Members of the Statewide Committee for Improving MDS Assessment and Use and QIPMO have developed educational materials to assist long-term care facilities with the Resident Assessment Instrument (RAI) processes, such as the Minimum Data Set (MDS). Quality Indicators (QIs) derived from the MDS were developed as a way of providing feedback to facilities about their quality of care and provide one way of using the MDS data for quality monitoring and improvement. The MDS team has found that facilities that use their QI reports and on-site clinical consultations with gerontological nursing specialists from the MDS team’s Quality Improvement Program for Missouri (QIPMO) program improve the quality of care they deliver and improve resident outcomes.

Aging in Place: Critical for Seniors to Remain Independent

Written By: Rice, Sheena

EXPERT AVAILABLE: Aging in Place Critical for Seniors to Remain Independent MU Professor Marilyn Rantz credits advanced nurses, technology and coordinated care as means for improving patient care and lowering health care costs COLUMBIA, Mo. – Quality of care...

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Better care, better quality: reducing avoidable hospitalizations of nursing home residents

Written By: Rantz, M.J., Flesner, M.K., Franklin, J., Galambos, C., Pudlowski, J., Pritchett, A., Alexander, G., & Lueckenotte, A.

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...

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Randomized clinical trial of a quality improvement intervention in nursing homes

Written By: Rantz, M.J., Popejoy, L, Petroski, G.F., Madsen, R.W., Mehr, D.R., Zwygart-Stauffacher, M., Hicks, L.L., Grando, V., Wipke-Tevis, D.D., Bostick, J., Porter, R., Conn, V.S., & Maas, M.

Purpose: The purpose of the study was to determine if simply providing nursing facilities with comparative quality performance information and education about quality improvement would improve clinical practices and subsequently improve resident outcomes, or if a stronger intervention, expert clinical...

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Preparing nursing homes for the future of health information exchange

Written By: Alexander, G.L., Rantz, M., Galambos, C. Vogelsmeier, A., Flesner, M., Popejoy, L.L., Mueller, J., Shumate, S., & Elvin, M.

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...

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Integrating advanced practice registered nurses into nursing homes: The Missouri Quality Initiative experience

Written By: Vogelsmeier, A., Popejoy, L., Rantz, M., Flesner, M., Lueckenotte, A., & Alexander, G.

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....

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Health Outcomes Improved in States Where Nurse Practitioners Independently Provide Primary Care

Written By: Jessica Mueller

Click here for the video! As America’s population ages, life spans lengthen and more individuals enroll in insurance plans under the Affordable Care Act, the need for health care professionals will increase. The Association of American Medical Colleges estimates...

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Staff perceptions of social work student contributions to home health care services at an independent living facility

Written By: Galambos, C., Starr, J., Musterman, K., & Rantz, M.

This exploratory qualitative study examined staff perceptions of social work student contributions to client services, family and client communication, and staff workload in an independent living setting for older adults. Ten employees who had contact with the students, clients...

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Are older persons willing to accept and use amplifiers to better understand speech?

Written By: Lane, K., Rantz, M., Rawn, C., & Bien, A.

Hearing loss, the partial or total inability to perceive sound (Bance, 2007), is the third leading chronic illness in older adults, exceeded only by hypertension and arthritis (Hannula, 2011). In nursing homes, the prevalence of hearing loss is staggering, with reports...

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Nursing home quality, cost, staffing, and staff-mix

Written By: Rantz, M.J., Hicks, L., Grando, V.T., Petroski, G.F., Madsen, R.W., Mehr, D.R., Conn, V., Zwygart-Stauffacher, M., Scott, J., Flesner, M., Bostick, J., Porter, R., & Maas, M.

The purpose of this study was to describe the processes of care, organizational attributes, cost of care, staffing level, and staff mix in a sample of Missouri homes with good, average, and poor resident outcomes. In facilities with good...

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Assessing contributors to cost of care in nursing homes

Written By: Hicks, L.L., Rantz, M. J., Petroski, G.F., Madsen, R.W., Conn, V.S., Mehr, D., & Porter, R.

