The Quality Improvement Program for Missouri's Long - Term Care Facilities (QIPMO) is committed to Missouri's Elderly.
The "Aging-in-place" model allows older adults to receive health care in their preferred place of living, eliminating the need for a more restricted living space, such as a nursing home.
TigerPlace is a specially designed elder housing project initiated by the MU Sinclair School of Nursing, working to provide elders a better quality of life.
AgingMO is a centralized online home for the University of Missouri’s Aging in Place (AIP) program and its related projects. Our unique AIP model allows older adults to receive health care in their preferred place of living. As their care needs increase, residents contract for more care in the same setting, eliminating the need for a move to a more restrictive living environment such as a nursing home. This project, which began in 1996, is a multidisciplinary project including MU’s School of Nursing, College of Electrical and Computer Engineering, School of Social Work, Department of Physical Therapy, Department of Management and Informatics, Biostatistics Group, and Department of Family and Community Medicine, along with outside consultants. We have developed this website to assist you by allowing complete and easy access to the many distinctive aspects of our groundbreaking research.
America’s 75 million aging adults soon will face decisions about where and how to live as they age. Current options for long-term care, including nursing homes and assisted-living facilities, are costly and require seniors to move from place to place. University of Missouri researchers have found that a new strategy for long-term care called Aging in Place (AIP) is less expensive and provides better health outcomes. The AIP model provides services and care to meet residents’ increasing needs to avoid relocation to higher levels of care. AIP includes continuous care management, a combination of personalized health services with nursing care coordination. Click here for an AIP overview.
The MOQI Intervention Model3 illustrates the key components of the intervention. An APRN guides the intervention delivering care to the residents and training the facility staff to improve their skills. An MOQI intervention team assists with medical care, care transitions, health information technology, and evidence-based INTERACT (Interventions to Reduce Acute Care Transfers) II assessment tools. The project promotes the use of INTERACT, which is a set of evidence-based clinical practice tools and strategies developed with funding from the CMS to reduce hospitalizations from nursing homes.5 The tools and strategies assist the nursing home staff in early identification, assessment, communication, and documentation about changes of condition in nursing home residents.
The APRN works collaboratively with the facility staff on assessing and managing chronic and acute conditions, recognizing early illness, using the INTERACT II tools, enhancing goals of care and end-of-life (EOL) discussions and advance directive (AD) decision making, and increasing the use of health information technology for improved communication.
Rantz, M.J., Flesner, M.K., Franklin, J., Galambos, C., Pudlowski, J., Pritchett, A., Alexander, G., & Lueckenotte, A. (2015). Better care, better quality: reducing avoidable hospitalizations of nursing home residents. Journal of Nursing Care Quality, 30(4), 290-297.
Objective: Our purpose was to describe how we prepared 16 nursing homes (NHs) for health information exchange (HIE) implementation.
Background: NH HIE connecting internal and external stakeholders are in their infancy. U.S. initiatives are demonstrating HIE use to increase access and securely exchange personal health information to improve patient outcomes.
Method: To achieve our objectives we conducted readiness assessments, performed 32 hours of clinical observation and developed 6 use cases, and conducted semi-structured interviews with 230 participants during 68 site visits to validate use cases and explore HIE.
Results: All 16 NHs had technology available to support resident care. Resident care technologies were integrated much more with internal than external stakeholders. A wide range of technologies were accessible only during administrative office hours. Six non-emergent use cases most commonly communicated by NH staff were: 1) scheduling appointments, 2) laboratory specimen drawing, 3) pharmacy orders and reconciliation, 4) social work discharge planning, 5) admissions and pre-admissions, and 6) pharmacy-medication reconciliation. Emerging themes from semi-structured interviews about use cases included: availability of information technology in clinical settings, accessibility of HIE at the point of care, and policies/procedures for sending/receiving secure personal health information.
Conclusion: We learned that every facility needed additional technological and human resources to build an HIE network. Also, use cases help clinical staff apply theoretical problems of HIE implementation and helps them think through the implications of using HIE to communicate about clinical
Alexander, G.L., Rantz, M., Galambos, C. Vogelsmeier, A., Flesner, M., Popejoy, L.L., Mueller, J., Shumate, S., & Elvin, M. (2015). Preparing nursing homes for the future of health information exchange. Applied Clinical Informatics, 6, 248-266.*
THERE are nearly 1.5 million older adults residing in nursing homes (NH) across the United States. Reducing avoidable hospitalizations among vulnerable NH residents has become a national priority. Estimates suggest more than $14 billion of Medicare funding is spent annually on hospitalizations for this vulnerable population. The most common causes of avoidable hospitalizations are conditions of septicemia, pneumonia, congestive heart failure, and urinary tract infections. Experts identify that NHs have limited capacity for early illness detection and/or prevention to avoid the need for hospitalization. As such,
it is vital that NHs improve their capacity to identify and treat acute illness in their residents to avoid hospitalization. Evidence suggests that advanced practice registered nurses (APRNs) improve NH outcomes including reducing avoidable hospitalizations. Moreover, major health care cost savings have been measured when APRNs work in NHs. This improvement appears to be related to the APRNs expertise in clinical management of health conditions, early detection of illness, and problem solving with NH staff to provide the needed care to manage clinical conditions within the NH. Despite evidence that APRNs improve resident outcomes, little evidence exists to describe how APRNs actually integrate their advanced practice role into NHs to influence care delivery. This article reports on a series of 3 focus groups held with APRNs who were embedded full-time in 16 Missouri NHs. The purpose of the focus groups was to describe the integration of APRNs into the NH setting including their their perceived challenges and successes.
Vogelsmeier, A., Popejoy, L., Rantz, M., Flesner, M., Lueckenotte, A., & Alexander, G. (2015). Integrating advanced practice registered nurses into nursing homes: The Missouri Quality Initiative experience. Journal of Nursing Care Quality, 30(2), 93-98.