title: Approaches to quality improvement in nursing homes: lessons learned from the six-state pilot of CMS's Nursing Home Quality Initiative.
abstract: BACKGROUND
  In November 2002, the Centers for Medicare & Medicaid Services (CMS) launched a Nursing Home Quality Initiative that included publicly reporting a set of Quality Measures for all nursing homes in the country, and providing quality improvement assistance to nursing homes nationwide. A pilot of this initiative occurred in six states for six months prior to the launch.
  
  
  METHODS
  Review and analysis of the lessons learned from the six Quality Improvement Organizations (QIOs) that led quality improvement efforts in nursing homes from the six pilot states.
  
  
  RESULTS
  QIOs in the six pilot states found several key outcomes of the Nursing Home Quality Initiative that help to maximize the potential of public reporting to leverage effective improvement in nursing home quality of care. First, public reporting focuses the attention of all stakeholders in the nursing home industry on achieving good quality outcomes on a defined set of measures, and creates an incentive for partnership formation. Second, publicly reported quality measures motivate nursing home providers to improve in certain key clinical areas, and in particular to seek out new ways of changing processes of care, such as engaging physicians and the medical director more directly. Third, the lessons learned by QIOs in the pilot of this Initiative indicate that certain approaches to providing quality improvement assistance are key to guiding nursing home providers' desire and enthusiasm to improve towards a using a systematic approach to quality improvement.
  
  
  CONCLUSIONS
  The Nursing Home Quality Initiative has already demonstrated the potential of public reporting to foster collaboration and coordination among nursing home stakeholders and to heighten interest of nursing homes in quality improvement techniques. The lessons learned from this pilot project have implications for any organizations or individuals planning quality improvement projects in the nursing home setting.
authors.affiliation: Rhode Island Quality Partners, Providence, RI 02908, USA. skissam.ripro@sdps.org
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kissam
authors.forename: David
authors.initials: D
authors.lastname: Gifford
authors.forename: Peggy
authors.initials: P
authors.lastname: Parks
authors.forename: Gail
authors.initials: G
authors.lastname: Patry
authors.forename: Laura
authors.initials: L
authors.lastname: Palmer
authors.forename: Linda
authors.initials: L
authors.lastname: Wilkes
authors.forename: Matthew
authors.initials: M
authors.lastname: Fitzgerald
authors.forename: Alice Stollenwerk
authors.initials: AS
authors.lastname: Petrulis
authors.forename: Leslie
authors.initials: L
authors.lastname: Barnette