Hospitalization for nursing home residents is a national concern. Studies suggest the majority of hospital transfers are avoidable, often resulting from poor care processes such as lack of early illness detection, adverse event occurrences, and poor communication between nursing home staff, providers, and residents/families about goals of care. Efforts supported by the Centers for Medicare and Medicaid Services are underway in the United States to reduce avoidable hospitalizations for nursing home residents. In 2012, the University of Missouri Sinclair School of Nursing was one of 7 sites across the United States selected for their evidence-based model called the Missouri Quality Initiative (MOQI), based on the nationally recognized Quality Improvement Program of Missouri (QIPMO). The goal of the MOQI was to work with 16 nursing homes in the Midwestern United States who had higher than national averages of hospitalization rates to change their systems of care delivery so that reduced hospital transfers could be achieved. Since 2012, the MOQI has achieved a 30% reduction in all-cause admissions following full implementation.
The MOQI method of reducing hospitalizations embeds a full-time advanced practice registered nurse (APRN) in each nursing home to implement early illness identification strategies including using Interventions to Reduce Acute Care Transitions (INTERACT) tools,8 managing acute and chronic conditions, initiating advance directives/advance health care planning, and facilitating the use of health information technology. APRNs use data to drive systems-level change including the use of monthly feedback reports showing the number of hospital transfers and changes of condition that provide longitudinal performance data to the APRN and nursing home team. Additionally, APRNs complete root cause analyses of all hospital transfers to help identify underlying causes. These root cause analyses are reviewed monthly with the project supervisor who is a member of the multidisciplinary intervention team.
The multidisciplinary intervention team has expertise in nursing home practice, geriatric medicine, advance care planning, end-of-life care, health information technology, and systems/quality improvement (QI). This team provides support to each MOQI APRN, hereafter referred to as APRN, to ensure achievement of successful outcomes. The APRN and the intervention team work closely with nursing home leaders and staff to facilitate system-level change to sustain lower hospital transfer rates. The purpose of this article is to describe the critical role of the multidisciplinary intervention team of clinical experts in supporting improved processes and sustained outcomes.
Vogelsmeier, A., Popejoy, L., Kist, S., Shumate, S., Pritchett, A., Mueller, J., & Rantz, M. (2020). Reducing avoidable hospitalizations for nursing home residents: role of the Missouri Quality Initiative Intervention Support Team. Journal of Nursing Care Quality, 35(1), 1-5.View the PDF