Improving Nursing Home Quality:

Accelerating Change through the Advancing Excellence in America’s

Nursing Homes Campaign

Centers for Medicare & Medicaid ServicesSatellite Broadcast and Webcast

Friday, March 23, 20071:00 PM –3:00 PM EDT

Campaign Aim

To pursue excellence in the quality of life and quality of care for the more than 1.5 million residents of America’s nursing homes by enhancing choice, strengthening workforce and improving clinical outcomes.

www.nhqualitycampaign.org

National Founding Members

• The Alliance for Quality Nursing Home Care• American Association of Homes and Services for the Aging --

AAHSA• American Association of Nurse Assessment Coordinators --

AANAC• American College of Health Care Administrators – ACHCA• American Health Care Association -- AHCA• American Medical Directors Association -- AMDA• Centers for Medicare & Medicaid Services -- CMS• The Commonwealth Fund• The Evangelical Lutheran Good Samaritan Society• National Association of Health Care Assistants -- NAHCA• National Citizens’ Coalition for Nursing Home Reform -- NCCNHR• National Commission for Quality Long-term Care

An Unprecedented Coalition

Representing:• 11,000 nursing homes nationwide• 45,000 health care professionals, including:

– 3,500 Health Care Administrators– 6,000 Directors of Nursing – 7,200 Medical Directors – 9,000 Gerontological Nurses and Nurse Coordinators– 20,000 Certified Nursing Assistants

• 1,000 Consumer Advocates; Millions of caregivers• 1.8 million Service Employees• National Commission for Quality Long-term Care:

– Two Governors– Four current Members of Congress– Former Senator Kerrey and Former Speaker Gingrich– Quality experts

Campaign Components

• Meaningful Goals• Measures and Data Sources• National and State Infrastructure • Technical Assistance

• Evidenced-based Protocols• Guidelines

National Quality Initiatives: Common Goals

Goal / Aspect of the campaign

Advancing Excellence in America’s Nursing Homes

Quality First(AHCA, AAHSA, The Alliance)

Nursing Home Quality Initiative(CMS)

Culture Change

AMDA-FLTC Quality Improvement Study

Voluntary participation X X X X

Reduce Pressure Sores X X X X

Reduce use of restraints

X X X

Reduce pain in long-stay residents

X X X X

Reduce pain in short stay residents

X X X X

Set targets for clinical quality improvement

X X X

Measure resident / family satisfaction and incorporate into care plan

X X X X

Measure staff turnover and develop plans to improve staff retention

X X X X

Adopt “consistent assignment” of CNAs

X X

Campaign Goals

Clinical Goals:• Reduce prevalence of pressure ulcers

among high risk residents• Reduce use of daily physical restraints• Management of pain among long stay

residents• Management of pain among post acute

residents– Measure definitions available on www.cms.hhs.gov/nhcompare– Data derived from MDS– Automatically updated quarterly from MDS

Campaign Goals

Organizational Goals:• Target setting among nation’s nursing

homes• Measurement of resident and/or family

satisfaction• Reduce workforce turnover• Adoption of consistent assignment

Provider Benefits of a National Campaign

• Advances Evidenced-based Practice• Improved Strategies to Promote Positive Clinical

Outcomes and Regulatory Compliance• Improved Customer Satisfaction • Focus on Staff Retention• Cost Savings• Improved Decision-making Strategies • Supports Risk Management • Supports Pay for Performance Initiatives• Advances Use of Technology• National Support At the Table – Now & in the Future

National Benchmarks & Targets

Baseline3rd Q/2005

Goals2008

Pressure Ulcer Reduction 13% 10%

Physical Restraints Reduction 7% 5%

Pain/Long Stay Reduction 6% 4%

Pain/Post Acute Reduction 23% 15%

Target Setting (baseline 2006) 34% 90%

Measuring Customer Satisfaction (estimate) 20% 80%

Measuring Staff Turnover (estimate) 20% 80%

Consistent Staffing X 33%

Target Setting

• Definition: Setting personal quality improvement goals for pressure ulcers, physical restraints, and pain

• Use www.nhqi-star.org– Easy to use– More than 8,000 nursing homes have already set targets– Pre-established accounts for all providers– Provides ideas about how to set targets

• Updated at least annually

Measuring Customer

Satisfaction• Definition: Is the resident and/or family member

satisfied with the quality of care and services received?

• Use www.nhqualitycampaign.org– Providers can select from a drop down list

• Or enter “other”– Use this information for internal improvement

• Self-reported at least annually on Web site

Measuring & Reducing

Nursing Staff Turnover• Definition: Reducing the number of nursing staff (RN, LPN,

CNA) who leave the facility annually

• Use www.nhqualitycampaign.org– Download excel spreadsheet – Document clinical staff terminations & average number

clinical staff– Use this information to calculate annual turnover– Enter turnover rate on campaign website

• Self-reported at least annually on Web site

Adoption of Consistent Assignment

• Definition: Having the same caregiver consistently caring for the same person on at least 85% of that caregiver’s shifts

• Use www.nhqualitycampaign.org– Click yes or no– Date when first initiated

• Self-reported at least annually on Web site

Advancing Excellence Considerations

• Understand the clinical and organizational goals• Measurement• Each process framework

• Benchmark how your facility is doing• Evaluate costs and outcomes• Assess which goals you are already working on and

ones that you want to work on• Spend time on www.nhqualitycampaign.org • Work with your LANE or QIO to learn how the

campaign complements what you’re already doing

National and State Infrastructure

• National Campaign Steering Committee• Local Area Networks for Excellence (LANES)• Quality Improvement Organizations (QIOs)• Clinical Tools

– www.nhqualitycampaign.org – www.medqic.org – Quality First Online Resources– Clinical Practice Guidelines from American Medical

Director’s Association– Agency for Healthcare Research and Quality

Guidelines

National Campaign Steering Committee

• New relationship paradigm that includes consumer advocates, nursing home providers, key sectors of government, quality improvement organizations, nurses, medical experts, and others.

• Provide leadership, communication, and motivation for the campaign.

• Monitor key indicators of nursing home quality; promoting excellence in care giving for nursing home residents, and acknowledging the critical role nursing home staff has in providing care.

Local Area Networks for Excellence (LANEs)

Network of individuals and organizations across the state (or territory) working together to fulfill needs at the local level to ensure campaign success.

Roles and Responsibilities:• Raise Awareness• Drive Enrollment• Convene Meetings• Provide Technical Assistance• Communicate Key Campaign Messages• Respond to Critical Issues

Monitoring Campaign Progress

Visit Web site at www.nhqualitycampaign.org,

will be updated regularly with campaign progress:

– Enrollment by state and nationally– List of providers enrolled in campaign – Progress toward campaign goals– (Voluntary) individual progress towards

campaign goals

How to Become a Participating Provider

Visit www.nhqualitycampaign.org:• Click on link “For Nursing Homes”• Commit to three to eight goals for quality

improvement and register• Begin to work on selected goals using

available technical resources• Connect with LANE or QIO• Join thousands of other providers• We encourage you to register by November

30, 2007

How to Become a Participating Consumer

Visit www.nhqualitycampaign.org:• Click on “For Consumers”• Read about opportunities for

consumers to support the campaign• Fill out registration form• Begin communicating with others

about the campaign

Improving Nursing Home Quality:

Accelerating Change through the Advancing Excellence in America’s

Nursing Homes Campaign

www.nhqualitycampaign.org