QI Index Page

The Nursing Home Quality Initiative

CMS began the Nursing Home Quality Initiative (NHQI) in April 2002 with a Pilot Project in six states. The initiative consists of two primary activities - providing information to consumers on quality measures, and QIOs working with nursing homes on quality improvement strategies. The initiative was rolled out in all states in November 2002. Find detailed information and link to relevant sites below.

HHS News Release detailing the November rollout of the Nursing Home Quality Initiative. (November 12, 2002) (link to HHS news page)

Fact Sheet about the Nursing Home Quality Improvement Initiative - Questions and answers. (Updated October 24, 2002). This document provides an overview of the initiative and is a good basic training tool for ombudsmen and the general public.  

PowerPoint Presentation: David Schulke presented this overview of the project to State and Local Ombudsmen in April and June 2002.

NCCNHR Press Release. Applauds spotlight on quality of care in nursing homes (April 24, 2002).

NCCNHR Press Release (November 12, 2002). Praises CMS initiative to improve public access to nursing home quality information .

List of newspapers carrying the ads for the national rollout, November 12, 2002.

 

CMS Initiative Activities:

QIO Mediation for Medicare Beneficiaries - This CMS initiative began as a pilot project in two states - NY and CA.  As of September 2003 it has been expanded nationally. See an overview of the initiative.

• Barbara Paul, MD, Director of Quality Measurement & Health Assessment Group;
• Angela Brice-Smith, RN, MPA, Deputy Director of the Survey & Certification Group;
• William Rollow, MD, MPH, Deputy Director of the Quality Improvement Group, CMS

QIO lessons learned from the pilot project, presented July 24, 20002 at the AHQA conference in Baltimore.

Press release and ads were distributed to the media.  See newspaper distribution list for the pilot states.

 

Ombudsman Training:

Training Curriculum approved by CMS (December 2002). Complete curriculum developed by Sara Hunt, ORC Consultant, now available for ombudsman training. Includes several updated PowerPoint presentations and pdf files developed for Ombudsmen and QIO training. (section contents updated 1/15/03)

Ombudsman Curriculum Developed by Sara Hunt

Equipping Consumers A PowerPoint presentation developed by Janne Swearengen

Meeting the Challenge - by Barbara Paul, MD (October 2002)

Consumer Use of Quality Measures - A PowerPoint presentation developed by Janne Swearengen

Partners in Improving Long Term Care - by David Schulke presented at a LTCO conference in NY (October 2002)

Understanding the Quality Measures - a QIO training (September 2002)

Improvement - QIOs role in improving nursing home quality. An executive summary.

Resource Manual - this CMS document is 185 pages (it may take a few moments to download)

Web-enhanced conference calls held in November to train state and local ombudsmen (November 2002) Call I of series included:

CMS Initiative Overview A PowerPoint presentation by Barbara Paul, MD.

Excerpts from the NHQI training curriculum for Long Term Care Ombudsmen. Developed by Sara Hunt.

 

Ombudsman Involvement in Initiative:

NHQI Final Report, prepared by Dr. Donna Lind Infeld (February 24, 2003).  Evaluation of the Relationship between Long-Term Care Ombudsman Programs (LTCOPs) and Quality Improvement Organizations (QIOs). The NHQI Project has served to enhance, and in some instances initiate working relationships between Ombudsmen and QIOs, which ultimately benefits consumers and those concerned about quality nursing home care. If you have any questions contact Mark Miller NASUA (202) 898-2578 mmiller@nasua.org

NHQI Mid-project report, prepared by Dr. Donna Lind Infeld (September 23, 2002).  Evaluation of the relationship between QIOs and State Ombudsman Programs. If you have any questions contact Mark Miller NASUA (202) 898-2578 mmiller@nasua.org

Ombudsmen in the News: State Ombudsmen are being quoted in the press. See the stories below.

• Maine and Mississippi ombudsmen interviewed by reporters (December 12, 2002)
• Hawaii ombudsman quoted in Honolulu Star Bulletin (November 13, 2002)

HHS announcement of new initiative supporting ombudsman efforts to help consumers use nursing home quality information.

AoA media advisory on ombudsman partnership with QIOs (May 21, 2002).

Ombudsman/QIO relationships in the initiative were defined by CMS and AoA based on the experience of the pilot states. Assistant Secretary Carbonell distributed the document in August 2002. (pdf version of document)

Advice for Ombudsmen in Preparing for the Nursing Home Quality Initiative (April 19, 2002). Prepared by ORC to assist ombudsmen in readying for an increased volume of calls as a result of media publicity in their communities.

Information from the Pilot States

Washington State Ads (Nov. 2002) Washington has produced a series of ads that will appear along with the national rollout.  Please note: these ads cannot be used by others without the permission of Qualis Health.

