Nursing Home Quality Initiative

Nursing Home Quality Initiative

[Name of the Writer]

[Name of the Institution]

Nursing Home Quality Initiative

Introduction

History of the nursing home is coming from the 17th century when English settlers introduced the concept of almshouses. The practice continued through the 20th century and America got nursing homes all over the nation by 1965. Improving the Quality of Care in Nursing Homes Act of 2010 lead the nursing homes performance on the next level. The act was made after the quality concerns of the nursing home. The issue like unskilled nursing, communication gap between patients and nurses, and improper guidance plan were making the Medicare less efficient in the nation. Nursing home quality initiatives were implemented throughout the United States through health policy formulation and implementation. It included the study of the current methodology using in the nursing home, nature of the relationship among Medicaid services and centers of Medicare. The core objective of the implementation is to assess the nursing home by doing the survey and promoting organizational changes. The initiative guides the organizations and leader because leadership is the crucial component for quality improvement in nursing homes. Nursing home quality initiative measures the methodology and health care payment and its impact on quality improvement. Report is made every year which provide the obtained points on quality scale for each nursing home. The reports are publically available which is useful for the consumers as it helps them to compare different nursing homes and their quality to select the best one within their residential area. The study regarding nursing home quality initiative is important to study as it helps us to understand the measure that nursing homes are taking and the changes which are being made by them to improve the quality. The quality improvement is not only important to improve the patient's health but also for the reputation of the nursing home as NHQI provides the outcome on improvement scale each year.

Literature Review:

In the article (Bakerjian & Zisberg, 2013), researchers researched about the quality assurance improvement program that had been implemented to improve the nursing staff quality. The case study is used to analyze the progress of the improvement program in nursing homes. The analyses concluded that leadership and administration play an important role to improve the quality of the nursing homes. Whenever leaders provide professional leadership to their staff, sustainability in quality improvement increased. QI concept was implemented to the ulcer patient but results indicate that the way nurses took the responsibility and showed improvement, program can be applied to other complex diseases where poor outcomes are identified. QAPI program if compliance with the new regulation, an improved outcome can be illustrated as it provides the systematic way of planning and thinking regarding the division of labor and their duties that should be application-oriented and straight forward.

In the article (Berlowitz et al., 2003), researchers examined the QI implementation in the nursing homes. They also focused on the QI association with the culture of the organization and its influence on pressure ulcer care. To complete the research primary data was used from thirty-five nursing homes that maintained the organizational culture and QI implementation. Other data that was considered in the research included the database and medical records. The study was based on cross-sectional analysis where the survey was conducted in which 1065 nurses participated. The finding from the data indicated that the improvement in nursing homes was more where organizational culture, teamwork, and innovation was mainly focused. There was an increase of 0.83 points in these nursing homes out of five satisfaction scale. Researchers concluded that quality improvement implementation is highly successful in the nursing home with innovation promotion and organizational culture. In addition, staffs who are satisfied with their job and believe that they are providing better care are the core reason for the improvement in nursing home performance.

In the article (Castle & Ferguson, 2010) researcher conducted the research whose main purpose was to analyze the nursing home quality and its indicators that help to measure it. The research was based on past data and researches. SPO model was used to analyze the data. Quality indicators that are discussed in the research include; deficiency citations, nursing home compare, facility quality indicator profile report, and the advancing excellence campaign. The result indicated that indicators to measure the nursing home quality are a mix of the outcome measure, structural, and process which not only note the advantages but also the disadvantage of program. Some steps need to be taken for future improvement which include; advanced policy in the certification process, pay for performance, report cards, and market-based incentives. Therefore, it can be concluded that the nursing home is showing improvement and their indicators are perfectly highlighting the chances, however, there is still a room to enhance the quality of nursing homes.

In the article (Harris, n.d.), the outcome of the nursing home quality measurement has been observed. The article explained the nursing home quality program, its implications, consequences, and lessons learned for future work. The article is useful to understand the NHQI. CMs worked on improving the communication with beneficiaries of Medicare to ensure the guidance to the families of the patients regarding the healthcare of the patients. Development of nursing home QIs began in mid1990 when health care financing administration took initiatives to sponsor the payment demonstration for skilled nursing facility perspective. The initiative gets advanced in contemporary time by introducing the internet tool known as nursing home compare. This tool measures the performance of the nursing home and allows consumers to compare the facilities of different nursing homes. The nursing home quality initiative began in 2002 where quality improvement organization collaborate with CMS and provide the quality improvement information publically. Researchers through the collected information concluded that NHQI is the implementation that improves the quality of nursing at the nursing home and it provides the complete spectrum of performance which is useful for the consumers to identify the excellent facility in their area.

