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Long-Term and Post-Acute Care

Long-term and post-acute care (LTPAC) facilities are essential to the Partnership to Reimagine Health Care. Comagine Health is working with centers across our six-state QIN-QIO region — Idaho, Nevada, New Mexico, Oregon, Utah and Washington — to improve resident outcomes and care processes through innovative quality improvement initiatives and data-driven approaches.

We offer direct technical assistance, collaborative and educational events, and evidence-based resources to help nursing homes:

  • Improve quality scores
  • Decrease opioid misuse
  • Increase access to behavioral health services
  • Prioritize patient safety through antibiotic stewardship
  • Boost vaccination rates
  • Implement infection prevention best practices
  • Reduce readmissions and other unnecessary emergency department visits

We also assist facilities with translating policy — including keeping them informed of the latest changes to Medicare regulations — implementing innovative activities that support their QAPI plans, and developing strategies that can effectively address gaps in care.

Comagine Health regularly creates and curates LTPAC resources for your use. We have a robust library of relevant toolkits, guides, checklists and assessments that can help your facility succeed. We also feature most recordings of virtual events on our YouTube channel.

Below you will find comprehensive resource bundles that group resources resulting from months-long interventions designed to educate nursing home providers on several priority issues, including infection prevention, care transitions, medication management, behavioral health and staff resiliency.

Driving Clinical Excellence During Unstable Times

This learning series is designed to help nursing facilities ensure they have an effective system and processes in place to support QAPI activities, opportunities to learn best practices from peers and options for testing changes leading to improvements in those processes.

Several tools are available to complement this collaborative:

Introduction and Building the 'Why' (Learning Session 1)

This session orients participants to the collaborative learning series format and introduces strategies for leading improvement efforts during challenging times (i.e., pandemic, staff shortages and turnover, etc.). Participants are encouraged to review available data sources to guide focus for improvement. To support operational understanding of the concepts, a case study is presented for discussion.

Exploring Your Data (Mastery Session 1a)

This session guides centers to look more closely at current data practices for collecting, analyzing, and sharing data for the purposes of:

  • Improving care processes and clinical outcomes

  • Creating transparency about care processes and clinical outcomes

  • Learning as an organization to continuously improve and sustain improvements

  • Potentially increasing staff retention as a result of engagement with improvement activities

WATCH: Driving Clinical Excellence Mastery Session 1a presentation

Plan to Prioritize (Mastery Session 1b)

This session promotes a standardized approach to prioritizing identified improvement opportunities and using this process to communicate the need for change with staff to create a shared vision for improvement. Participants are given the opportunity to identify how they responded to the COVID-19 pandemic by quickly implementing necessary changes for patient care and safety, and explore how these types of responses can be incorporated into ongoing approaches for quality improvement through their QAPI program. The session concludes with discussion on how to use the 15-minute-a-day approach to engage staff in quality improvement discussions.

Creating a Compelling Case for Change (Learning Session 2)

This session promotes a standardized approach to prioritizing identified improvement opportunities using the Prioritization Worksheet for Performance Improvement Projects. Participants are guided in using this information to develop and communicate a message about the need for change with staff to create a shared vision for improvement. Discussion questions are posed to focus on the standardized prioritization approach. Content briefly addresses Identifying and engaging change champions.

Increasing Efficiency (Mastery Session 2a)

This session focuses on assessing staff engagement and building alignment between organizational, team, and individual goals in support of quality improvement efforts. The value of building alignment of goals for productivity and efficiency, as well as sustainability for change efforts is highlighted.

Fostering Staff Investment (Mastery Session 2b)

This session focused on sharing real-life experiences with implementation of the collaborative learning series concepts and tools. Participants heard from the administrator at a Washington state center about how he began incorporating the 15-minute a day approach into their quality improvement practices in August and the results so far. The presenters model how the Quick QAPI Calendar tool supports a purposeful approach to the 15-minute a day approach for quality improvement.

Foundations of a Just Culture (Learning Session 3)

This session focuses on assessing staff engagement and building alignment between organizational, team, and individual goals in support of quality improvement efforts. Participants will learn the value of building alignment of goals for productivity and efficiency, as well as sustainability for change efforts.

Sustainability Planning (Mastery Session 3a)

This session guides participants through the key elements of sustainability planning. Discussions support understanding of how leadership can promote sustainability by utilizing the existing Quality Assessment & Assurance committee for performance management once the performance improvement project has achieved its goals and a new system or process is standardized, moving the responsibility from the QAPI committee.

Human Factors and Coaching (Mastery Session 3b)

This session introduced the science of human factors and how this relates to creating a just culture. Facilities explored a coaching process with staff that used the Decision Tree and Intervention Selection Tool to identify underlying causes for performance failures and select interventions that support improved performance. The focus of the session was to support a just culture to improve resident safety.

Building Shared Responsibility for Continuous QI (Learning Session 4)

This session provided an overview to The Model for Improvement and developing the Plan-Do-Study-Act (PDSA) cycle with considerations for health equity. Several strategies for engaging frontline staff with quality improvement and the PDSA cycles were explored to build shared responsibility and achieve successful outcomes. Participants had the opportunity to learn about quality improvement “timeouts” and how these timeouts can reinvigorate the effectiveness of improvement efforts. Ideas for how to celebrate the small wins from improvement efforts will be discussed to reinforce staff engagement.

