State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. Sustainability and Lessons Learned


The State of Washington currently has a $2 billion budget deficit; so all non-mandatory programs will be closely scrutinized. QAN program administrators, however, reported that the program has had the highest level of support by the Administration and that this has been true from the beginning--a critical factor in the program's success they say. One factor that may also help protect the QAN program from budget cuts is the numerous additional roles that the QAN staff plays in addition to QANing. Program managers said that they particularly emphasize the UR function and discharge review to the Legislature, as part of the Agency's mission to make sure that people in Washington State have appropriate choices for care. Further, QAN program managers purposely sought out the casemix review function (which they do as "contractors") because that was seen as a way to provide additional sustenance for the QAN program. By contrast, a newly implemented "Boarding Home/Assisted Living Quality Improvement Consultant (QIC) program that focused solely on quality consulting was recently stripped of its staff due to budget pressures.

Nearly all those with whom we spoke would recommend the QAN program to another state, although many cautioned that any program would need to be tailored to specific conditions in the state. The very few dissenters took issue with the relative effectiveness of this type of program versus another, cautioning other states "Don't do a QAN program if your intent is to improve quality because the effect is likely to be negligible."

The sharpest division among those interviewed regarded the issue of the dual role of the QAN nurses--as both surveyor and provider of information exchange (technical assistance). Program managers and QAN nurses all agreed that the two roles should be integrated, noting "We didn't truly understand the survey until we were trained on it" and "we started with the two roles separate but from experience put them together." Virtually all of the providers interviewed, however, said "The QANs should not also be surveyors," and "Keep the role pure."

Despite that difference, many agreed that the regulatory focus of the QAN assistance (i.e., its close ties to the survey) was a good aspect of the program, one that might well be emulated by other states. Many from both the state and provider sides also emphasized the critical importance of hiring truly top people for the QAN job, given the nature of the task. The program manual and the protocols were also suggested as models for others.

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