Quality Improvement Program for Missouri (QIPMO)

Background & Goal

Of the nearly 40 million persons 65 years of age or older in the United States, about 1.7 million live in nursing homes, a figure which is projected to grow to more than 5 million in 2030. Nursing home residents are among the frailest elders in our country, with major limitations in activities of daily living, multiple chronic illnesses, major limitations in mobility, and necessary 24 hour oversight by professional nurses and nursing staff to assist them in meeting basic goals. Seniors and their families seek high quality nursing home care where staff members use the most up-to- date, evidence-based care practices. Simultaneously, states seek to provide high quality care at reduced costs. The Quality Improvement Program for Missouri (QIPMO) assists families and States in achieving both missions.

QIPMO aims to disseminate evidence-based best practices into mainstream clinical care in Missouri nursing homes. Through on-site clinical consultations, RN’s with graduate education in gerontological nursing provide role-modeling, analysis of care systems, guidance, team building, and knowledge transfer. QIPMO reaches out to all nursing homes in the state to improve care delivery and outcomes.

Center Description

When initiated in 1999, QIPMO was the first official state program of its kind in the United States. QIPMO is a cooperative service of the University of Missouri’s Sinclair School of Nursing under contract with the Missouri Department of Health and Senior Services. It is funded by the Nursing Facility Quality of Care fund, established to provide training and technical assistance to facilities.

QIPMO provides free on-site clinical consultation comparing each facility to others in the state using Minimum Data Set (MDS) data. These confidential site visits (data are not shared with state regulators) typically last 2 to 3 hours and focus on quality of care, evidence-based practices, and quality improvement using quality measures (QMs) derived from the MDS data for monitoring progress toward care improvements. In 2011, the QIPMO program expanded to include a Leadership Coaching Service provided by experts licensed as nursing home administrators. Nursing homes receive consultation on issues such as corporate compliance, budget analysis, regulations, process improvement, leadership skills, staff training and retention, contract review, survey readiness, and culture change. Coaching is tailored to meet administrator needs within the context of operational situations as well as the corporate and business models in Missouri. The most frequent educational requests from nursing homes to QIPMO are for help in explaining and understanding how to interpret and use federal or state quality indicator/quality measure reports and survey readiness preparation. As evidence of the demand for QIPMO services, in 2015 nursing home visits totaled 878 for QIPMO nurses and 443 for QIPMO coaches. QIPMO is connected to most facilities in the state via email, telephone and fax, and maintains a web site with training materials that can be downloaded for free and helpful links (www.nursinghomehelp.org). In addition to disseminating evidence-based guidelines and practices, QIPMO also disseminates the latest research results provided by on-going research from the MU and MDS and Quality Research team.

Evidence of Success

• Clinical outcomes that improved in the early years of the program include scores at the median, 90th and 95th percentiles, in such things as pressure ulcers for high and low risk residents, range of motion or activities of daily living, dehydration, fecal impaction, residents remaining in bed, depression, depression with no treatment, problem behaviors, cognitive impairment, incontinence without a toileting plan, antianxiety, and hypnotic drug use. (Rantz et al., 2003).
• Clinical outcomes that improved in the later years of the program include five QIs with improved trends of 4% to 41% in important clinical problems of pressure ulcers, pressure ulcers for high-risk residents, weight loss, bedfast residents, and falls. Five other indicators also improved 2.5% to 20.7%, including important clinical problems of incontinence, incontinence for low-risk residents, urinary tract infections, depression, and use of physical restraints. (Rantz et al., 2009).
• A cost analysis performed from July 2007-June 2008 revealed that 990 residents avoided the development of expensive, debilitating problems at a care cost savings of over $4.7 million (Medical News Today, 2009). This followed cost savings from the 2006/2007 period of $1.5 million dollars from the facility at-risk group (n=60) and $1.6 million from the 2005/2006 annual period from the facility at-risk group (n=45) (Rantz et al., 2009).