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Nursing Home Program Reduces Pain by 45 Percent
Medicines and tender loving care spur
progress
Sept. 16, 2004 – Nursing
homes participating in a two-year quality improvement program say data
collected so far show they have improved their management of residents'
pain by about 45 percent.
In addition to improving
their assessment and treatment of pain through pharmacological agents,
the nursing home staff participating in the project also safely and
effectively employed non-pharmacological approaches to reduce pain
including exercise, physical therapy, music and aroma therapy,
hydro-therapy (whirl pools), use of comfort items like a treasured
blanket, a teddy bear and massage.
The project is sponsored
by the Centers for Medicare & Medicaid Services (CMS). Paul McGann, MD,
FRCPC, with CMS, observed, "This effort shows quantitatively what we can
accomplish when we all share our knowledge and data across disciplines
and organizations to improve the care people receive in nursing homes."
David Gifford, MD, MPH,
Chief Medical Officer for Quality Partners of Rhode Island, the Medicare
Quality Improvement Organization (QIO) for Rhode Island, said that the
participating nursing home companies that initiated the project include
some of the largest long-term care organizations in the United States.
According to Dr.
Gifford, participating nursing homes were able to significantly improve
their performance on managing residents' pain through work on the
project, called the Corporate Nursing Home Improvement Collaborative (CNHIC).
"This project brings home the importance of assessing every nursing home
resident closely, and responding with a creative, personal approach that
meets the residents' unique needs and experience," Dr. Gifford said.
CMS initiated the CNHIC
at the request of nursing home companies interested in collaborating to
improve quality of care. Companies participating in the project
included: Beverly Healthcare, Genesis HealthCare, HCR Manor Care,
Kindred Healthcare, Mariner Health Care, Sovereign Health Care,
SunBridge Healthcare Corporation, and Trans Healthcare, Inc. The
companies pledged to continue to work individually and together to
ensure gains achieved through the project are maintained and serve as a
stepping-stone to future improvements in many other nursing homes.
The project is
coordinated by the Colorado Foundation for Medical Care and Quality
Partners of Rhode Island, both non-profit QIOs that contract with
Medicare. The project is funded by CMS, an agency of the U.S. Department
of Health and Human Services.
CMS
also sponsors the Nursing Home Quality Initiative (NHQI), a broader
effort designed to improve the care delivered at all nursing homes that
accept Medicare or Medicaid payment.
About Nursing Home Quality Initiative
The national
Nursing Home Quality Initiative was launched in November, 2002, by the
Centers for Medicare and Medicaid Services to further improve the
quality of care given to the millions of Americans who live in nursing
homes. The initiative combines new information for consumers about the
quality of care provided in individual nursing homes with important
resources available to nursing homes to improve the quality of care in
their facilities.
"This is a new
approach to bringing about better quality care in our nation's nursing
homes," HHS Secretary Tommy G. Thompson said. "Not only will consumers
be better informed, but nursing homes themselves will be able to see
more clearly what they must do to make the quality grade. They will have
to compete in the quality arena. This is a major effort, and it will
grow and improve over time, with improving data and new levels of
collaboration to help nursing homes ensure high quality care."
On Wednesday, Nov.
13, 2002, HHS' Centers for Medicare & Medicaid Services (CMS) published
advertisements in 71 newspapers in all 50 states that included a
sampling of the quality data. The complete quality data, as well as "A
Guide To Choosing A Nursing Home," are available at Medicare's consumer
Web site, http://www.medicare.gov, and through Medicare's help line,
1-800-MEDICARE (1-800-633-4227).
HHS' National
Nursing Home Quality Initiative is a four-pronged effort, consisting of:
CMS' continuing
regulatory and enforcement efforts conducted by state survey agencies;
improved consumer
information on the quality of care in nursing homes;
continual
community-based, quality improvement programs offered to nursing homes
by Medicare's Quality Improvement Organizations (QIOs); and
collaboration and partnership to leverage knowledge
and resources.
To support CMS'
evolutionary process of improving nursing home quality measures, a
National Quality Forum (NQF) steering committee recommended domains of
care for the public reporting pilot. NQF's nursing home steering
committee included providers, state government representatives, consumer
advocates, and others. For the national rollout, CMS made minor
modifications to the list of measures, based on a comprehensive
validation report and experience during the pilot.
The 10 quality
measures fall into two categories -- six for chronic care patients
(long-term stay residents) and four for post-acute care patients
(short-term patients).
The six measures
for long-stay residents are:
percentage of
residents with loss of ability in basic daily activities
percentage of
residents with infections
percentage of
residents with pain
percentage of
residents with pressure sores
percentage of
residents with pressure sores (with additional facility level risk
adjustment)
percentage of
residents in physical restraints
The four measures
for short-stay residents are:
percentage of
short-stay residents with delirium
percentage of
short-stay residents with delirium (with additional facility level risk
adjustment)
percentage of
short-stay residents who walk as well or better
percentage of
short-stay residents with pain
Another key
component of the initiative is the assistance that every Quality
Improvement Organization (QIO) has available to improve quality of care
in local nursing home facilities. QIOs are CMS contractors that have
offered improvement assistance to hospitals, physician offices, and, in
some states nursing homes over the past decade. As part of the Quality
Initiative, the QIOs are expanding their scope by providing information
and consultation to skilled nursing facilities in all states.
In addition, QIOs
and state and local long-term care ombudsmen will use the new data,
along with other information and personal visits, to help families make
informed decisions about placement in nursing homes. The ombudsmen are
primarily volunteers who help nursing-home residents and their families
on a daily basis and are trained and funded through HHS' Administration
on Aging.
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