Quality Improvement in Nursing Facilities

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Resident safety is the basis of high quality health care. Quality improvement focuses on patient safety and practices that prevent harm and promote positive outcomes. The entire health team is critical to the surveillance and coordination of quality improvement that reduces adverse outcomes, and results in the best possible resident care.

A variety of coalitions, initiatives, and organizations are focused on improving quality of long-term care.

Topical Resources

Agency for Healthcare Research and Quality

Quality Improvement Organizations

Quality improvement organizations (QIOs) are funded by the Centers for Medicare & Medicaid Services to work with providers to improve quality of health care. The national organization that represents the state and regional QIOs is the American Health Quality Association.

Advancing Excellence in America’s Nursing Homes

This public-private partnership is a campaign to help improve nursing home quality by encouraging nursing homes to voluntarily commit to improving performance on selected quality measures.  The campaign began in 2006.


ASCP Statement on OIG Report Regarding Adverse Events in Skilled Nursing Facilities
A newly released report from the Department of Health and Human Services Office of Inspector General (OIG) entitled “Adverse Events In Skilled Nursing Facilities: National Incidence Among Medicare Beneficiaries” (February 2014 OEI-06-11-00370), highlights the prevalence of adverse events in Skilled Nursing Facilities (SNF’s). The report sampled 655 Medicare beneficiaries, all of whom stayed in a SNF for less than 35 days. This report sought to determine whether or not an adverse event had occurred, whether the event was preventable, and whether there were any associated costs to the Medicare program because of the event. According to the findings, of the adverse events that happened, 37% were found to be medication related. ASCP released a statement in response to the report’s findings and how consultant pharmacists, the experts in medication management, are uniquely equipped to prevent certain types of adverse events.

CMS Report Indicates Improvement in Five-Star LTC Facility Ratings

The Centers for Medicare and Medicaid Services (CMS) announced in a recent report that long-term care facilities have shown general improvement since the agency launched its Five-Star Quality Rating System. The 2013 Nursing Home Compare Five-Star Quality Rating System: Year Three Report shows a general improvement in all three domains since the implementation of the system: health inspection surveys, quality measures (QM), and staffing levels. The proportion of facilities with a one-star overall rating decreased 7% over the three-year period, and the proportion with a four- or five-star overall rating increased 6%. Staffing scores were the most consistent during the three-year period. QM scores fluctuated the most, although they were held constant from March 2011 to July 2012, due to the implementation of the Minimum Data Set 3.0. CMS credits the rating system, which is intended to help residents and their families distinguish between high and low performing long term care facilities, with motivating facilities to improve performance.

CMS Releases New Quality Assurance and Performance Improvement Tools

In response to provisions in the Affordable Care Act, CMS has released new materials for its Quality Assurance and Performance Improvement (QAPI) program to help nursing homes establish best practices for quality improvement. The new materials are hosted on CMS’s website, and include:

  • QAPI at a Glance, a step-by-step guide for implementing QAPI
  • Four process tools to help nursing homes get started laying a foundation that will sustain QAPI
  • QAPI News Brief – a newsletter describing QAPI principles which can be posted for review by caregivers, residents and family members
  • Video- Nursing Home QAPI – What is in it for you?

For more information about QAPI and available resources, visit CMS’s website. Questions about the program or new materials should be directed to nhqapi@cms.hhs.gov.

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