Content by Keyword: Nurses

We observed part of a QAN visit, which was said to be "fairly typical." In preparation for the visit, the QAN nurse reviewed the following: the facility's Quality Indicator (QI) reports and trends, trends in casemix, complaint issues, and discharge issues. QAN visits were said to be generally focused on issues identified by the QAN in advance of t

As noted above, QAN staff are responsible for a number of activities such as conducting surveys in addition to their role providing information exchange (technical assistance). The latter activity is referred to as "QANing" and is the heart of the state's unique program.

In Washington, quality assurance activities occur at several different levels. The state is divided into six geographic regions, with a core staff of surveyors assigned to each region. In each region, there are dedicated complaint nurses who investigate complaints initiated by the public or facility self-reports. Each region also has a team of qu

Washington's QAN program has evolved over time. The state traces its origins to a program in the 1970s in which a "Nursing Care Consultant" from the state was in each facility about once a month to perform utilization review. Transformation of this role to include additional aspects of quality was spurred by Congressional passage of OBRA '87--the

Abt staff member Terry Moore and project team consultant Barbara Manard met with individuals involved in the management and operation of Washington's QAN program, as well as representatives from two of the state's provider groups, the state's Long Term Care Ombudsmen, and others familiar with the state's program. Over a three-day visit in Septembe

Since Texas, like most states, has substantial budget problems, virtually all programs are theoretically at greater risk now than in better economic times. Most of the programs are relatively inexpensive and during our visit, the only program that was said to be potentially vulnerable in the short term was the new Quality Monitor Program. Among th

This educational initiative began in April 2000. The program is a self-sustaining effort funded through registration fees (about $20,000 per session). The purpose of the series is to provide a forum to disseminate information to facility staff and others (DHS surveyors, social workers, consulting pharmacists, LTC regulatory staff, LTC physicians,

The Quality Monitor Program is paid for with Title 19 funds and was budgeted for the first biennium of operation at approximately $2.7 million. The match is 50 percent federal and 50 percent state for the managers and 25 percent state, 75 percent federal for the nurses in the field. In order to fund its share of this program, the state transferre

SB 1839 also mandated the development of "Rapid Response Teams" (RRTs) that are used to conduct more comprehensive assessments of facility quality than a single monitor can accomplish. An RRT is made up of two or more Quality Monitors. The RRT sometimes operates as a "SWAT Team", going unannounced to facilities that have been identified as being

The Statewide Quality Review provides an independent, structured assessment of the appropriateness of care for specific clinical issues identified by the state as quality improvement priorities. This initiative is a legislatively-mandated annual study of quality of care, quality of life, and consumer satisfaction in Texas nursing homes. First cond

The Missouri program is unique for several reasons. First, it is the only quality improvement program identified by the research team that involves an agreement between a state survey agency and a university. The activities of the university are entirely separate from that of the state survey agency and each appears to respect the others' area of

QIPMO faces an uncertain future and during our visit Dr. Rantz had voiced serious concerns about the program's chances for survival. The transition of the survey agency into the Department of Health with the resulting loss in staff that had previously supported the program coupled with the QIO initiative has created an uncertain situation. Rantz s

Missouri is far ahead of other states in terms of evaluating the impact of its quality improvement programs. Dr. Rantz uses MDS data to measure the change in quality indicators associated with the program and has published several journal articles that report these results. In addition, facilities that receive QIPMO visits provide feedback through

Although the feedback from facilities on the value and effectiveness of the various aspects of the QIPMO program was very positive, it was reported that less than half (45 percent) of Missouri facilities take advantage of the free program. When questioned as to reasons for non-participation, those we spoke with stated that facilities that were par

Most of the stakeholders contacted believed that the program as a whole was very beneficial. Feedback from providers that is collected on evaluation forms following technical assistance visits by the QIPMO nurses was overwhelmingly positive. A facility director of nursing expressed that "QIPMO visits are free, not punitive, supportive and encourag

Technical assistance visits are conducted by seven QIPMO nurses, with each nurse covering one of the seven geographic areas of the state. Requests for visits are received by the program coordinator at the University School of Nursing who in turn contacts the nurse covering that particular region. Educational programs are provided by both the QIPMO

There are three sources of funding for state quality improvement programs: (1) Nursing facility quality improvement fund, (2) Annual nursing facility licensing fee and (3) Civil Money Penalty fines. The state has a bed tax based on the number of residents in each facility. By law, a portion of the tax must be spent on quality improvement. Because

The Missouri Quality Improvement Program for Missouri (QIPMO) is an on-site clinical consultation program intended to assist nursing homes with their quality improvement programs. There are several distinctive features of the QIPMO program:

As we compare the various state programs, the research team determined that it would be useful to identify a standard for quality improvement that could be applied to the various state programs as a means by which to compare them. The following key principle and framework for quality improvement as described by Dr. M. Rashad Massoud was identified

Marilyn Rantz states that the guiding principle of QIPMO is that "things can be done differently." She explains that much of the care provided in nursing homes is routine and is provided the way it is simply because "it's always been done that way." The QIPMO nurses challenge facilities to think about care planning differently and to make changes