State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. Summary and Conclusions


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 expertise. Surveyors defer to the QIPMO nurses on clinical issues and QIPMO nurses do not give advice regarding enforcement regulations. The future of the QIPMO program is uncertain, however, as support within the agency and the legislature is no longer sure. The QIO initiative at this particular time adds to the uncertainty by introducing a program that by some opinion duplicates what the state is paying the university to provide.

Secondly, the program has a tireless proponent in Marilyn Rantz. She is a uniquely talented individual, highly trained and experienced in research protocols who brings enthusiasm, vision and commitment to the elderly, the long term care community and quality improvement efforts. The QIPMO program reports voluntary participation of 45 percent of facilities, despite the initial and unfortunate connection to the survey process. Facilities that use the program overwhelmingly praise the assistance and support offered by the QIPMO nurses.

Lastly, the QIPMO program is unique in that it is research-based. The design of QIPMO was influenced by the results of a randomized clinical trial that was conducted in 1999. In this trial, facilities were assigned to one of three groups (facilities that received workshop and feedback reports only, facilities that also received clinical consultation and a control group.) This research indicated that on-going clinical consultation is effective in influencing change in nursing care that affects resident outcomes. This was the foundation for QIPMO and the "Show-Me" reports. Dr. Rantz and her colleagues have also studied the impact of QIPMO on CHSRA quality indicators in the state. In addition to analyzing median quality indicator scores, the research team analyzes trends for the 90th and 95th percentile, so that the effectives of the program in improving outcomes for low-quality facilities can be understood.

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