In 1994 12.7% of the population was 65 and over, while 10.6% were 85 and over. Expenditures for nursing homes reached $72.3 billion in 1994 (much of which is tax-supported) accounting for 8.7% of all personal health money spent....

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Setting thresholds for quality indicators derived from MDS data for nursing home quality improvement reports: An update

Written By: Rantz, M. J., Petroski, G., Madsen, R., Mehr, D., Popejoy, L., Hicks, L., Porter, R., Zwygart-Stauffacher, M. & Grando, V

Determining meaningful thresholds to reinforce excellent performance and flag potential problem areas in nursing home care is critical for preparing reports for nursing homes to use in their quality improvement programs. This article builds on the work of an...

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Setting thresholds for MDS quality indicators for nursing home quality improvement reports

Written By: Rantz, M. J., Petroski, G.F., Madsen, R.W., Scott, J., Mehr, D., Popejoy, L., Hicks, L., Porter, R., Zwygart-Stauffacher, M., & Grando, V.

An important area of inquiry in quality measurement when using quality indicators (QIs) lies in determining what thresholds indicate good and poor resident outcomes. In July 1996, a cross-section of 13 clinical care personnel from nursing homes participated on...

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Advances in measuring quality of care in nursing homes: a new tool for providers, consumers, regulators, and researchers

Written By: Rantz, M.J., Zwygart-Stauffacher, M., & Flesner, M.

Over the past 12 years, members of the Minimum Data Set (MDS) and Quality Research Team at the University of Missouri-Columbia have been working with the Missouri Department of Health and Senior Services to improve care in Missouri nursing...

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Field testing, refinement and psychometric evaluation of a new measure of nursing home care quality

Written By: Rantz, M., Zwygart-Stauffacher, M., Mehr, D., Petroski, G., Owen, S., & Madsen, R

The primary aim of this NINR-NIH-funded field test in 407 nursing homes in 3 states was to complete the development of and conduct psychometric testing for the Observable Indicators of Nursing Home Care Quality Instrument (Observable Indicators, OIQ). The...

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Improving quality of care in nursing facilities: The gerontological clinical nurse specialist as research nurse consultant

Written By: Popejoy, L.L., Rantz, M.J., Conn, V., Wipke-Tevis, D., Grando, V., & Porter, R.

It is becoming increasingly common for nursing facilities to use Quality Indicators (QI) derived from Minimum Data Set (MDS) data for quality improvement initiatives within their facilities. It is not known how much support facilities need to effectively review...

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Impact of nurse practitioners on health outcomes of Medicare and Medicaid patients

Written By: Oliver, G.M., Pennington, L., Revelle, S., & Rantz, M.

Strengthening healthcare overall is essential to the health of our nation and promoting access to healthcare as well as controlling healthcare costs in a quality cost-effective manner. Nurse practitioners have demonstrated in prior research to be effective and cost-effective...

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QIPMO Video

Written By: Strata Commun

Wonder what QIPMO is all about? Click here for a quick and informative video! Strata Commun

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Care Improvement Program Saves Nursing Homes Millions

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. Medical News Today. May...

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Improvements in Missouri Nursing Homes Using QIPMO Services

The Quality Improvement Program for Missouri (QIPMO) is a cooperative service of the University of Missouri Sinclair School of Nursing and the Missouri Department of Health and Senior Services. (2008)

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Pain management in nursing homes: What do quality measures tell us?

Written By: Russell, T., Madsen, R., Flesner, M.K., & Rantz, M.

Pain management for older adults residing in nursing homes continues to present multifaceted challenges to health care practitioners and researchers. This study, which focuses on improvement in pain assessment and management, is a secondary analysis of data from a...

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The MDS Mortality Risk Index: The evolution of a method for predicting 6-month mortality in nursing home residents

Written By: Porock, D., Parker Oliver, D., Petroski, G., & Rantz, M

Accurate prognosis is vital to the initiation of advance care planning particularly in a vulnerable, at risk population such as care home residents. The aim of this paper is to report on the revision and simplification of the MDS...

