State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. Aspects of QIPs that were Noted to be Less Successful


The central themes regarding aspects of the Maryland quality initiatives that were less successful were around communication of quality initiatives with the Ombudsman, provider access to funding, and the minimum staffing requirement. With the exception of one person we spoke with (a supervisor), Ombudsman were not at all familiar with the Second Survey, and wished that they were more informed about this. In general, ombudsmen were unaware of or at least personally unfamiliar with two other initiatives: the clinical alerts and the decubitus ulcer project. They also objected to facilities' inconsistent approach to communicating with them regarding QA meetings and QA activities. All received different levels of communication from their facilities regarding the QA meetings, some inconsistently received meeting minutes, and all wished to be kept abreast of QA activities on a regular basis.

HFAM believes that the health quality account could be more accessible (argues that state has $2 million in CMP monies that they should be able to access for QIPs). Lifespan agreed that more money needed to be made available for quality improvement projects such as WellSpring (Lifespan has applied for grant money from state, but still awaiting approval and funding).

In terms of the staffing requirements, two main areas of program weakness were noted. Ombudsman stated that--despite the facilities' seeming compliance with the posting of staff mandate--facilities often post the number of staff that were on the schedule, not necessarily those that actually reported for work or are actually working on that particular unit. Also some facilities posted the information, but not always in a visible location. This can be confusing for family members. With regard to the minimum staffing requirement, most providers we spoke to believe this requirement to be unnecessary, as the levels required were described as "the bare minimum" and claimed that most facilities staff well above those minimums.

One comment was made regarding potential improvements to the Quality Indicator Study. The state reported that many nursing facilities had unrealistic expectations regarding their expected performance on quality indicators. For example, some facilities may have set goals to have a zero percent QI rate, rather than simply attempting to decrease the rate by a certain percentage. Improved understanding of this issue will be required in order to assist providers in attaining quality improvement goals. The state has begun to conduct an evaluation of this program by looking at baseline data and follow up rates of the three targeted quality indicators.

Another comment was made about the medical director requirement, which was that medical directors are concerned that they do not have enough time to fulfill their responsibilities. For this reason, some questioned the ability of this regulation to have any impact.

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