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1
Collaborative Overview
IHI’s Collaborative Model for Achieving
Breakthrough Improvement
2
Objectives
• Explain the purpose of the Nursing Home
Collaborative
• Explain the Nursing Home Collaborative Structure
• Explain the key elements of IHI Breakthrough
Series
• Explain the Composite Score
3
Collaborative Mission
To provide a structure for learning and action that
engages nursing homes to make real, system level
changes that will lead to dramatic improvements in
care and care practices resulting in a person-
centered just culture.
4
Collaborative Purpose
• Facilitate sharing among collaborative members
• Instill quality improvement practices
• Improve quality and performance by nursing homes
• Eliminate healthcare acquired conditions (HACs)
• Improve resident and staff satisfaction
5
National Nursing Home Quality Care CollaborativeNNHQCC
• Convened by QIN-QIO (Quality Innovation Network-
Quality Improvement Organization)
• Each state has a Nursing Home Quality Care
Collaborative
• Each state’s NHQCC is part of the NNHQCC
6
Collaborative Overview
• Subject matter experts and application experts gather
• Timeframe established
• Change areas selected
– Hospitalizations
– Medications (Reducing Antipsychotic Use)
– Staff Stability
• Changes are planned by the group to implement at each
facility
• Teams return to their individual nursing homes to test
planned change
7
The IHI (Institute for Healthcare Improvement) Breakthrough Series Model
www.ihi.org
8
Application Experts Role
Topics:
• Medication- Reduce
Antipsychotic
Medication Use
• Re-Hospitalization-
Reduce preventable
hospitalizations
• Staff Stability-Retaining
staff to maintain
consistent assignments
9
Subject Matter Experts Role
Participation of Subject Matter
Experts :
• Join the collaborative
• Complete pre-work, watch
the 3 videos posted on the
website
• Participate in each learning
session
10
Collaborative Learning
• Participate in
Learning Sessions
• Complete activities
during Action Periods
• Submit data as
requested
• Celebrate successes
11
QAPI Self-Assessment Pre-work Video
• Complete as you begin working on
QAPI
• Update semi-annually or annually
to evaluate progress
• 24 statements for the Steering to
discuss and decide how closely
each fits your nursing home
– Not started
– Just starting
– On our way
– Almost there
– Doing great
• Write notes for each statement to
clarify reason for rating
12
QAPI OverviewPre-Work Video
• QAPI build from QA
• Leadership to direct care staff
• Systems is the focus
• Involve people working the
process in the fixing of the process
• Communication, teamwork, and
ongoing education
• 5 Elements are the foundation
• 12 Action Steps to operationalize
• Driven by data
• Plans, implementation and
sustainment of process
improvements are written.
QAPI at a Glance
13
Collaborative HandbookPre-work Video
• Informational resource
• Inclusive listing of useful
tools and other
resources
• Knowledge enhancing
examples
14
Nursing Home Quality Care Collaborative Composite Score
15
Composite ScoreA measure of effectiveness
Is collaborative making a difference?
• 13 QMs from CASPER Reports that represent larger
systems in nursing homes
– Numerators-number of residents that triggered for that measure
on CASPER Reports
– Denominators-number of residents in the population for that
measure
– Divide numerator total by denominator total then multiple by 100
• Target is composite score of 6 or less
16
Composite Score: 13 QMs
1. Percent of residents with one or more falls with major injury
2. Percent of residents with a UTI
3. Percent of residents who self-report moderate to severe pain
4. Percent of high-risk residents with pressure ulcer
5. Percent of low-risk residents with loss of bowels or bladder
6. Percent of residents with catheter inserted or left in bladder
7. Percent of residents physically restrained
8. Percent of residents whose need for help with ADL has increased
9. Percent of residents who lose too much weight
10. Percent of residents who have depressive symptoms
11. Percent of residents who received antipsychotic medications
12. Percent of residents assessed and appropriately given flu vaccine
13. Percent of residents assessed and appropriately given Pneumococcal vaccine
17
Composite Score Numerator and Denominator
Calculated for each nursing home from their facility Level CASPER Report data.
18
Composite Score Calculations
From CASPER Reports
• Numerators- residents that triggered for that QM
• Denominator-residents with assessments that meet the
QM criteria
Composite Calculations
• Composite numerator-sum of 13 QM numerators
• Composite denominator-sum of 13 QM denominators
• Composite score- divide composite numerator by
composite denominator and multiply by 100
Goal is composite score of 6 or less
19
Composite ScorePicture that tells a story
20
Summary
Each state has a Nursing Home Quality Care
Collaborative which forms the National Nursing Home
Quality Care Collaborative (NNHQCC). The core purpose
is to instill practices for the improvement of quality and
performance by nursing homes and eliminate
healthcare acquired conditions (HACs). Composite
scores are how progress is measured in the NNHQCC.
Lower composite scores are better.
21
Questions
22
Today’s workgroups opportunity
• Brainstorm
– Share your professional experiences
– Share ideas about root causes for problem
• Target a root cause for correction
• Decide on a change idea to correct the root cause
• Create a draft or a sample PIP Charter to take back to your nursing
home
– Use Worksheet to Create a Performance Improvement Project
Charter
– Use Goal Setting Worksheet
• Return to nursing home during Action Period
– Present change idea to Steering Team
– Test the change
This material was prepared by Telligen, Medicare Quality Innovation Network Quality Improvement
Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of
the U.S. Department of Health and Human Services. The contents presented do not necessarily
reflect CMS policy. 11SOW-IL-C2-04/15-088