 

Quality Measure Information:

National Quality Forum Steering Committee Reviews Two Measures (January 2004).  At its meeting on September 30, 2003 , the National Quality Forum Board of Directors endorsed 14 voluntary consensus standards for assessing nursing-home performance – standards that CMS had agreed to use in its Nursing Home Quality Initiative.  At that time, however, the NQF Board failed to act on two of the draft consensus standards, weight loss and staffing, and instead directed that these standards be reconsidered within NQF’s Consensus Development Process with assistance from the Steering Committee.  The Steering Committee conferenced by phone in December.  On weight loss, the committee was not inclined to recommend new measures at this point, and CMS noted that the feeding tube measure was not validated in the Mega QI study. There was consensus that the staffing information on Nursing Home Compare must continue, and NQF should not do anything that might encourage that information to be removed.  In general, the Committee also felt that improving the OSCAR system is preferable to using various data sources at the state level, but differed on whether to endorse standards based on OSCAR pending its improvement.  Possibilities for handling this situation included (1) NQF endorsing the inclusion of the staffing standard in the nursing home set, encouraging the immediate improvement of OSCAR, and allowing for the best available data source to be used until an improved, federal data source is available; (2) including the staffing standard without specifying a data set but encouraging immediate improvement of OSCAR; and (3) not including a staffing standard at all pending the improvement of OSCAR.   Notably, the first or second options were supported not only by NCCNHR, but also by Steering Committee members Lee Partridge of the National Partnership for Women & Families, Dave Gifford of the Rhode Island Quality Improvement Organization, David Zimmerman of the University of Wisconsin Center for Health Systems Research and Analysis, and Katie Maslow of the Alzheimer’s Association.  Committee members were to vote on their choices by December 29th.  Source: Donna Lenhoff, Esq. representing NCCNHR on December conference call.  Click here for more details.

What Are Nursing Home Quality Measures. Prepared by the American Health Quality Association (AHQA), April 2002. 

Risk Adjustment & Quality Measurement in the Nursing Home Public Reporting Pilot Project: A Comparison with Current Measures. Prepared by AHQA, April 2002.

"Validation of Long Term and Post-Acute Care Quality Indicators." This report prepared for CMS examines 45 different quality measures. August 2, 2002.

Quality Measures for 2002 Rollout CMS report that spells out details of the quality measures for fall rollout. Clarifies differences between pilot project measures and national rollout measures. August 9, 2002.

 

Quality Improvement Strategies for Nursing Home Improvement:

"Improving Nursing Home Quality" by David Gifford, MD MPH explains the quality improvement processes that QIOs will be using with select nursing homes in each state. AHQA conference July 25, 2002.

 

Quality Care Indicators. Special Section from NCCNHR's "Quality Care Advocate," April/May 2000:

Quality Indicator Reports: Use when you can get them and be Cautious (pdf )

Facility Quality Indicator Profile - Sample

QI’s: New Tool for Nursing Home Consumers by Morris J. Kaplan, Esq., NHA (pdf)    

QI’s: A Potential Resource for Consumers in Monitoring Care by David R. Zimmerman, Ph.D. (pdf)

 

Consumer Education and Training Tools:

Consumer Guide to Choosing a Nursing Home. Published by NCCNHR, this document advises consumers on the use of  various information resources. (pdf version)

Presentation to Resident Council of WA (September 2002) provides tips on how to review and understand quality measures. (Posted 11/03.)

NHQI Curriculum excerpts for LTCOP. 

This information includes several resources being distributed by NASUA as part of the NHQI Pilot Project supported by the Centers for Medicare and Medicaid Services and the Administration on Aging in order to foster partnerships between the Long-Term Care Ombudsman Program and the Quality Improvement Organizations, ensure that the LTCOPs are involved in the national rollout of the Nursing Home Quality Initiative (NHQI), and to help older people and their families use the NHQI as they make nursing home placement and quality of care decisions.

Transmittal letter November 8, 2002

Curriculum excerpts for ombudsman training developed by Sara Hunt

PowerPoint presentation for ombudsman training: "Equipping Consumers to Use Quality Measures" by Janne Swearengen

PowerPoint presentation for consumers' use of quality measures: "Consumer Use of Quality Measures: How to be a Savvy Consumer" by Janne Swearengen

 

Relevant Websites:

American Health Quality Association website at www.ahqa.org  provides a description about the QIO role in the Quality Initiative. Presentations and agenda from AHQA conference on the initiative, July 24-25, 2002. 

The Centers for Medicare and Medicaid Services (CMS) website at www.cms.hhs.gov has information regarding the nursing home quality initiative including a letter sent from CMS to the administrators of nursing homes in the six pilot project states. 

The Nursing Home Compare site at www.medicare.gov displays the quality measure data for the six pilot states and the resident indicators for the non-pilot states.

 

Federal Reports:

Nursing Homes: Federal Efforts to Monitor Resident Assessment Data Should Complement State Activities (February 2002).  This report is published by GAO and can be retrieved on line by going to www.gao.gov. You may search by title or use the document number GAO-02-279.