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Cost, staffing, and quality impact of bedside electronic medical record (EMR) in nursing homes

Written By: Rantz, M.J., Hicks, L., Petroski, G.F., Madsen, R.W., Alexander, G., Galambos, C., Conn, V., Scott-Cawiezell, J., Zwygart-Stauffacher, M., & Greenwald, L.

There is growing political pressure for nursing homes to implement the electronic medical record (EMR) but there is little evidence of its impact on resident care. The purpose of this study was to test the unique and combined contributions...

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The influence of teams to sustain quality improvement in nursing homes that “need improvement”

Written By: Rantz, M.J., Zwygart-Stauffacher, M., Flesner, M., Hicks, L., Mehr, D., Russell, T., & Minner, D.

Objectives: Qualitatively describe the use of team and group processes in intervention facilities participating in a study targeted to improve quality of care in nursing homes “in need of improvement.” Design/setting/participants: A randomized, two-group, repeated-measures design was used to...

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Challenges of using quality improvement methods in nursing homes that “need improvement”

Written By: Rantz, M.J., Zwygart-Stauffacher, M., Flesner, M., Hicks, L., Mehr, D., Russell, T., & Minner, D.

Objectives: Qualitatively describe the adoption of strategies and challenges experienced by intervention facilities participating in a study targeted to improve quality of care in nursing homes “in need of improvement”. To describe how staff use federal quality indicator/quality measure...

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Initiative to test a multidisciplinary model with advanced practice nurses to reduce avoidable hospitalizations among nursing facility residents

Written By: Rantz, M., Alexander, G., Galambos, C., Vogelsmeier, A., Popejoy, L., Flesner, M., Lueckenotte, A., Crecelius, C., & Zwygart-Stauffacher, M.

Consider the current reality for Mrs. Florence Jones, a woman of advanced age and mild dementia in a long-term care facility, who insists everyone call her “Flossie”: On May 1, Karen, the nurse aide taking care of Flossie, needs...

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Stability and sensitivity of nursing home quality indicators

Written By: Rantz, M.J., Hicks, L. Petroski, G.F., Madsen, R.W., Mehr, D.R., Conn, V., Zwygart-Stauffacher, M., & Mass, M.

The issues of stability and sensitivity of indicators to actually detect differences in quality of care in nursing facilities are not only of concern to researchers, but also to public policy makers, who are reporting indicators to providers and...

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Nursing home quality and pressure ulcer prevention and management strategies

Written By: Wipke-Tevis, D.D., Williams, D.A., Rantz, M.J., Popejoy, L.L., Madsen, R.W., Petroski, G.F., & Vogelsmeier, A.A

OBJECTIVES: To measure pressure ulcer quality indicator (QI) scores and to describe the self-reported skin integrity assessment, pressure ulcer risk assessment, and pressure ulcer prevention and treatment practices in long-term care facilities (LTCFs). DESIGN: Retrospective analysis of a large data set...

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International comparison of quality indicators in the United States, Icelandic and Canadian nursing facilities

Written By: Jensdottir, A.B., Rantz, M.J., Hjaltadottir, I., Guomundsdottir, H., Rook, M., & Grando, V.

We discuss the results of a comparison using minimum data set (MDS)-based quality indicators (QIs) for residents in nursing facilities in three countries (Iceland; Ontario, Canada; and Missouri, United States) together with implications regarding nursing practices and resident outcomes...

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Lower respiratory infections in nursing home resident with dementia: A tale of two countries

Written By: Mehr, D.R., van der Steen, J.T., Kruse, R.L., Ooms, M.E., Rantz, M., & Ribbe, M.W.

A focus on palliative care for residents with dementia is much more common in Dutch nursing homes than in the United States. We compared treatment and mortality in U.S. and Dutch nursing home residents with lower respiratory infections (LRI),...

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Hospice and non-hospice nursing home residents

Written By: Parker-Oliver, D., Porock, D., Zweig, S., Rantz, M., & Petroski, G.

