May 13, 2009 Aging adults living in nursing homes and relying on the care of others are often susceptible to a long list of medical problems. These problems are debilitating for the residents and cost facilities millions of dollars. In a new study, a University of Missouri researcher found that long-term care facilities in Missouri saved more than $6 million in the past three years after implementing a quality care improvement program. Savings for the facilities were more than 10 times the program costs.
Marilyn Rantz, professor in the MU Sinclair School of Nursing completed a three-year analysis of the Quality Improvement Program of Missouri (QIPMO) and found significant improvements in overall care quality of residents in participating facilities. Last year, a total of 990 residents avoided developing clinical problems, including pressure ulcers, depression symptoms and weight loss, resulting in a total savings of $3.7 million statewide for facilities and health care providers in the state.
According to the U.S. Department of Health and Human Services, the primary goal of quality improvement plans is to improve nursing home care practices. In Missouri, QIPMO is a cooperative service of the Sinclair School of Nursing and the Missouri Department of Health and Senior Services; it was created to pair facilities with gerontological nurse experts. The nurses perform on-site visits to offer technical assistance, care-planning help and clinical consultations. One of the nurses' primary functions is to identify "best practices" for care procedures and make such information available throughout the state.
"Quality improvement is cost effective for everyone involved," Rantz said. "Focusing efforts to improve quality of care not only helps to improve that care and the positive outcomes for people, but it also saves the industry and facilities money."
In the study, Rantz found that the cost savings for each year exceeded the total program cost by more than $1 million. Statewide trends among residents included improvements in pain, fall reduction and pressure ulcer reduction, and fewer tube feedings and restraint reduction.
QIPMO is funded through Missouri's Nursing Facility Quality of Care Fund, which is generated from care facilities paying taxes according to the number of beds in their facilities. The cost per facility to use the program was less than $3 per bed.
"The impact on improving the quality of care by expert gerontological nurses consulting in nursing homes is significant in addition to the cost savings for the facilities and health care system in general," Rantz said. "The role of these nurses should be embraced by state agencies, nursing home providers and consumers as an ongoing strategy to continuously improve the quality of nursing home care."
The program works with a range of facilities in the state, including those that already embrace quality improvement and those that need help with care issues. Throughout 2007-08, QIPMO nurses made 855 contacts with 246 different facilities in the state, and they made 417 site visits in 227 nursing facilities. Results showed that facilities who participated did improve, and costs of care problems were reduced.
"A criticism of QIPMO services in the past was that we might be working only with the best nursing facilities or places that wanted to improve," Rantz said. "But these three years, we focused on facilities identified as at risk for problems, not just ones that volunteered. In all instances, when we compared those using the service to those not using the service, we saw improvements."
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- Rantz et al. Helping Nursing Homes “At Risk” for Quality Problems: A Statewide Evaluation. Geriatric Nursing, July/August 2009; DOI: 10.1016/j.gerinurse.2008.09.003
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