Fellowship's focus: long-term health-care quality
A collaboration between the University of Mississippi School of Nursing and Information & Quality Healthcare, a member of the atom Alliance, a five-state Quality Improvement Network-Quality Improvement Organization, is helping implement key health care legislation.
The collaboration is led by Dr. Robin Christian, associate professor of nursing.
"The kickoff was the Affordable Care Act of 2010," Christian said.
One goal of the ACA is to shift health care payment models toward quality. Providers are now reimbursed by the Centers for Medicare and Medicaid Services based on the quality of care patients receive rather than the traditional fee-for-service model.
CMS has developed a range of tools to track health care quality in hospitals, including the Hospital Readmissions Reduction Program, Hospital Value-Based Purchasing and the Hospital-Acquired Condition Reduction Program. The IMPACT Act of 2014 expanded these efforts to long-term care facilities, including nursing homes, home health agencies and inpatient rehabilitation centers.
"What started in hospitals is now coming to nursing homes," Christian said.
Information & Quality Healthcare has supported Mississippi providers for decades, serving as an educational liaison between CMS and health care organizations. The group helps providers stay focused on patient care while adapting to evolving guidelines.
"When CMS releases an initiative, we receive the training and share it with providers," said Mae McDaniel, IQH quality improvement advisor. "We do not regulate. We educate."
The partnership is integrated into the School of Nursing's Doctor of Nursing Practice quality improvement course, pairing faculty mentors with front-line nurses from long-term care facilities across Mississippi.
Faculty mentors include Christian; Dr. Kim Hoover, dean; Dr. Janet Harris, professor; Dr. Sheila Keller, associate professor; and instructors Jennifer Hargett and Kimberly Douglas.
"This is academics and the workforce coming together," McDaniel said. "It is an excellent on-the-job training opportunity."
The current focus is implementing Quality Assurance Performance Improvement, or QAPI, a CMS initiative required for long-term care facilities.
"Every nursing home must have a QAPI plan," McDaniel said. "It is essentially a business plan built on evidence-based practice."
CMS evaluates facilities using 13 long-stay quality measures, including pressure ulcers, falls with injury, infection rates, vaccination rates, weight loss and use of antipsychotic medications.
Bridgette Williams, a nurse at Jaquith Nursing Home on the Mississippi State Hospital campus in Whitfield, is one of five fellows in the program. Her mentor is Dr. Sheila Keller.
"We provided a strong foundation in quality improvement tools at the start," Keller said. "Now fellows can apply those tools in their facilities."
Williams is leading a project to reduce antipsychotic medication use by 12 to 15 percent.
"I noticed it was affecting our quality scores," Williams said.
Keller said Williams has identified best practices and secured support from leadership at her facility.
"Administrative support is essential for success," Keller said.
Williams said the project has improved collaboration among departments.
"We meet often, share ideas and better understand each other's roles," she said.
Her approach includes identifying alternatives to medication, such as behavioral interventions, family involvement and support from social workers.
As CMS regulations move toward full implementation, facilities will be held financially accountable for quality outcomes. Nurses are playing a critical role in driving these changes.
"I was overwhelmed at first, but the support from my mentors made a difference," Williams said. "Now I feel confident in the project."
"Having nurses on the front lines implementing these changes is key," Keller said.