Nursing Home Q&A with Angel Davis

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Angel Davis, RN, CMS
Angel Davis, RN, CMS

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 worked in Medicare program integrity. Davis holds a Master’s in Business Administration and a Master’s in Healthcare Administration from the University of Maryland University College. She received her Bachelors of Science in Nursing from the University of Maryland at Baltimore.

How has your background and experience informed your work as the subject matter expert for long-term care at the Centers for Medicare & Medicaid Services (CMS)?

As a registered nurse, I have more than 20 years of health care experience in medical-surgical nursing, long-term care, quality improvement, hospital utilization review and case management, as well as state government. I previously served as the subject matter expert for the Beneficiary and Family Centered Care (BFCC)-QIOs, the BFCC-National Coordinating Center and the Quality Improvement Initiatives for the QIN-QIOs.

The first stage of the National Nursing Home Quality Care Collaborative (NNHQCC) was just completed. What are some of the key takeaways? 

QIN-QIOs have expanded their reach in working with nursing homes over the last few years and serve as a go-to” resource for quality improvement support across the nation.

Nursing home staff turnover is a challenge, and it can impact a nursing home’s ability to achieve or sustain success. QIN-QIOs have played a key role in helping develop and nurture strong relationships with partners and stakeholders to align quality improvement initiatives and to help nursing homes leverage participation in the program. Finally, QIN-QIOs are seen as a key partner to support nursing homes with Quality Assurance and Performance Improvement (QAPI).

What progress have you made in your goal of recruiting 75 percent of all Medicare-certified nursing homes in the nation for the second collaborative, known as Collaborative II? 

We are very pleased that over 12,200 nursing homes (over 78 percent of all nursing homes in the nation) have joined Collaborative II and will work with their QIN-QIOs and other colleagues and partners in their states to improve care and outcomes for nursing home residents. I’d also point out that over 2,600 nursing homes with a one-star rating in CMS’s Five Star Quality Rating System have signed up. This is critical because nursing homes that have a one-star rating are most in need of quality improvement.

In what ways will Collaborative II differ from  or improve upon – the first collaborative?

Collaborative II will build upon successes and lessons learned through sharing of best practices by QIN-QIOs. The National Nursing Home Quality Care Collaborative will continue to focus on achieving system-wide improvement and ensuring that every nursing home resident receives the highest quality of care. QIN-QIOs and nursing homes will continue to strive to instill practices for the improvement of quality and performance by nursing homes serving beneficiaries; to eliminate health care-acquired conditions (HACs); and to dramatically improve resident satisfaction. Efforts will focus on nursing home systems that impact quality, such as consistent and permanent staff assignment, communications, leadership, regulatory compliance, clinical models and quality of life indicators.

In addition, Collaborative II will support the creation of a culture of resident safety in long-term care facilities. QIN-QIOs will provide participating nursing homes with training in TeamSTEPPS; antibiotic stewardship principles and practices; and Clostridium difficile management and prevention techniques using online sessions developed by the QIN National Coordinating Center. 

QIN-QIO efforts will also help establish a national baseline for Clostridium difficile infections (CDI) in nursing homes. To this end, QIOs have recruited 2,336 of Collaborative II participants to submit data into the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) long-term care database. It’s worth noting that having more than 2,300 nursing homes submitting data into NHSN exceeds the initial five percent of nursing homes reporting goal recommended in the U.S. Department of Health and Human Services’ 2013 Health Care-Associated Infections Action Plan

How has peer coaching and working more closely with beneficiaries advanced the Collaborative's mission?

Nursing homes identified as being high performers work with their QIN-QIOs to provide best practices and quality improvement methodology support for other nursing homes participating in the National Nursing Home Quality Care Collaborative. Peer coaches help to foster the creation of quality-centric nursing homes among peer nursing homes. 

Residents and family members are also essential participants in ensuring the quality of care and nursing home life. QIN-QIOs have worked with residents and family members in many ways, including to plan and conduct learning and action network events, to participate in quality improvement teams, to develop educational resources and to help support resident and family engagement in nursing homes. 

In December 2016, CMS launched a new Long-Term Care Hospital Compare website. What resources does this website offer Medicare patients?

The CMS Long-term Care Hospital (LTCH) Compare website reports information about the quality of care on over 420 hospitals across the nation. The LTCH Compare website helps Medicare patients find and compare LTCHs, and also provides other information to help patients learn how Medicare covers care in an LTCH. The Compare website takes quality measurement and health outcomes data that LTCHs are required to report to CMS and puts it into a format that can be used more readily by the public to get a snapshot of the quality of care each hospital provides.

For example, these tools can help families compare some key quality metrics, such as what percentage of an LTCH’s patients have new or worsened pressure ulcers, and what percentage of an LTCH’s patients are readmitted to an acute care hospital after discharge from that LTCH. Comparing how LTCHs perform on certain quality metrics allows consumers to make better-informed decisions about their health care.

Anything else you would like QIO News readers to know?

We are very excited about the work that the QIN-QIOs are doing in reducing health care-acquired conditions in nursing homes. We look forward to the work being done under Collaborative II, as well as to the recruited nursing homes’ contributions to establishing the CDI national baseline. Nursing homes that are interested in learning more about the collaborative should contact their regional QIN-QIO.

I also would like to highlight the National Nursing Home Quality Improvement (NNHQI) Campaign formerly known as Advancing Excellence in America’s Nursing Homes Campaign.” The NNHQI Campaign provides free, evidence-based and model-practice resources to support continuous quality improvement. The campaign focuses on individuals’ preferences, staff empowerment and involving all staff, consumers and leadership in creating a culture of continuous quality improvement. Please visit for additional information.