be monitored for quality under a corporate integrity agreement (CIA) with the OIG.

Project Duration: Ongoing

Primary Personnel

Principal Investigator: Jim Robinson
Contact: Jim Robinson

Sponsoring Agency

Department of Health and Human Services

Links

Department of Health and Human Services