State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. Role of Federal Government in Quality Improvement


Washington State was a pilot state for the recent federal piloting of national public reporting of quality indicators (QIs). Many of the suggestions for the federal role were related to the federal QI and quality measures (QM) initiatives and to the QIOs. There were very mixed opinions of the QI/QM public reporting, though general agreement among those who commented that "quality indicator" rather than "quality measure" was a more accurate descriptor, since those interviewed did not believe that the QMs are the only aspect of quality that should be considered when making judgments about facility quality. On QIOs, providers, state program managers, and the Ombudsmen were not very enthusiastic about Washington's experience to date, noting among other things that the QIOs appeared to know relatively little about NFs. Many (among those who were not state employees) said that the money might have been better spent in Washington by giving it directly to the state. Some also suggested that there should be direct grants to the states for innovative quality programs. Among other things, an Ombudsman suggested "[The Federal Government] should focus more funding on best practice programs; they should not divert money to the QIOs, but instead to QAN-like programs."

Some providers expressed concerns about what they perceived to be over-regulation from the Federal Government; others were less concerned about the amount of oversight and most concerned about understandable regulations. One provider suggested that it would be very helpful if the Federal Government paid for a "pre survey," so that facilities would truly know what to expect. A number agreed with the provider who said, "We're over-regulated and under-funded."

Those consumers who were interviewed at a meeting of the Washington Resident Councils Board were intensely focused on the importance of staffing to quality. They said "The best thing the feds can do is whatever it takes to improve staffing," "We need minimum staffing," and "More staffing is essential; sometimes I have to wait 1 hour and 45 minutes to get help." These consumers were also skeptical of the QI/QM initiative, saying "The QIs are too clinical," "The QIs don't tell the quality story; you need to talk to residents and the low level staff know what's going on," and "These was no correlation between performance on those QIs in the pilot and 'real quality' as we can see it from our perspective." Finally, these consumers argued that the Federal Government should do more to assure that there is more consumer (resident) representation on federal quality initiatives such as the QI/QM and QIO projects.

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