Objective: To compare hospice residents in nursing homes with residents who are noted as end-stage, but not in hospice programs. Design: Descriptive comparison of the outcomes reported on Minimum Data Set (MDS) for all residents admitted to Missouri nursing homes in...

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A profile of residents admitted to long-term care facilities for end-of-life care

Written By: Porock, D., Parker-Oliver, D., Zweig, S., Rantz, M., & Petroski, G.

Permanent placement in a Long-Term-Care (LTC) facility following hospitalization or when staying at home is no longer a viable option is the reality for a growing number of Americans. When death is imminent, the specialized knowledge and skill of...

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High-quality nursing home care is more cost effective than low-quality care

Written By: Rantz, M., Hicks, L., Petroski, G.F., Madsen, R.W., Conn, V., Zwygart-Stauffacher, M., & Maas, M.

Two studies of Missouri nursing homes – a random sample of facilities and a larger, statewide analysis – suggest that high-quality LTC actually costs less than poor-quality LTC. The researchers found that larger nursing homes, in particular, can realize...

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A statewide strategy to improve quality of care in nursing facilities

Written By: Rantz, M.J., Vogelsmeier, A., Manion, P., Minner, D., Markway, B., Conn, V., Aud, M.A., & Mehr, D.R.

We describe the development of a statewide strategy to improve resident outcomes in nursing facilities, and we present some evaluative data from this strategy. Key components of the strategy include (a) a partnership between the state agency responsible for...

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Getting the basics right: Critical processes of care delivery in nursing homes that achieve good resident outcomes

Written By: Rantz, M.J., Grando, V., Conn, V.S., Zwygart-Stauffacher, M., Hicks, L., Flesner, M., Scott, J., Manion, P., Minner, D., Porter, R., & Mass, M.

Rantz, M.J., Grando, V., Conn, V.S., Zwygart-Stauffacher, M., Hicks, L., Flesner, M., Scott, J., Manion, P., Minner, D., Porter, R., & Mass, M. (2003). Getting the basics right: Critical processes of care delivery in nursing homes that achieve good...

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Nursing home costs and quality of care outcomes

Written By: Hicks, L.L., Rantz, M.J., Petroski, G.F., & Mukamel, D.B.

The article focuses on nursing homes costs and quality of care outcomes. Consumers are demanding mechanisms that will allow them to evaluate the quality of care provided in nursing homes. Policymakers, who are responsible for oversight of the public...

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Back to the fundamentals of care: A road map to improve nursing home care quality

Written By: Rantz, M.J. & Zwygart-Stauffacher, M.

See PDF. Rantz, M.J., & Zwygart-Stauffacher, M. (2004). Back to the fundamentals of care: A road map to improve nursing home care quality. Journal of Nursing Care Quality, 19(2), 92-94. Journal of Nursing Care Quality

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Developing a residential care facility version of the observable indicators of nursing home care quality instrument

Written By: Aud, M.A., Rantz, M.J., Zwygart-Stauffacher, M., & Manion, P.

The last decade has seen a substantial growth in the development of residential care facilities (assisted-living facilities). Evaluation of the quality of care in this service delivery sector has been hampered by the lack of a consensus definition of...

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Prevalence and characteristics of nursing home residents needing light-care

Written By: Grando, V., Rantz, M., Petroski, G., Maas, M., Popejoy, L., Conn, V. & Wipke-Tevis, D.

Rising nursing home (NH) costs and the poor quality of NH care make it important to recognize elders for whom NH care may be inappropriate. As a first step in developing a method to identify these elders, we examined...

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Preparation of nurse leaders in the 21st century workplace

Written By: Flesner, M.K., Scott-Cawiezell, J., & Rantz, M.J.

Creating work environments in which health care is delivered in a safe manner requires a new type of nursing leader, one who can transform the environment and the culture of a health care organization. This is the concept identified...

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Systematic review of studies of staffing and quality in nursing homes

Written By: Bostick, J.E., Rantz, M.J., Flesner, M.K., & Riggs, C.J.

