State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. Aspects of Missouri's Quality Improvement Programs Noted to Work Well


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 encouraging." QIPMO visits have been available since mid-2000 and current facility participation runs around 45 percent. Monthly support groups, initiated in May 2000, seem to be instrumental in introducing the QIPMO nurses to the community, providing education and networking support for the MDS Coordinators and at the same time indirectly promoting the program.

The fact that the quality improvement activities operate separately from the survey activities and that each entity favors and respects the separation was seen as a positive aspect of the program. Surveyors appear to defer to QIPMO nurses on clinical issues, while the QIPMO nurses do not get involved in enforcement/regulatory issues. The survey agency has taken a strong stance in maintaining their role as monitors and regulators and distancing themselves from any consultative role.

The strong leadership and vision of Marilyn Rantz is seen as another positive aspect to the program. Others were impressed by her knowledge of issues related to quality of care in nursing homes and her research skills, as well as her passion for improving quality and her determination in obtaining support for quality improvement programs. She has had to use all of these qualities to successfully implement QIPMO in Missouri. Her experience having worked under David Zimmerman and her familiarity with the CHSRA QIs along with her employment as a nursing home administrator for a 400-bed county home prepared her both as a quality expert and as someone experienced in dealing with the politics sometimes necessary to achieve one's goals. Her strong background in education has been critical to the development and structure of QIPMO and to the training of the QIPMO nurses.

The fact that the QIPMO program is research based puts the program ahead in other states in terms of evaluation and demonstrated effectiveness. The technical assistance visits grew out of a pilot program that demonstrated the effectiveness of on-going, on-site visits by advanced practice nurses on resident outcomes. Dr. Rantz and her colleagues have completed numerous studies on the impact of QIPMO on nursing home residents as measured by the CHSRA quality indicators.

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