Angel Davis is a registered nurse and the Centers for Medicare & Medicaid Services’ subject matter expert for the Quality Improvement Organization (QIO) Program’s long-term care work. In this role, she is responsible for overseeing Quality Innovation Network-QIO (QIN-QIO) quality improvement activities with long-term care facilities. She previously worked as a pharmacy senior policy analyst in Medicaid, as well as in Medicare program integrity. Davis holds a master’s degree in business administration and a master’s degree in health care administration from the University of Maryland University College. She received her Bachelor of Science in Nursing from the University of Maryland at Baltimore.
Q. Tell us about the CDI baseline initiative — who’s involved, progress and goals, why the need?
Clostridioides difficile (C. diff, previously known as Clostridium difficile) infections affected almost half a million U.S. patients in 2015, according to the Centers for Disease Control and Prevention (CDC). More than 80% of the deaths associated with C. diff occurred among Americans aged 65 or older, and more than 100,000 of these infections developed in nursing homes.
The 2013 U.S. Department of Health and Human Services (HHS) National Action Plan to Prevent Health Care-Associated Infections (HAIs) set a goal to have 5% of U.S. nursing homes report C. diff to the CDC’s National Healthcare Safety Network (NHSN). So, in support of this goal, the CDC and Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organization (QIO) Program worked together on a C. diff reporting and reduction project beginning in May 2016.
Q. How has the program evolved since the initiative began? Have there been lessons learned along the way?
Everyone involved has learned lessons along the way — including what types of support are needed and most helpful for nursing homes to enroll in NHSN and report accurate data over time. Nursing homes need to have a clear understanding of the need for surveillance and reporting for their organization, as well as for their state, region and nation. They need to have a vision of the commitment necessary for the process and what NHSN reporting involves so that they can provide leadership and support.
Education and technical assistance for nursing home reporting was key for success, and Quality Innovation Network (QIN)-QIO support throughout the process proved to be very valuable for nursing homes. Educational resources provided by the CDC were used and enhanced throughout the project. Working closely with the CDC, QIN-QIOs used and supplemented these resources to support implementation in nursing homes. Long-term care stakeholder partnerships at the state level also evolved to further align efforts and leverage resources and synergy to help nursing homes with C. diff infection (CDI) reporting and reduction.
Q. What are some key milestones in the program so far? What are the top goals and priorities?
The project has resulted in a marked increase in the number of nursing homes that are consistently reporting data into the NHSN. In terms of key milestones:
- 2,292 nursing homes consistently reported data during a baseline period (March-December 2017)
- During the two re-measurement periods:
This achievement of roughly 15% of nursing homes reporting CDI data into NHSN has allowed us to learn more about facilitators and barriers to CDI reporting and begin to analyze the data to better understand the burden, patterns and predictors of CDI in nursing homes.
Q. How is CMS collaborating with the CDC in this effort? What are some of the benefits of that partnership?
CMS and CDC partnered to support the QIN-QIOs by way of bi-weekly calls throughout the project period. CMS and CDC discussed educational needs and enrollment challenges with the NHSN support team at the CDC; the CDC used the feedback to provide timely training and resources.
A few examples of support provided to the QIN-QIOs includes the distribution of 12 step-by-step guidance documents outlining the NHSN enrollment process and CDI tracking and reporting protocols, as well as eight live training sessions conducted via webinar to guide participants through the enrollment and reporting process.
This collaboration enabled the monitoring of C. diff rates in nursing homes, which will help to characterize the actual burden of C. diff infections; measure progress and assess trends of C. diff in nursing homes at the local, state and national levels; and evaluate intervention effectiveness.
Q. Can you talk about the results you've seen so far? What kind of impact do you see as a result of the initiative?
The most significant impact is the QIN-QIOs’ recruitment of 3,200 nursing homes, or 15% of the nation’s nursing homes, to participate in the C. diff reporting and reduction project as part of the National Nursing Home Quality Care Collaborative.
A national baseline for CDI in nursing homes was developed as a result of QIN-QIO work with participating nursing homes. As a result, the number of nursing homes reporting C. diff infections to CDC’s NHSN reporting increased from approximately 200 nursing homes to more than 2,300 nursing homes nationally, exceeding the 5% goal established by the HHS National Action Plan.
QIN-QIOs also supported nursing homes to continue surveillance and reporting of C. diff in 2018 and to prevent and manage CDI.
In addition to supporting nursing homes with reporting C. diff to the NHSN, we established additional focus areas to support the creation of a culture of resident safety in long-term care facilities. QIN-QIOs trained all of the participating nursing homes in TeamSTEPPS, or Team Strategies and Tools to Enhance Performance and Patient Safety, as well as antibiotic stewardship principles and practices and C. diff management and prevention. We used online sessions developed by the QIN-NCC in collaboration with the CDC, which can be found here.
Q. Anything else you think would be relevant to our readers?
I want to thank the QIN-QIOs for all of their hard work and dedication to this project and to the nursing homes that voluntarily agreed to participate in this effort.
I’d also like to note that we have an upcoming training that our partners at the CDC are hosting: the 2019 NHSN Annual Training for Long-term Care Facilities, held on the CDC campus in Atlanta, Georgia. Part of the training, which will take place July 9-11, includes an opportunity for nursing home staff to complete the process for enrolling in NHSN so they can track and submit data. We encourage those who may be interested to register here.