Nursing Home Quality Improvement

Nursing Home Quality improvement has always been a large focus for CHSRA. CHSRA researchers are known for the development of the original Quality Indicator (QI) reporting system which the Center for Medicare and Medicaid Services (CMS) released to states in July 1999. This QI reporting system was developed by CHSRA under a subcontract that was part of a general contract with CMS. The QIs developed by CHSRA researchers are markers that indicate either the presence or absence of potentially poor nursing home care practices or outcomes. QIs represent the first known systematic attempt to longitudinally record the clinical and psychosocial profile of nursing home residents in a standardized, relatively inexpensive and regular manner requiring the expertise of only in-house staff. In 2005 CMS extended the state reporting system to make use of a new set of Quality Indicators/Quality Measures (QI/QMs). The new QI/QMs are based on the original CHSRA QIs with a new numbering system, a new way of adjusting for risk factors for 3 of the QI/QMs and the inclusion of a pain measure and 3 new Post Acute Care (PAC) QI/QMs.

CHSRA researchers continue to work towards quality Improvement in nursing homes through projects such the Clinical Resource Center (CRC) founded in 2007, Antibiotic Stewardship Intervention for Nursing Homes, the Wisconsin ScoreCard project and analysis and research support for monitoring quality of care with the Office of the Inspector General (OIG).

Related Projects

  • Building a Novel Antibiotic Stewardship Intervention for Nursing Homes (OASIS) The Optimizing Antibiotic Stewardship In Skilled Nursing Facilities." (OASIS) Collaborative is a system redesign initiative to improve antibiotic prescribing in skilled nursing facilities. The study aims to improve antibiotic prescribing in nursing homes by facilitating \ antibiotic decision-making. Improvements target two decisions: the initial antibiotic decision before an antibiotic is prescribed, and a subsequent review of the antibiotic order after the antibiotic is prescribed. The intervention is being implemented using a Quality Improvement Collaborative (QIC) process, a facilitated implementation that includes coaching facilities both individually and in groups.
  • Clinical Resource Center (CRC) CRC is a website designed to provide key information about clinical care for staff working in skilled nursing facilities (SNFs).
  • Texas CRC Texas is the second state to join the Clinical Resource Center. Up to 500 Skilled Nursing Facilities (SNFs) in the state of Texas will be given access to the CRC – Texas website through a grant provided by the Texas Health Care Association (THCA) through CMP funding.
  • Wisconsin CRC The Wisconsin Clinical Resource Center (WCRC) was originally developed in 2007 with Civil Money Penalty (CMP) funds. The Clinical Resource Center (CRC) project is jointly sponsored by CHSRA, the Wisconsin Department of Health Services (DHS), Wisconsin Health Care Association (WHCA) and LeadingAge Wisconsin, through funding from the Wisconsin DHS. The WCRC was renamed to the Clinical Resource Center (CRC) at the beginning of 2016 in order to facilitate growth.
  • Wisconsin CRC ScoreCard In Phase I of this initiative, CHSRA, with input from the Wisconsin DHS, nursing home associations and other long term care stakeholders, produced a nursing home quality performance measurement system tested for credibility and ready for statewide implementation. Phase II was a pilot test in select nursing homes of this measurement system and related CRC connected content, and Phase III will involve converting the system to an online version for statewide access.
  • Analytic and Research Support for Monitoring Quality of Care (OIG) The purpose of this project is to assist the Office of the Inspector General (OIG) of the Department of Health and Human Services to identify nursing home chains to be monitored for quality under a corporate integrity agreement (CIA) with the OIG.