One Year Post-Launch, National Nursing Home Collaborative Makes Gains

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Peer Coach Success Story: Reducing Antipsychotic Medications

One year since the April 2015 launch of the National Nursing Home Quality Care Collaborative (NNHQCC), its mission to improve care for the 1.4 million nursing home residents across the country is a step closer to realization.

Led by the Centers for Medicare & Medicaid Services (CMS) and the Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs), the NNHQCC strives 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.

Recruitment by the Numbers

For the first of two breakthrough improvement initiatives, Collaborative I, QIN-QIOs have recruited just over 50 percent of the nation’s 15,518 nursing homes. As of February 2016, a total of 8,341 facilities, including 958 with a Nursing Home Compare quality star rating of one, have joined the Collaborative.

Recruitment for Collaborative II will begin on October 1, 2016 and continue through March 31, 2017, with the goal of recruiting up to 75 percent of all nursing homes within each state. Building upon the successes of Collaborative I, this second initiative will focus on quality reporting and the reduction of Clostridium difficile in nursing homes.

Peer Coaching for Increased Sharing and Insights

QIN-QIOs have also recruited 379 high-performing nursing home staff to act as Peer Coaches for facilities participating in the NNHQCC, as well as 59 beneficiaries and beneficiary representatives. These individuals provide participants with additional support and channels to share successes and lessons learned.

Maureen Brown, administrator at Miami Shores Nursing and Rehabilitation Center in Florida, recently shared how her facility’s success in reducing unnecessary antipsychotic medications was due to its use of Peer Coaches. Watch Miami Shores’ story for an example of how QIN-QIOs are utilizing Peer Coaching to reach and exceed quality improvement goals.

Supporting Development of Overall Quality Strategy

QIN-QIOs are educating nursing home staff and assisting in assessing readiness for upcoming Quality Assurance and Performance Improvement (QAPI) regulations under the Affordable Care Act. To date, 2,418 of the participating nursing homes have completed a QAPI self-assessment to help them identify areas of success and opportunities for improvement. QIN-QIOs are reviewing the results to help determine facilities’ overall and individual technical assistance needs.

Measuring Quality Improvement Progress

To monitor progress at the national, regional and nursing home level, CMS is using the Quality Measure Composite Score. The score is comprised of 13 publically reported, long-term stay quality measures that represent processes and interrelated systems of care within the long-term care setting. Since nearly 10 percent of the nation’s nursing homes had a Composite Score of 6.00 or less prior to the launch of the first NNHQCC in early 2013, that number was established as the benchmark.

"For the first of two breakthrough improvement initiatives, Collaborative I, QIN-QIOs have recruited just over 50 percent of the nation’s 15,518 nursing homes."

The average current score for nursing homes participating in the collaborative is 8.39, a 7.7 percent relative improvement from 9.09 during the same period a year ago. In comparison, the average Composite Score among non-participating nursing homes was reduced from 9.07 to 8.45, a 6.8 percent relative improvement.

Providing Resources for Continued Education

In order to leverage resources and provide consistent support for nursing home providers, QIN-QIOs are working with key partners, including state survey agencies, state health departments, trade associations, professional associations, resident advocacy organizations, higher learning organizations, the Agency of Healthcare Research and Quality, the Centers for Disease Control and Prevention, and Advancing Excellence Local Area Networks of Excellence.

QIN-QIOs are also 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. They also are providing additional education and technical assistance to NNHQCC participants to help improve Composite Scores.