Helping nursing homes "at risk" for quality problems: a statewide evaluation.
The Quality Improvement Program for Missouri (QIPMO), a state school of nursing project to improve quality of care and resident outcomes in nursing homes, has a special focus to help nursing homes identified as "at risk" for quality concerns. In fiscal year 2006, 92 of 492 Medicaid-certified facilities were identified as "at risk" using quality indicators (QIs) derived from Minimum Data Set (MDS) data. Sixty of the 92 facilities accepted offered on-site clinical consultations by gerontological expert nurses with graduate nursing education. Content of consultations include quality improvement, MDS, care planning, evidence-based practice, and effective teamwork. The 60 "at-risk" facilities improved scores 4%-41% for 5 QIs: pressure ulcers (overall and high risk), weight loss, bedfast residents, and falls; other facilities in the state did not. Estimated cost savings (based on prior cost research) for 444 residents who avoided developing these clinical problems in participating "at-risk" facilities was more than $1.5 million for fiscal year 2006. These are similar to estimated savings of $1.6 million for fiscal year 2005 when 439 residents in "at-risk" facilities avoided clinical problems. Estimated savings exceed the total program cost by more than $1 million annually. QI improvements demonstrate the clinical effectiveness of on-site clinical consultation by gerontological expert nurses with graduate nursing education.
Rantz
Marilyn J
MJ
Sinclair School of Nursing and Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA.
Cheshire
Debra
D
Flesner
Marcia
M
Petroski
Gregory F
GF
Hicks
Lanis
L
Alexander
Greg
G
Aud
Myra A
MA
Siem
Carol
C
Nguyen
Katy
K
Boland
Clara
C
Thomas
Sharon
S
D017046:Cost Savings; D008923:Missouri; D009735:Nursing Homes / Q000191:economics / Q000592:standards*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care