Objectives: The National Academies of Sciences, Engineering, and Medicine (NASEM) Nursing Home Quality report recommends that states “develop and operate state-based…technical assistance programs…to help nursing homes…improve care and…operations.” The Quality Improvement Program for Missouri (QIPMO) is one such program. This longitudinal evaluation examined and compared differences in quality measures (QMs) and nursing home (NH) characteristics based on intensity of QIPMO services used.

Design: A descriptive study compared key QMs of clinical care, facility-level characteristics, and differing QIPMO service intensity use. QIPMO services include on-site clinical consultation by expert nurses; evidence-based practice information; teaching NHs use of quality improvement (QI) methods; and guiding their use of Centers for Medicare and Medicaid Services (CMS)-prepared QM comparative feedback reports to improve care.

Setting and Participants: All Missouri NHs (n = 510) have access to QIPMO services at no charge. All used some level of service during the study, 2020–2022.
Methods QM data were drawn from CMS’s publicly available website (Refresh April 2023) and NH characteristics data from other public websites. Service intensity was calculated using data from facility contacts (on-site visits, phone calls, texts, emails, webinars). NHs were divided into quartiles based on service intensity.

Results:All groups had different beginning QM scores and improved ending scores. Group 2, moderate resource intensity use, started with “worse” overall score and improved to best performing by the end. Group 4, most resource intensity use, improved least but required highest service intensity.

Conclusions and Implications: This longitudinal evaluation of QIPMO, a statewide QI technical assistance and support program, provides evidence of programmatic stimulation of statewide NH quality improvements. It provides insight into intensity of services needed to help facilities improve. Other states should consider QIPMO success and develop their own programs, as recommended by the NASEM report so their NHs can embrace QI and “initiate fundamental change” for better care for our nation’s older adults.

Rantz, M.J., Martin, C., Zaniletti, I., Mueller, J., Galambos, C., Vogelsmeier, A., Popejoy, L., Thompson, R.A., & Crecelius, C. (2024). Longitudinal evaluation of a statewide Quality Improvement Program for Nursing Homes. Journal of the American Medical Directors Association. Published online January 31, 2024.

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Purpose: To identify leadership styles and staffing strategies in Missouri long-term care (LTC) facilities that stood out among their peers as “positive deviants” with regard to COVID-19 infections and staffing shortages.

Methods: Statewide survey of all LTC facilities to identify exemplar facilities with stable staffing and low rates of COVID-19. Interviews with senior leaders were conducted in 10 facilities in the state to understand the strategies employed that led to these “positive outliers.” A result-based educational program was designed to describe their actions and staff reactions.

Results: Exemplar leaders used transformational leadership style. Top reasons for their success were as follows: (1) trusting and supportive staff relationships; (2) positive presence and communication; and (3) use of consistent staffing assignments. Strong statewide participation was noted in the educational programs.

Martin, N., Frank, B., Farrell, D., Brady, C., Dixon-Hall, J., Mueller, J., & Rantz, M. (2022). Sharing lessons from successes – long-term care facilities that weathered the storm of COVID-19 and staffing crises. Journal of Nursing Care Quality, 38(1), 19-25.

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The National Academies of Sciences, Engineering, and Medicine (NASEM) convened a committee in Fall 2020 to address the quality of nursing home care with three specific tasks: (1) examine how our nation delivers, regulates, finances, and measures the quality of nursing home care; (2) delineate a framework and general principles for improving the quality of care in nursing homes; and (3) consider the impact of the coronavirus disease 2019 (COVID-19) pandemic on nursing home care. The Committee comprised 17 members, including six nurses. Over a period of 18 months, the Committee held numerous meetings, including public forums with key stakeholders, conducted extensive reviews of the evidence, and produced a report with seven goals along with recommendations specific to those goals. The complete report is available in print and online (NASEM, 2022). The following discussion describes the seven goals, which address Tasks 1 and 2. With regard to Task 3, the Committee’s conclusion was that the COVID-19 pandemic made evident the long-standing deficiencies in nursing home care in the United States. As a family caregiver stated in her testimony to the committee, “The pandemic has lifted the veil on what has been an invisible social ill for decades.” The pandemic resulted in high rates of mortality for residents and staff and shed light on each area described in the Committee’s recommendations.

Alexander, G.L., Travers, J., Galambos, C., Rantz, M., Ferrell, B., & Stevenson, D. (2022). Strategic recommendations for higher quality nursing home care in the United States: The NASEM report. Journal of Gerontological Nursing, 48(11), 3-6.

