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Comagine Health Partnership With the UW Center for Scholarship in Patient Care Quality and Safety to Build QI Capacity in Nursing Homes

Full implementation of a Quality Assurance and Performance Improvement (QAPI) program is a requirement in nursing homes since November 28, 2019. With the COVID-19 public health emergency and resulting changes to staffing stability in nursing homes, sustaining this effort became even more challenging. To support this effort, Comagine Health partnered with the University of Washington (UW) to offer nursing homes in the Comagine Health QIN-QIO six-state region the opportunity to develop capacity for quality improvement (QI).

The course began with 25 teams representing 29 unique nursing homes, including 85 participants overall. Despite some attrition, 14 teams completed the nine-week education portion and have selected their improvement projects to be developed during a break before regrouping in 2023. Seven nursing homes presented their final projects to their peers on March 8. Projects focused on improving:

  • Hand hygiene (15.56% compliance prior to intervention)
  • Missed medications (4% to 0.06%, now in sustainability mode)
  • Practices to prevent and heal pressure ulcers/injuries (high risk residents – 17.1% observed rate; new or worsened pressure ulcers – 10.5% observed rate; goal to reduce by 30% by May 31)
  • Management of suspected urinary tract infections following clinical guidelines to decrease antibiotic use in the absence of symptoms (5 UTIs, only 2 clinically appropriate for antibiotic treatment)
  • Appropriate use of personal protective equipment (expanded audits to weekend and night shifts; previous audit all done during the day shift)
  • Care for urinary tract infections to prevent hospitalizations due to urosepsis (also addressed antibiotic stewardship)
  • Skin care to prevent skin infections and cellulitis

To determine the impact of this program, participants were asked to self-rank their knowledge and experience on a scale of 0 (none) – 100 (expert) across several program concepts for three occasions of measurement: prior to the start of the program, at the program midpoint and at the close of the program. In general, participants increased their self-perceived knowledge and experience across the course of the program. Concepts that would be more commonly accessed by healthcare professionals, such as antibiotic stewardship, had higher baseline measures compared to concepts such as conducting impact equity analysis. This data suggests the program drives increased knowledge of key program elements and self-perceived ability to act on these concepts by the midpoint of the program, with those knowledge and skills maintaining or continuing to increase through the end of the program.

Comagine Health and the UW plan to offer this program again, with more information coming in May.

This program will be part of a poster presentation at the CMS 2023 Quality Conference: Building QI Capacity in Nursing Homes.

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