The nursing home quality initiative (NHQI) is a project for residents in Medicaid-certified nursing facilities to evaluate annual performance and quality of care. The initiative provides information and resources related to payment, care comparison, minimum data set, certified information, and quality measures for providers through a website. The information is mostly about quality measures, where states, providers, researchers, and customers can compare different nursing homes. According to the Centers for Medicare and Medicaid Services (CMS), many nursing homes have significantly improved care quality by taking advantage of the information and materials available.
Information about the initiative is available through the CMS website, where it is defined, and roles and mission are explained. Furthermore, the website provides related links for people requiring more information about the initiative. Websites like Google Scholar, Z-library, and the ASU library have several peer-reviewed scholarly articles rich in information about the initiative. These are good sources to understand the contributions and changes that the initiative has undergone over the years. I have chosen to investigate this initiative because I have seen an increasing number of the elderly in the US. As this population keeps increasing, the more important it is to ensure there is an effective system to care for them. Additionally, researching the topic will provide answers to many questions that people have about this initiative.
Mission and Goals
Nursing homes care for residents who need special care, including those with ongoing chronic conditions like dementia. The NHQI works through quality improvement organizations (QIOs) to achieve its roles. The QIOs are responsible for promoting awareness, providing assistance to nursing homes, and using publicly reported quality measures to improve performance. This is achieved through sending messages to the public that some nursing homes do better than others to caregivers and beneficiaries. The QIOs also provide necessary information and assistance in providing better care to needy institutions. All the activities associated with this initiative are meant to monitor, analyze, and improve processes’ quality and outcomes. The nursing homes only need to gather and analyze data in key areas and implement changes effectively. The QIOs are non-regulatory partners and work with nursing homes voluntarily. The mission of NHQI is to ensure in the coming years, residents using nursing homes will receive high-quality care by choosing nursing homes based on quality measures available on the website.
Served Population, Stakeholders, and Interpersonal Teams
Due to increased pressure from customers and government regulations, performance in nursing homes has evolved. These institutions have become sophisticated and highly regulated for quality care and treatment. Nursing homes mostly deal with patients associated with old age physical health or mental health conditions. More than half of nursing home residents are aged 85 and above (Konetzka, 2020). Most are women, divorced, with few or no family for support. Those with mental illnesses require special care as it is hard to talk to or help them at home. Only trained professionals can handle them and provide healthy and happy aging care. Overall, those served by the NHQI mostly depend on the nurses to speak up for them and make decisions regarding their health.
Key stakeholders include trade associations, representatives of the nursing homes, medical directors, geriatric nursing assistants, state survey agencies, directors of nursing, and ombudsmen. The associated interprofessional teams include the professional healthcare providers, caregivers, families, patients, and communities. They work collaboratively, considering and communicating each other’s unique perspectives to achieve the highest possible quality care.
Plan, Do, Study, Act Cycle
The main role of NHQI is to promote awareness about nursing homes’ quality measures and support the institutions in improving performance. This alone shows that nursing homes have not reached the highest level of care that can be provided. There is room for improvement, and others are underperforming. According to Hirt (2022), nursing homes have increasingly reported abuse and neglect cases. Emotional abuse is the most common form, where professionals use insults or threats to control residents. Quality healthcare is the degree to which care services increase the chances of recovery to the desired outcomes. When residents are abused emotionally or physically, that shows a failure, which the NHQI seeks to fix. The proposed outcomes include reduced cases of abuse and happy aging even with severe conditions. Care compares put some nursing homes in low positions, so they have to improve so customers can choose them. With time, all nursing homes will have a better rating, high-quality measures, and improved performance.
The NHQI is committed to improving health care quality in all nursing homes. As mentioned earlier, it provides resources and assistance needed in all nursing homes in need. Through the CMS, civil monetary funds provide the initiative with money to improve the quality of care and protect and improve the lives of residents in nursing homes. To promote transparency, the initiative posts care compares and other associated information on its website, which all nursing homes and their customers can access. For this initiative, the long-term care ombudsman (LTCOPs) assists residents and their loved ones and interested citizens in using quality measures in nursing home selection and investigates customer complaints. In these roles, the LTCOPs collaborate with QIOs in identifying and working with struggling institutions on quality improvement initiatives. Finally, they advocate for nursing homes’ residents and other adult care facilities. Overall, the NHQI has set a new standard of practice, challenging nursing homes still facing quality issues to seek help and improve.
The NHQI displays information about nursing homes’ quality measures on a website assessable by customers, providers, and anyone interested. If the initiative goals are met, there will be a significant difference in the data compared to the current information in years to come. For example, some nursing homes may be at the bottom of the list regarding quality measures. However, in collaboration with the NHQI initiative, they can improve and hold upper positions in the future. This will be an indication of the success of the initiatives. The CMS can also assess the effectiveness of the NHQI by assessing the length of stay, readmission rates, cases of abuse, and patient satisfaction, through public and private organizations. Comparisons then would show whether the initiatives have been effective or not. If found to have failed, the CMS can determine ways to revise the initiative to improve its effectiveness and efficiency.
Significant refinement has been done by updating quality measures and staffing information on the initiative’s website. Based on the accumulated data, the NHQI has contributed significantly to the improvement of performance in nursing homes. According to CMS, many nursing homes have taken advantage of the information, materials, and support. As a result, they have improved, each aiming to be listed at the top of the NHQI website. However, the quality of care still needs improvement as it has been challenging in countries like the United States (US). The US has seen increased abuse and neglect cases and poor conditions in the last decade (Konetzka, 2020). The government established the current regulatory requirements and initiatives for nursing homes. They included regular assessment of residents and electronic data storage in national databases to control quality. Over the years, the NHQI has targeted improving nurse staffing levels and other associated projects by state or federal governments, researchers, and nursing homes, all targeting improving care. Unfortunately, while there are many nursing homes and improvements, low-quality services remain endemic in the US and worldwide.
The NHQI was meant to improve quality care provision in nursing homes. Residents in these institutions, mostly the old, may be unable to fight for themselves when they face abuse or neglect. Some health professionals may take advantage of patients’ conditions and give quality services. The NHQI filled this position, offering support and resources to all nursing homes to ensure residents receive quality health. Through a website, the NHQI provides comparison information about the minimum data sets, care comparisons, certified information, and quality measures about different institutions. Customers can choose the best nursing homes for themselves or their loved ones. So far, the initiative has provided the resources and information needed for improvement and has improved overall outcomes. Nurses have moral and professional obligations to advocate for their patients. They can therefore participate in policy making and politics about matters that concern their practice in nursing homes by sending representatives to boardrooms and government meetings. Conclusively, while there have been numerous contributions by the NHQI, there is still more that needs to be done to improve performance in nursing homes regarding quality care.
Health literacy universal precautions toolkit, 2nd Edition: plan-do-study-act (PDSA) directions and examples. (2020). Agency for Healthcare Research and Quality.
Hirt, J., Adlbrecht, L., Heinrich, S., & Zeller, A. (2022). Staff-to-resident abuse in nursing homes: a scoping review. BMC geriatrics, 22(1), 1-14.
Konetzka, T.R. (2020). The challenges of improving nursing home quality. Jama Network 3 (1).
Nursing home quality initiative. (2022). CMS. Gov.
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