Numerous studies in the past three decades have explored the relationships between staffing levels in nursing homes and quality of care measures. However, the wide array of studies researching staffing and quality of care, many with conflicting results, make...

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Entrepreneurial program of research and service to improve nursing home care

Written By: Rantz, M., Mehr, D., Hicks, L., Scott-Cawiezell, J., Petroski, G.F., Madsen, R.W., Porter, R., & Zwygart-Stauffacher, M.

This is a methodological article intended to demonstrate the integration of multiple goals, multiple projects with diverse foci, and multiple funding sources to develop an entrepreneurial program of research and service to directly affect and improve the quality of...

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A new reliable tool for nurse administrators, nursing staff, regulators, consumers, and researchers for measuring quality of care in nursing homes

Written By: Rantz, M.J. & Zwygart-Stauffacher, M.

Funding from NINR enabled large-scale field testing of an instrument to measure the observable multidimensional components of the concept of nursing home care quality. Field testing in 3 states was directed by research teams at the University of Missouri-Columbia...

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Clinical information systems in nursing homes: an evaluation of initial implementation strategies

Written By: Alexander, G., Rantz, M., Flesner, M., Diekemper, M., & Siem, C.

This article presents qualitative results collected 6 months after implementation of a clinical information system in four nursing homes in the Midwestern USA. Researchers explored initial implementation strategies, discussed employee experiences, and analyzed employee satisfaction. Transcript-based analysis and axial...

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Improving care in nursing homes using quality measures/indicators and complexity science

Written By: Rantz, M.J., Flesner, M.K., Zwygart-Stauffacher, M.

The authors report on a NIH multilevel intervention study (n=58; 29 intervention, 29 control) performed in a Midwestern state over a 2 year time frame. Complexity science was the theoretical model used to analyze the observations made by research...

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Randomized multilevel intervention to improve outcomes of residents in nursing homes in need of improvement

Written By: Rantz, M.J., Zwygart-Stauffacher, M., Hicks, L., Mehr, D., Flesner, M., Petroski, G.F., Madsen, R.W., & Scott-Cawiezell, J.

Objectives: A comprehensive multilevel intervention was tested to build organizational capacity to create and sustain improvement in quality of care and subsequently improve resident outcomes in nursing homes in need of improvement. Design/Setting/Participants: Intervention facilities (N ¼ 29) received...

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Involvement of Advanced Practice Nurse in the management of geriatric conditions: examples from different countries

Written By: Fougère, B., Lagourdette, C., Abele, P., Resnick, B., Rantz, M., Kam Yuk Lai, C., Chen, Q., Moyle, W., Vellas, B., & Morley, J.E.

The increasing demand for healthcare services is placing great strain on healthcare systems throughout the world. Although the older population is increasing worldwide, there is a marked deficit in the number of persons trained in geriatrics. It is now...

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APRN-conducted medication reviews for long-stay nursing home residents

Written By: Vogelsmeier, A., Popejoy, L., Crecelius, C., Orique, S., Alexander, G. & Rantz, M.

Objective: As part of the Missouri Quality Initiative (MOQI) to reduce hospitalizations for long-stay nursing home residents, this article describes reasons MOQI advanced practice registered nurses (APRNs) recommended medication order changes as part of their medication review process as...

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Reducing avoidable hospitalizations and improving quality in nursing homes with APRNs and interdisciplinary support: lessons learned

Written By: Rantz, M., Popejoy, L., Vogelsmeier, A., Galambos, C., Alexander, G., Flesner, M., Murray, C., & Crecelius, C.

Reduction in avoidable hospitalizations of nursing home residents is a major concern to health care providers as well as payers. Not only are hospitalizations costly but also hospitalized nursing home residents experience functional and physical decline as a result...

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Impact of advanced practice registered nurses on quality measures: The Missouri Quality Initiative experience

Written By: Rantz, M.J., Popejoy, L., Vogelsmeier, A., Galambos, C., Alexander, G., Flesner, M., Murray, C., Crecelius, C., Ge, B., & Petroski, G.

