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