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Results of the Missouri Quality Initiative in Sustaining Changes in Nursing Home Care: Six-Year Trends of Reducing Hospitalizations of Nursing Home Residents

  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

The purpose of this article is to present six-year findings of the Missouri Quality Initiative (MOQI) to reduce unnecessary hospitalizations for long-stay nursing home residents.

Design

A CMS funded demonstration project analyzed over 6-years using a single group design.

Setting and Participants

The setting was 16 Midwestern US nursing homes ranging in size between 121 and 321 beds located in urban and rural areas in one geographic region. The sample of eligible residents averaged from 1819 in 2014 to 1068 in 2019.

Measures

Resident data were analyzed using descriptive methods of aggregate facilities’ hospital transfer rates per 1000 resident days and changes per year of average hospital transfer rates. Individual facility transfer rates were grouped by level of performance (best, mixed, and low). Leadership turnover and engagement were also described.

Intervention

Full-time advanced practice registered nurses (APRN) and an operations support team focused on reducing unnecessary hospitalizations for long-stay nursing home residents.

Results

Total transfers for 2014–2019 was 6913 and the average transfer rate per 1000 resident days declined from 2.48 in 2014 to a low of 1.89 in 2018 and slightly increased to 1.99 in 2019. Eleven nursing homes achieved sustained improvement, five did not. Differences in leadership turnover and engagement were noted by level of performance; however, three outlier facilities were identified.

Conclusions/Implications

The MOQI intervention achieved improved outcomes over six-years in the majority of nursing homes in the project. The embedded APRN’s daily focus on project goals supported by a multi-disciplinary operations team facilitated success. Facility leadership stability and engagement in the project likely contributed to outcomes. Full-time presence of APRNs coupled with an operations’ support team improved nursing homes outcomes, however Medicare currently restricts APRNs hired by nursing homes from billing Medicare for direct care services. This unnecessary restriction of practice discourages nursing homes from hiring APRNs and should be abolished.

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Acknowledgments

We want to acknowledge the participation of 16 NHs in the St. Louis area, their staff, the APRNs, and other staff of the Missouri Quality Initiative. Without everyone’s support and hard work, the advances of the initiative would not have been possible.

Author information

Authors and Affiliations

  1. Sinclair School of Nursing, University of Missouri, Columbia, MO, USA

    Amy Vogelsmeier

  2. Innovative Partnerships, Sinclair School of Nursing, University of MO, Columbia, MO, USA

    L. Popejoy

  3. School of Social Work, University of Missouri, Columbia, MO, USA

    K. Canada

  4. Applied Gerontology and Professor, Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Madison, WI, USA

    C. Galambos

  5. Office of Medical Research, School of Medicine, University of Missouri, Columbia, MO, USA

    G. Petroski

  6. MOQI Initiative, Sinclair School of Nursing; on-site, St. Louis, MO, USA

    C. Crecelius

  7. Columbia University, New York, NY, USA

    G. L. Alexander

  8. Emerita, Sinclair School of Nursing, University of Missouri, Columbia, MO, USA

    M. Rantz

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  1. Amy Vogelsmeier
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Contributions

Author contributions: The following authors contributed to the Study concept and design: Marilyn Rantz, Amy Vogelsmeier, Lori Popejoy, Colleen Galambos, Charles Crecelius, and Gregory Alexander. The following authors contributed to the acquisition of data: Amy Vogelsmeier, Marilyn Rantz, Kelli Canada, Collen Galambos, Lori Popejoy, Charles Crecelius, Gregory Petroski, and Gregory Alexander. The following authors contributed to drafting and critical revisions of the manuscript for important intellectual content: Marilyn Rantz, Amy Vogelsmeier, Lori Popejoy, Kelli Canada, Colleen Galambos, Gregory Petroski, Charles Crecelius, and Greg Alexander.

Corresponding author

Correspondence to Amy Vogelsmeier.

Ethics declarations

Financial Disclosure: This project was supported by grant numbers 1E1CMS331080 and 1E1CMS331489 from the Centers for Medicare & Medicaid (CMS) Innovations Center and Medicare-Medicaid Coordination Office (http://innovation.cms.gove/initiatives/rahnfr/) that focuses on improving care and outcomes for Medicare-Medicaid enrollees residing in nursing facilities.

Conflict of interests: All authors report grants from the Centers for Medicare and Medicaid for Phase 1 and Phase 2 during the conduct of this study. Drs. Vogelsmeier, Popejoy, and Rantz also declare work with NewPath Health Solutions, LLC, outside of the submitted work.

Ethical standards: This study was approved by the University of Missouri Health Sciences Review Board as a demonstration project funded by the Centers for Medicare and Medicaid Services.

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Vogelsmeier, A., Popejoy, L., Canada, K. et al. Results of the Missouri Quality Initiative in Sustaining Changes in Nursing Home Care: Six-Year Trends of Reducing Hospitalizations of Nursing Home Residents. J Nutr Health Aging 25, 5–12 (2021). https://doi.org/10.1007/s12603-020-1552-8

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  • DOI: https://doi.org/10.1007/s12603-020-1552-8

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