In the article (Rahman & Applebaum, 2009), minimum data set MDS is studied to measure the nursing home quality. The past researches related to MDS is included to understand the instrument in depth. In addition, MDS version 1 and 2 is used to check the manifest function of MDS. Consequences and evaluation of MDS 3.0 concluded that MDS is the instrument that is helpful to increase validity, measurement accuracy, and reliability. It provides an accurate assessment and defined nursing home quality effectively. However, not all version of MDS is equally efficient. Unintended concerns are observed whenever MDS is used for multipurpose. Therefore, even using in different tasks like the effort to serve regulators, researchers, funders, consumers, and facilities, MDS may not fulfill the expectation due to the conflicting demands. MDS 3.0 is best to use within a broad multifaceted quality improvement framework.

In the article (Weissblum, Huckfeldt, Escarce, Karaca-Mandic, & Sood, 2019), the researcher focused on the Skilled Nursing Facility Participation in Medicare’s Bundled Payments for Care Improvement Initiative. The main objective of the research is to find out the difference in the characteristics of patients and facility along with the outcome between participants and skilled nursing facilities. The article is based on the retrospective study and cross-sectional analysis between BPCI non-participants and participants. Total of 15,172 medical certified SNFs and 873,739 patients of these SNFs during 2011-2012 became the participant for the research. Bundled payment program was the interventions which are used to make the assessment of the nursing quality which included the financial responsibility of care for ninety days. The results indicated that quality improvement is higher in the participant of SNFs than the non-participants. Patients find a socioeconomic status patient with similar clinical characteristics. In addition, admission duration and readmission rates show a prominent fall for BPCI participants than the non-participants.

Conclusion

The study of the nursing home quality initiative is significant to understand the role of a performance evaluation project for quality improvement. Literature review evaluated the importance of the nursing home quality initiative through various implementation and past researches. Through the literature reviews, it can be conducted that leaders and administration plays an important role to increase the nursing quality through efficient professional leadership. By making an effort on organizational culture, teamwork, and innovation quality can be increased. This is because staff who are satisfied with their jobs and find positive organizational culture are more willing to perform better. Deficiency citations, nursing home compare, facility quality indicator profile report, and the advancing excellence campaign are some of the indicators that are helpful to analyze the improvement in quality accurately. Minimum data set MDS is significant to measure the quality improvement however not all version of the MDS provides the accurate results. MDS 3.0 is useful if used within a broad multifaceted quality improvement framework. In addition, payment demonstration implementation and Bundled payment program resulted in lowering the days of patients staying in the nursing home and the readmission of the patients also fell as compared to the patient who did not participate in the program. Through the conclusion, it can be recommended that leadership and administration should be trained to bring improvement more rapidly. In addition, different programs like payment demonstration implementation, Bundled payment program, and other new programs should be implemented in the nursing house. The method for analyzing the quality measure should be efficient to avoid the inaccurate reports of the nursing homes’ performance.

References

Bakerjian, D., & Zisberg, A. (2013). Applying the Advancing Excellence in America’s Nursing Homes Circle of Success to improving and sustaining quality. Geriatric Nursing, 34(5), 402–411. https://doi.org/10.1016/j.gerinurse.2013.06.011

Berlowitz, D. R., Young, G. J., Hickey, E. C., Saliba, D., Mittman, B. S., Czarnowski, E., … Moskowitz, M. A. (2003). Quality Improvement Implementation in the Nursing Home. Health Services Research, 19.

Castle, N. G., & Ferguson, J. C. (2010). What Is Nursing Home Quality and How Is It Measured? The Gerontologist, 50(4), 426–442. https://doi.org/10.1093/geront/gnq052

Harris, Y. (n.d.). Achieving Improvement Through Nursing Home Quality Measurement. HEALTH CARE FINANCING REVIEW, 23(4), 14.

Rahman, A. N., & Applebaum, R. A. (2009). The Nursing Home Minimum Data Set Assessment Instrument: Manifest Functions and Unintended Consequences--Past, Present, and Future. The Gerontologist, 49(6), 727–735. https://doi.org/10.1093/geront/gnp066

Weissblum, L., Huckfeldt, P., Escarce, J., Karaca-Mandic, P., & Sood, N. (2019). Skilled Nursing Facility Participation in Medicare’s Bundled Payments for Care Improvement Initiative: A Retrospective Study. Archives of Physical Medicine and Rehabilitation, 100(2), 307–314. https://doi.org/10.1016/j.apmr.2018.08.186