Purpose: The purpose of this article is to review the impact of advanced practice registered nurses (APRNs) on the quality measure (QM) scores of the 16 participating nursing homes of the Missouri Quality Initiative (MOQI) intervention. The MOQI was...

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An observational study of antipsychotic medication use among long-stay nursing home residents without qualifying diagnoses

Written By: Phillips, L.J., Birtley, N.M., Petroski, G.F., Siem, C., & Rantz, M.

Introduction: Antipsychotic use in nursing homes varies widely across the United States; inadequate staffing, skill mix, and geropsychiatric training impede sustained improvement. Aim: This study identified risk factors of antipsychotic use in long-stay residents lacking qualifying or potentially qualifying...

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Written By: Popejoy, L., Vogelsmeier, A., Galambos, C., Flesner, M., Alexander, G., Lueckenotte, A., Lyons, V., & Rantz, M.

The Centers for Medicare & Medicaid Innovations Centers partnered with 7 Enhanced Care and Coordination Provider (ECCP) sites across the United States with the goal to reduce potentially avoidable hospital transfers for nursing home residents. The University of Missouri Sinclair...

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Impact of pain on outcomes in long-term care residents with and without multiple sclerosis

Written By: Newland, P., Wipke-Tevis, D., Williams, D., Rantz, M., & Petroski, G.

This study was to compare long-term care (LTC) residents with and without multiple sclerosis (MS); to compare admission status of pain, physical disability, pressure ulcers, depression, and cognitive performance in LTC residents with and without MS; and to examine...

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Call to action: APRNs in US nursing homes to improve care and reduce costs

Written By: Rantz, M.J., Birtley, N.M., Flesner, M., Crecelius, C., & Murray, C.

Background: Centers for Medicare and Medicaid Innovation Center sponsored the initiative to reduce avoidable hospitalizations among nursing facility residents. Purpose: Missouri Quality Initiative (MOQI) designed inter-professional model in nursing homes with advanced practice registered nurses (APRNs). Method: MOQI APRN...

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Exploring health information exchange implementation using qualitative assessments of nursing home leaders

Written By: Alexander, G., Popejoy, L., Lyons, V., Shumate, S., Mueller, J., Galambos, C., Vogelsmeier, A., Rantz, M., & Flesner, M.

Objectives: Limited research exists on nursing home information technologies, such as health information exchange (HIE) systems. Capturing the experiences of early HIE adopters provides vital information about how these systems are used. In this study, we conduct a secondary...

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Randomized trial of intelligent sensor system for early illness alerts in senior housing

Written By: Rantz, M., Phillips, L.J., Galambos, C., Lane, K., Alexander, G.L., Despins, L., Koopman, R.J., Skubic, M., Hicks, L., Miller, S., Craver, A., Harris, B., & Deroche, C.B.

Objectives: Measure the clinical effectiveness and cost-effectiveness of using sensor data from an environmentally embedded sensor system for early illness recognition. This sensor system has demonstrated in pilot studies to detect changes in function and in chronic diseases or...

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Successfully reducing hospitalizations of nursing home residents: results of the Missouri Quality Initiative

Written By: Rantz, M., J., Popejoy, L., Vogelsmeier, A., Galambos, C., Alexander, G., Flesner, M., Crecelius, C., Ge, B., & Petroski, G.

Purpose: The goals of the Missouri Quality Initiative (MOQI) for long-stay nursing home residents were to reduce the frequency of avoidable hospital admissions and readmissions, improve resident health outcomes, improve the process of transitioning between inpatient hospitals and nursing...

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Analysis of advance directive documentation to support palliative care activities in nursing homes

Written By: Galambos, C., Starr, J., Rantz, M., & Petroski, G.

As part of an intervention to improve health care in nursing homes with the goal of reducing potentially avoidable hospital admissions, 1,877 resident records were reviewed for advance directive (AD) documentation. At the initial phases of the intervention, 50...

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