ALABAMA QUALITY ASSURANCE FOUNDATION

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ALABAMA QUALITY ASSURANCE FOUNDATION

• FALL PREVENTION PROGRAM IN SKILLED NURSING
  FACILITIES

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Alabama Quality Assurance Foundation - AQAF

• Medicare Peer Review Organization (PRO) for
  Alabama
• Quality Improvement Organization (QIO)
• Under contract to the Centers for Medicare
  Medicaid Services (CMS)
• Statutory Authority Titles XI XVII of Social
  Security Act

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Major Medicare QIO Efforts

• HCQIP
• Local/Alternate Settings
• Managed Care
• PEPP
• Medicare Beneficiary Complaint Program and Other
  Case Review

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AQAF And Nursing Homes

• 6th Scope of Work Contract
• Alternate setting - Skilled Nursing Homes
• Fall Prevention
• Convened a study group
• Representatives from ADPH, ANHA, UAB, nursing
  home staff

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Collaborative Partnerships

• Alabama Nursing Home Association
• Alabama Dept. of Public Health - Division of
  Health Care Facilities
• Key nursing home staff DON, CNA, administrator,
  corporate nurse
• Medical Directors
• Researchers - University of Alabama at Birmingham
  
• QI healthcare consultant

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Objectives

• Develop collaborate relationships with nursing
  homes
• Strengthen quality improvement processes within
  skilled nursing facilities
• Decrease falls in skilled nursing facilities

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Outcome Assessment

• Fall Rates
• Assessment of Team Function
• Program Evaluation

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Inclusion Criteria

• skilled nursing unit
• 70-160 beds
• designated fall prevention team
• administrator or DON in place at least 1 year
• letter of cooperation signed
• attend Fall Prevention 2-day seminar
• willing to assist in eval of current CQI plan

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Recruitment

• Introductory letter by State Health Officer
• Brochure and letter from AQAF
• 40 letters sent to SNFs with QI rates for falls
  above state average for 1999 17 letters of
  cooperation returned
• 1st 14 facilities to return letter were invited
  to participate

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Interventions

• Randomize into 2 groups
• immediate intervention (Oct. 2000-May 2001)
• delayed intervention (June 2001-Dec. 2001)
• Introductory site visit
• identify current QA process
• Vanderbilt Fall Prevention Seminar

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AQAF Interventions

• Quality Improvement/Continuous Improvement
  Seminar
• primer developed
• teaching methods included
• lecture, demonstration and small group root cause
  analysis using falls as the problem
• concepts included
• team functioning
• conducting team meetings
• root cause analysis

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AQAF Interventions

• Monthly newsletter
• falls and quality improvement articles
• AQAF onsite visits
• CEUs for inservices/conferences
• Close-out meeting
• pizza party and evaluation of project

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Evaluation of Interventions - Newsletters
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Evaluation of Interventions - AQAF Onsite Visits
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Evaluation of Interventions - CI Inservice
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Evaluation of Interventions -2-Day Vanderbilt
Training
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Overall Effectiveness of Vanderbilt Fall Program
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Facility Fall Rates - Immediate Intervention
Facilities
Pre-Intervention
1st Period
2nd Period
Post-Intervention
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Facility Fall Rates - Delayed Intervention
Facilities
Pre-Intervention
1st Period
2nd Period
Post-Intervention
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Potential Implications for Alabama Nursing Homes

• Prevent 4,000-9,000 falls per year
• Prevent 400-900 serious injuries per year
• Reduce number of deaths due to hip fractures
• Increase quality of life for residents by
  decreasing morbidity and fear of falling

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Team Assessment

• Nursing Home Culture
• Work Satisfaction
• QI and Fall Prevention Team Activities
• Supervisor Expectations

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Team Assessment

• Nursing Home Culture
• To what extent are the following items
  characteristic of your nursing home
• work together as a team
• ethical in their work
• constructively deal with disagreements
• remain focused on goals of careplan
• incorporate different staff perspectives into
  careplan

