Nursing Home Quality Award Criteria
Nursing Home recipients of the 2016 HealthInsight Quality Award will be selected based upon the following criteria:
Using the MDS 3.0 quality measures reported on www.medicare.gov, ALL of the long stay quality measures will be selected for analysis. Facilities that have obtained a ranking at or above 75% and that have an overall star rating of three or higher, will meet Part One of the award criteria. Achievement of this ranking (at or above 75%) is not based on each individual measure, but on a cumulative basis of all quality measures in this analysis. These measures are:
- Percent of long-stay residents experiencing one or more falls with major injury
- Percent of long-stay residents who had a urinary tract infection
- Percent of long-stay residents who self-report moderate to severe pain
- Percent of high-risk residents who have pressure ulcers
- Percent of long-stay low-risk residents who lose control of their bowels or bladder
- Percent of long-stay residents who have/had a catheter inserted and left in their bladder
- Percent of long-stay residents who were physically restrained
- Percent of long-stay residents whose need for help with daily activities has increased
- Percent of long-stay residents who lose too much weight
- Percent of long-stay residents who have depressive symptoms
- Percent of long-stay residents assessed and given the seasonal influenza vaccine
- Percent of long-stay residents assessed and given the pneumococcal vaccine
- Percent of long-stay residents who received an anti-psychotic medication
The rankings and applicable star ratings are based on the April 2016 update of Nursing Home Compare, and represent the time period 1/1/2015 - 12/31/2015. Please note that any nursing home who has received a deficiency citation rated at scope and severity 'G' or more severe will be excluded from eligibility.
In order to meet the final 2016 HealthInsight Quality Award criteria, nursing home facilities must select one of the below methods and share with HealthInsight details of improvement efforts as noted.
Too often, nursing facility residents experience potentially avoidable inpatient hospitalizations. These hospitalizations are expensive, disruptive and disorienting for frail elders and people with disabilities. Nursing facility residents are especially vulnerable to the risks that accompany hospital stays and transitions between nursing facilities and hospitals, including medication errors and hospital-acquired infections.
Demonstrate how your facility has targeted reducing readmissions to acute care. Describe improvement efforts by sharing with HealthInsight both qualitative and quantitative data related to how your facility organized around this national initiative and what your results were. Positive trending is required to meet this portion of the award criteria but all positive trends are welcome (no minimum improvement is required). Data shared must represent a minimum of two full quarters and must occur within the previous twelve months. At a minimum, facilities will need to share:
- How the need for improvement was identified.
- How your facility organized itself around the effort. Was a team formed? Who were the members? What role did leadership play in the project?
- How was performance measured? How did your facility know that the interventions were appropriate? How did your facility know if the interventions were working or not working?
- What were the interventions? What did you do and how did you do it? What is different today as a result of this project that was not occurring before it began?
- What were the results? What percentage of improvement did you experience? What was your return to acute (RTA) rate before the initiative (baseline) and what were your results after the initiative (remeasurement)?
- Did you partner with any local hospitals or other community health care providers? If so, please share your experience.
– OR –
It has been a common practice to use various types of psychopharmacological medications in nursing homes to try to address behaviors without first determining whether there is a medical, physical, functional, psychological, emotional, psychiatric, social or environmental cause of the behaviors. Medications may be effective when they are used appropriately to address significant, specific underlying medical or psychiatric causes, or new or worsening behavioral symptoms. However, medications may be ineffective and are likely to cause harm if given without a clinical indication. CMS recognizes the problematic use of medications, such as antipsychotics, in nursing homes and other settings (i.e. hospitals, ambulatory care) as a "quick fix" for behavioral symptoms or as a substitute for a holistic approach that involves a thorough assessment of underlying causes of behaviors and individualized, person-centered interventions.
Share quantitative and qualitative data with HealthInsight showing how your facility has focused on reducing the unnecessary use of antipsychotic medications for people with dementia by incorporating the fundamental principles of care for a resident with dementia. These principles are founded on an interdisciplinary approach that focuses on the needs of the resident as well as the needs of the other residents in the nursing home, and include:
- Person-Centered Care. How does your facility provide a supportive environment that promotes comfort and recognizes individual needs and preferences?
- Quality and Quantity of Staff. How does your facility assess the staffing ratios and the quality of staff training in relationship to meeting the needs of the residents as determined by resident assessments and individual plans of care? (i.e., timely interactions to engage resident in meaningful activity to prevent frustration or anxiety; addressing loneliness, depression, or care preferences)
- Thorough Evaluation of New or Worsening Behaviors. Describe the process for evaluating new or worsening behavioral or psychological symptoms of dementia (BPSD) by the interdisciplinary team, including the physician, in order to identify and address treatable medical, physical, emotional, psychiatric, psychological, functional, social and environmental factors that may be contributing to behaviors.
- Individualized Approaches to Care. Describe the consistent process used to reduce behavioral expressions of distress in some residents by identifying a resident's individual needs and understanding behavior as a form of communication.
- Critical Thinking Related to Antipsychotic Drug Use. Explain how your facility determines if a resident may benefit from the use of antipsychotic medications to treat a specific condition and target symptoms as diagnosed and documented in the record. What is the process used for gradual dose reductions and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs? Provide data on the number of residents with dementia in your facility and the number of those residents prescribed an antipsychotic medication. Include the number of gradual dose reductions attempted and antipsychotic medications discontinued. Data shared must represent a minimum of two full quarters and must occur within the previous twelve months.
- Engagement of Resident and/or Representative in Decision-Making. Describe how your facility involves residents (to the extent possible) and/or family or resident representatives in the discussion of potential approaches to address behavioral symptoms. How do you ensure these conversations are documented consistently in the medical record?
In Utah, applications are due August 31, 2016. For questions, contact Michelle Carlson in Utah at (801) 892-6646.
In Nevada, applications are due August 10, 2016. For questions, contact Donna Thorson at (702) 933-7327.
For questions about the Nursing Home Quality Award progam in New Mexico, contact Khara Davis at (505) 998-9755.