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The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff

The Committee on the Quality of Care in Nursing Homes began their work in the fall of 2020 at a pivotal time when a bright light had been cast on care delivered in nursing homes because of the COVID-19 pandemic. While much of society previously had little awareness of the care delivered in nursing homes, the evening news channels and social media projected daily images of the pandemic’s impact and of the inadequate care that put the safety of both residents and staff at risk while distraught family members watched from afar as their frail older loved ones were kept in isolation. The committee worked to describe the care being delivered in nursing homes before the pandemic, now made manifest by the crisis.

Read the full report HERE! Or check out the highlights (summary document) HERE!

Press regarding the report release: Associated Press | McKnights Long-Term Care News | STAT | Modern Healthcare | ABC 17 (KMIZ) News

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Marilyn Rantz, a Curators’ professor emerita at the MU Sinclair School of Nursing, is a member of the Committee on the Quality of Care in Nursing Homes. The panel was organized by the National Academies of Sciences, Engineering and Medicine and first met in the fall of 2020, according to a news release.

Read the full article about the committee’s report HERE!

KOMU News, April 18, 2022. Written by Hannah Norton.

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MU Sinclair School of Nursing was well represented by two members of the QIPMO team in a June 2021 public webinar sponsored by the National Academies of Science, Engineering, and Medicine to inform the national study currently being conducted by the Academies about the Quality of Care in Nursing Homes: www.nationalacademies.org/our-work/the-quality-of-care-in-nursing-homes.

QIPMO was invited to present about the statewide service provided to all the nursing homes in Missouri. It is a program funded by the MO Department of Health and Senior Services that was developed by research conducted by faculty of the Sinclair School of Nursing. The program began in 1999 and continues today to improve the quality of care of nursing home residents in Missouri.

View the presentation HERE!

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It was late afternoon on Jan. 30, 2020. A nurse from the Quality Improvement Program for Missouri (QIPMO) was leading a standard table top influenza pandemic exercise in Poplar Bluff when a call came through that would forever change the way healthcare would operate. The words were ominous and foreboding. “Folks, the CDC just confirmed the first case of coronavirus in the United States. This is no longer a drill.”

Click HERE to view the full-text article!

Pool, D. & Boren, W. (2020). Second responders: Answering the call for help in long-term care. McKnight’s Long-Term Care News, accessed online August 27, 2020.

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In the United States, the first case of the novel coronavirus 2019 (COVID-19) was detected in January 2020 in the state of Washington. By February 2020, COVID-19 was linked to 167 confirmed cases of staff and residents within a single nursing home in that same state, resulting in 34 deaths. As of March 21, the Kaiser Family Foundation reported that 7732 long-term facilities in 43 state had known COVID-19–positive residents. In the 38 states that reported nursing home mortality data, COVID-19 is responsible for 42% of the deaths. Residents in long-term care facilities are especially vulnerable to the effects of respiratory-borne illness (e.g. influenza), which now includes COVID-19. However, the vulnerability of nursing home residents goes beyond age, physical condition, and frailty and includes their physical environment. Nursing home residents share common caregivers and reside in close, often shared, living arrangements. In addition, pathogenic spread can occur through exposure during transfers to/from the hospital as well as exposure to staff, visitors, and other health care workers who go in and out of the facility.

Popejoy, L., Vogelsmeier, A., Boren, W., Martin, N., Kist, S., Rantz, M., & Miller, S. (2020). A coordinated response to the COVID-19 pandemic in Missouri. Journal of Nursing Care Quality, 35(4), 287-292.

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Platinum research: MU nursing home improvement program celebrates 20th anniversary

As people age and their health needs change, nursing homes become a source of care and support, especially for those who can no longer live independently.

Since 1999, the Quality Improvement Program for Missouri has been providing clinical practice consultations and technical assistance to nursing homes throughout the state. Curators’ Professor Emerita Marilyn Rantz is the project director for the program, which is a cooperative between the MU Sinclair School of Nursing and the Missouri Department of Health and Senior Services.

Find the full press release here.

Written by Brian Consiglio | Mizzou News

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Due to their role overseeing administrative, operational, and clinical services in nursing homes (NHs), licensed nursing home administrators (LNHAs) are responsible for quality of care and correcting deficiencies identified during the annual certification and survey process. State regulations vary widely in educational and work experience requirements for LNHAs. As an adjunct to traditional education, the Quality Improvement Program for Missouri (QIPMO) offers on-site 2-day survey readiness training from experienced LNHA-consultants to better prepare current LNHAs.

Phillips, L.J., Oyewusi, C., Martin, N., Youse, E., & Rantz, M.J. (2018). Impact of Survey Readiness Training on Nursing Home Quality of Care. Innovation in Aging, 2(Suppl 1), 723.

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