Abstract
ObjectivesTo measure the impact of advanced practice nurses (APRNs) on quality measures (QM) scores of nursing homes (NHs) in the CMS funded Missouri Quality Initiative (MOQI) that was designed to reduce avoidable hospitalizations of NH residents, improve quality of care, and reduce overall healthcare spending.DesignA four group comparative analysis of longitudinal data from September 2013 thru December 2019.SettingNHs in the interventions of both Phases 1 (2012–2016) and 2 (2016–2020) of MOQI (n=16) in the St. Louis area; matched comparations in the same counties as MOQI NHs (n=27); selected Phase 2 payment intervention NHs in Missouri (n=24); NHs in the remainder of the state (n=406).ParticipantsNHs in Missouri Intervention: Phase 1 of The Missouri Quality Initiative (MOQI), a Centers for Medicare and Medicaid (CMS) Innovations Center funded research initiative, was a multifaceted intervention in NHs in the Midwest, which embedded full-time APRNs in participating NHs to reduce hospitalizations and improve care of NH residents. Phase 2 extended the MOQI intervention in the original intervention NHs and added a CMS designed Payment Intervention; Phase 2 added a second group of NHs to receive the Payment. Intervention Only.MeasurementsEight QMs selected by CMS for the Initiative were falls, pressure ulcers, urinary tract infections, indwelling catheters, restraint use, activities of daily living, weight loss, and antipsychotic medication use. For each of the monthly QMs (2013 thru 2019) an unobserved components model (UCM) was fitted for comparison of groups.ResultsThe analysis of QMs reveals that that the MOQI Intervention + Payment group (group with the embedded APRNs) outperformed all comparison groups: matched comparison with neither intervention, Payment Intervention only, and remainder of the state.ConclusionThese results confirm the QM analyses of Phase 1, that MOQI NHs with full-time APRNs are effective to improve quality of care.
Highlights
In 1965, the first Nurse Practitioner program opened at the University of Colorado [1]
The analysis describes quality measures (QM) trajectories for each of the four groups
The 16 participating nursing homes (NHs) in Phase 1 reduced potentially avoidable hospitalizations (2014-2016) by 50% and all cause hospitalizations by 32% [21]. They reduced Medicare expenditures (2014-2016) per resident per year by 40.2% for potentially avoidable hospitalizations and 28.6% for all-cause hospitalizations [12]. These important outcomes were achieved in the Missouri Quality Initiative (MOQI) Intervention NHs (n=16) with full time advanced practice nurses (APRNs) embedded in their NHs to promote early interventions for residents with declining health conditions
Summary
In 1965, the first Nurse Practitioner program opened at the University of Colorado [1]. APRNs began practicing in nursing homes (NHs) in the 1970s [2] and studies about their positive impact on NH care began to emerge in the 1980s [3, 4, 5]. Four systematic reviews examining forty years of studies about the effectiveness of APRN care for NH residents demonstrate consistent results: improved resident health and functional status; reductions in hospitalizations, emergency room admissions and costs of care; improved resident quality of life; and improved resident and family satisfaction with care [5, 6, 7, 8]. External evaluators of the Initiative, after analyzing three years of quantitative data (Medicare claims and other NH assessments) compared with six other state sites, reported that MOQI interventions were associated with a consistent and significant reduction in the key outcomes [11]. The eight QMs selected by CMS for the Initiative as key measures of quality of care in long-stay residents were falls, pressure ulcers, urinary tract infections, indwelling catheters, restraint
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