Abstract
Purpose
The purpose of this article is to review the impact of advanced practice registered
nurses (APRNs) on the quality measure (QM) scores of the 16 participating nursing
homes of the Missouri Quality Initiative (MOQI) intervention. The MOQI was one of
7 program sites in the US, with specific interventions unique to each site tested
for the Centers for Medicaid and Medicare Services Innovations Center. While the goals
of the MOQI for long-stay nursing home residents did not specifically include improvement
of the QM scores, it was anticipated that improvement most likely would occur. Primary
goals of the MOQI were to reduce the frequency of avoidable hospital admissions and
readmissions; improve resident health outcomes; improve the process of transitioning
between inpatient hospitals and nursing facilities; and reduce overall healthcare
spending without restricting access to care or choice of providers.
Methods
A 2-group comparison analysis was conducted using statewide QMs; a matched comparison
group was selected from facilities in the same counties as the intervention homes,
similar baseline QM scores, similar size and ownership. MOQI nursing homes each had
an APRN embedded full-time to improve care and help the facility achieve MOQI goals.
Part of their clinical work with residents and staff was to focus on quality improvement
strategies with potential to influence healthcare outcomes. Trajectories of QM scores
for the MOQI intervention nursing homes and matched comparison group homes were tested
with nonparametric tests to examine for change in the desired direction between the
2 groups from baseline to 36 months. A composite QM score for each facility was constructed,
and baseline to 36-month average change scores were examined using nonparametric tests.
Then, adjusting for baseline, a repeated measures analysis using analysis of covariance
as conducted.
Results
Composite QM scores of the APRN intervention group were significantly better (P = .025) than the comparison group. The repeated measures analysis identified statistically
significant group by time interaction (P = .012). Then group comparisons were made at each of the 6-month intervals and statistically
significant differences were found at 24 months (P = .042) and 36 months (P = .002), and nearly significant at 30 months (P = .11).
Implications
APRNs working full time in nursing homes can positively influence quality of care,
and their impact can be measured on improving QMs. As more emphasis is placed on quality
and outcomes for nursing home services, providers need to find successful strategies
to improve their QMs. Results of these analyses reveal the positive impact on QM outcomes
for the majority of the MOQI nursing homes, indicating budgeting for APRN services
can be a successful strategy.
Keywords
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References
- Gerontological nurse practitioners: Implications for the future.J Gerontol Nurs. 2005; 31: 19-24
- Effects of a geriatric nurse practitioner on processed and outcomes of nursing home care.Am J Public Health. 1989; 79: 1271-1277
- Value-added outcomes; The use of advanced practice nurses in long-term care facilities.Gerontologist. 2000; 40: 654-662
- Care of nursing home residents by advanced practice nurses: A review of the literature.Res Gerontol Nurs. 2008; 1: 1-9
- What is nursing home quality and how is it measured?.Gerontologist. 2010; 50: 426-442
- MDS 3.0 quality measures user’s manual.2017 (Accessed November 26, 2017)
- Initiative to test a multidisciplinary model with advanced practice nurses to reduce avoidable hospitalizations among nursing facility residents.J Nurs Care Quality. 2014; 29: 1-8
- Initiative to reduced avoidable hospitalizations among nursing facility residents shows promising results.Health Affairs. 2017; 36: 441-450
- Successfully reducing hospitalizations of nursing home residents: Results of the Missouri Quality Initiative.J Am Med Direc Assoc. 2017; 18: 960-966
- Metric and Euclidean properties of dissimilarity coefficients.J Classification. 1986; 3: 5-48
- Development and testing of nursing home quality indicators.Health Care Financing Rev. 1995; 16: 107-127
Rantz MJ, Popejoy L, Vogelsmeier A, et al. Lessons learned from MOQI Initiative to reduce avoidable hospitalizations and improve quality in nursing homes with APRNs and interdisciplinary support. Submitted to Journal of Nursing Care Quality. (In press).
- The Interventions to Reduce Acute Care Transfers (INTERACT) quality improvement program: An overview for medical directors and primary care clinicians in long-term care.J Am Med Dir Assoc. 2014; 15: 162-170
- A systematic review of the effectiveness of advanced practice nurses in long-term care.J Adv Nurs. 2013; 69: 2148-2161
- Call to action: APRNs in US nursing homes to improve care and reduce costs.Submitted to Nurs Outlook. 2017; 65: 689-696
- Evaluation of the initiative to reduce avoidable hospitalizations among nursing facility residents: Annual report project year 4.(Available at:)https://innovation.cms.gov/Files/reports/irahnfr-finalyrfourevalrpt.pdfDate: 2017Date accessed: April 14, 2017
- Nursing home quality, cost, staffing, and staff-mix.Gerontologist. 2004; 44: 24-38
- Nursing home costs and quality of care outcomes.Nurs Economic. 2004; 224: 178-192
- The High Cost of Poor Care: The Financial Case for Prevention in American Nursing Homes.The National Consumer Voice for Quality Long-Term Care, formerly NCCNHR, Washington, DC2001 (Available at: http://theconsumervoice.org/uploads/files/issues/The-High-Cost-of-Poor-Care.pdf; 2001. Accessed November 26, 2017)
- The relationship between quality of care and costs in nursing homes.Am J Med Qual. 2006; 21: 40-48
Article info
Publication history
Published online: December 02, 2017
Footnotes
This project is supported by grant number 1E1CMS331080 from the Centers for Medicare and Medicaid (CMS) Innovations Center and Medicare-Medicaid Coordination Office (http://innovation.cms.gov/initiatives/rahnfr/), which is focused on improving care and outcomes for Medicare-Medicaid enrollees residing in nursing facilities. The content is solely the responsibility of the authors and does not necessarily represent the official views of CMS.
The authors declare no conflicts of interest.
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© 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
