National Nursing Home Quality Care Collaborative Aims to Create Lasting Improvements

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The National Nursing Home Quality Care Collaborative (NNHQCC) led by the Centers for Medicare & Medicaid Services (CMS) and the Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) launched in April 2015 with the mission to improve care for the 1.4 million nursing home residents across the country.

Specifically, over the next five years, the NNHQCC will strive to instill quality and performance improvement practices, eliminate health care-acquired conditions (HACs) and dramatically improve resident satisfaction by focusing on the systems that impact quality. These systems include staffing, operations, communication, leadership, compliance, clinical models, quality of life indicators and specific clinical outcomes such as mobility, inappropriate antipsychotic use for persons living with dementia, and health care-associated infections (HAIs).

Recruitment by the Numbers

While all nursing homes are encouraged to sign up for the national collaborative, QIN-QIOs are doing their part to engage nursing homes in local communities to participate. QIN-QIOs started the first of two breakthrough improvement initiatives, also referred to as Collaborative I, in April 2015. Collaborative II will begin in April 2017, building upon successes and introducing additional improvement opportunities.

Through March 2015, QIN-QIOs recruited 6528 nursing homes (out of 15,518 nationwide) for Collaborative I, including 783 homes with a Nursing Home Compare quality star rating of one. QIN-QIOs are continuing to recruit nursing homes for the collaborative.

Peer Coaching for Increased Sharing and Insights

QIN-QIOs are also recruiting high-performing nursing home staff to act as Peer Coaches for other facilities participating in the NNHQCC. These Peer Coaches will represent diverse disciplines and roles, and provide participants with additional support and channels to share successes and lessons learned to support improvement efforts nationally.

The Peer Coaches will assist the QIN-QIOs in instilling quality improvement methodologies and fostering the creation of quality-centric nursing homes among their peers.

Supporting Development of Overall Quality Strategy

According to the Affordable Care Act, nursing homes will be required to have their Quality Assurance and Performance Improvement (QAPI) plan in place one year after the anticipated regulation is issued. Effective QAPI planning and implementation requires nursing homes to create self-sustaining systems approaches to improving safety and quality, while involving staff from all affected departments in practical and creative problem solving.

The NNHQCC uses the QAPI structured approach as its framework for improvement.

Providing Resources for Continued Education

QIN-QIOs are sharing a Change Package developed and updated over time with participating nursing homes to help them select priority focus areas and implement tests of change. The Change Package is a menu of potential improvements, including strategies, change concepts and specific actionable items that any nursing home can choose from to begin piloting for purposes of improving quality of care.

The Change Package is focused on the successful practices of high performing nursing homes and includes specific replicable actions being taken by them, including how to lead with a sense of purpose, recruit and retain quality staff, connect with residents in a celebration of their life, nourish teamwork and communication, be a continuous learning organization and more.

The Change Package is intended to be complementary to such resources as literature reviews and evidence-based tools and resources. Nursing homes are encouraged to take advantage of the many resources for training and technical assistance materials available to them, including education and resources offered by each individual QIN-QIO