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Team Assessment

• Staff/Work Satisfaction
• How satisfied are you with the current effort of
  your nursing home
• assist families and caregivers with difficult
  problems
• improve quality of care
• reduce risk of resident falls
• resolve difficult technical problems
• resolve problems between different members of
  care team

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Team Assessment

• QI and Fall Prevention Team Activities
• How would you describe the effort staff in your
  nursing home devote to
• improving quality of care
• problem-solving on challenging residents
• productive team meetings
• assessing resident risk for falls
• reducing resident risk for falls
• overcoming misunderstandings among team members

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Team Assessment

• Supervisor Expectation
• Indicate the extent to which the following items
  are important expectations of your supervisor in
  your work
• attendance at team meetings by staff caring for
  residents
• improving quality of care
• preventing falls
• reducing risk of lawsuits
• meeting state survey requirements

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Team Assessments - Immediate Intervention
Facilities
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Team Assessments - Delayed Intervention Facilities
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Potential Implications for Alabama Nursing Homes

• Increase in staff satisfaction which may lead to
  decreased staff turnover
• Enhanced team efforts to improve quality of care
  for residents
• Improved quality of care leading to better
  resident outcomes

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Websites

• www.rnplus.com - website devoted to falls and
  restraints
• www.ascp.com - website of the American Society of
  Consulting Pharmacists
• www.aqaf.com

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Thank You to Facilities That Participated in the
AQAF Fall Prevention Project
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Whats Next?
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Publicly Reported Quality Measures

• New CMS (formerly HCFA) initiative to publicly
  report a set of quality measures for all nursing
  homes in the US
• Initial pilot project to occur in six states
• CO, FL, MD, OH, RI, WA
• Dates
• April - September 2002 Six State Pilot
• October 2002 National Rollout for all NHs
• 2003 - Possible rollout into HHA, Hospital, other
  providers

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Selection of the Quality Measures

• National Quality Forum Steering Committee
  recommended measures to CMS (www.qualityforum.org)
  
• 9 measures for six state pilot
• Some, none, or all 9 of the pilot measures could
  be used when the initiative goes national

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Publicly Reported Quality Measures

• Derived from MDS data only
• Post Acute Pain Management, Walking Improvement,
  Delirium
• Chronic ADL Decline, Infections, Pain
  Management, Pressure Ulcers, Restraints, Weight
  Loss

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CHSRA Indicators vs. Publicly Reported Quality
Measures

• Some clinical concepts overlap, some dont
• Short stay and long stay measures
• Risk adjustment strategies
• Inclusions and exclusions may be different
• QMs calculated on a quarterly basis

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Purpose of CMSs New Initiative

• Provide an additional data source to assist
  consumers decision making when selecting a
  nursing home
• Assist facilities to more effectively focus on
  quality improvement

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No Changes to State Survey

• State Survey Agency will still use the current
  CHSRA Quality Indicators
• State Survey process remains the same
• Facilities will still have access to their CHSRA
  QIs and reports through the state system.

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AQAFS Role in National Initiative

• Partner with state stakeholders
• Provide educational programs and materials to all
  nursing homes in the state
• Recruit a number of nursing homes to work more
  intensely with in implementing quality
  improvement strategies based on the QMs

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Websites

• www.cms.hhs.gov - latest information on nursing
  home initiative
• www.medicare.gov/nhcompare/home.asp - nursing
  home comparison website
• www.ahca.org - American Health Care Association
• www.ahqa.org - American Healthcare Quality
  Association

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For further information contactAQAFSue
Boldin, RN., MSN, CPHQ [phone] ext.
3232(205) 970-1600 ext. 3232alpro.sboldin_at_sdps.
orgor visit our website atwww.aqaf.com

• This material was prepared by Alabama Quality
  Assurance Foundation under a contract with the
  Centers for Medicare Medicaid Services (CMS).
  Contents do not necessarily represent CMS policy.
  6SOW-AL-GEN-02-26