Measuring Success (Mastery Session 4a)

This session provided a deeper look at how to effectively identify measures for Quality Assurance and Performance Improvement (QAPI) performance improvement projects (PIPs). Participants learned about the importance of balance measures to ensure there are no unintended negative outcomes from PIPs. Strategies for incorporating a health equity lens into PIPs were discussed using a case study and lived experience examples.

Incorporating the 4Ms of Age-Friendly System (Mastery Session 4b)

This session provided a deeper look at how incorporating the 4Ms of an Age-Friendly Health System into practice will positively impact the care provided to residents and reduce the potential risk of harm. Participants explored the potential impact of implicit bias on teamwork and resident care and the importance of cultural humility when interacting with others. One center shared how they successfully implemented the core elements of an age-friendly health system and how this approach improved resident-centered care.

Combatting Change Fatigue (Learning Session 5)

This session focused on changing the narrative around change fatigue. Participants explored strategies to avoid and overcome change fatigue, assess readiness for change, and maintain continuity when leadership changes. The case study will highlight the potential impact of change on residents. Strategies presented in the session will be connected to elements for improving joy in work in support of staff satisfaction and retention.

Maintaining Joy at Work (Mastery Session 5a)

This session focused on recognizing and addressing the impact of change fatigue on staff, residents, and family members, to reduce the potentially negative effects on quality improvement efforts and the quality of care. Large and small group discussion opportunities allowed participants to explore strategies for building a culture of psychological safety that supports engagement to reduce the risk for change fatigue.

Positive Leadership – What Matters to Staff (Mastery Session 5b)

This session focused on how leaders can do positive leadership walkrounds and engage staff in similar behaviors to build trust and reduce the impact of change fatigue. Role play, breakout, and case study opportunities were provided for real world experiences that reinforce learning.

Culture of Continuous Improvement (Learning Session 6)

This session focuses on strategies and resources to help balance new quality improvement projects with others that are nearing completion (entering the sustainment phase). Participants have the opportunity to hear from peers on how they engage staff and medical directors/providers in the QAPI program during roundtable discussions. Also the use of Kamishibai cards to ensure improvements are sustained and for gathering data about sustainment will be introduced.

COVID-19 Booster Sprint for Nursing Homes

To combat low uptake of the bivalent COVID-19 booster among nursing home residents, Comagine Health has created a communications kit that contains messaging and collateral aimed at family members of people in long-term care facilities and those who may be entering centers following hospital discharge.

Customizable Communications Kit

Skipping the latest booster leaves an already vulnerable population at an even higher risk for serious illness, hospitalization and death. We ask that you use these talking points and materials to educate nursing home residents and their family members about the importance of staying up to date.

Looking Beyond COVID-19:
Detecting Change in Resident Condition

Early detection of and timely response to resident change in condition may prevent complications and reduce transfers to the ER or hospital. Developing the skills of your clinical and nonclinical staff in this area has significant positive impacts on patient safety and well-being. Below are key summary points of each element of this process and ready-to-use tools for staff training and implementation of concepts.

Where to begin: Take this Self-Assessment to determine where to start and what areas might need the most attention.

Knowing Your Residents and Recognizing Baseline

Knowing a resident’s baseline is a critical first step in being able to recognize signs indicating decline or an acute change in condition so you can institute timely interventions. Use the following summary guides, resources and training tools to help all staff be alert and responsive to changes.

Communicating Concerns

Effective, timely communication and psychological safety in identifying potential concerns are vital to the goal of safe, quality care. Use the following summary guides, resources and training materials to establish processes that will enhance team performance and promote a culture of safety.

Nursing Assessment

Quality assessments and care planning are core nursing responsibilities and can often mean the difference between favorable and unfavorable care outcomes. Use the following guides, resources and recordings to help your staff gain the needed clinical competencies and ensure they are clear on their roles in the assessment process.

Monitoring and Reassessing the Resident

Ongoing monitoring and reassessment of the resident is essential to determining the effectiveness of their current plan of care as well as to ascertain whether the plan needs modification to meet continuing needs or address new needs. Use the below resources to establish safeguards to ensure your monitoring processes are consistent and effective. 

Documentation and Resident Response to Interventions

Documentation in the medical record is essential. It provides a chronological account of the residents' experiences while in your care, is used to create and manage treatment and care plans, provides a mechanism for communicating information about the residents’ past and current medical and functional status between caregivers and across disciplines and care settings, and is a legal record that may be used in risk management and in defense for litigation. Use the summaries, resources and tools below to help your staff better meet professional documentation standards and ensure quality.

Quality Improvement Review of Transfers

While emergency department transfers and hospital admissions/readmissions may be necessary to respond to a resident's urgent health crisis, data show that a percentage of these transfers are potentially preventable. Quality reviews can help providers identify trends that point to gaps in care processes, systems or communication among team members that may contribute to unnecessary transfers. Use the summary document and resources below to help your staff uncover patterns and identify opportunities for improvement.

Performance Improvement

Comagine Health has curated quality improvement tools that can help you examine processes, uncover root causes and implement needed change. Offerings include a root cause analysis tool, an A3 Report template and a PDSA worksheet to help you get started.

Staff Resiliency

Patient safety and individual/organizational resilience are linked. Attention to staff well-being is crucial to the healthy functioning of your center during this prolonged crisis. Use the curated resources and tool below to support your organization and team’s resilience and explore ways to strengthen these areas.

Half-Hour Hot Topics

Comagine Health’s Half-Hour Hot Topics was a 2020 webinar series designed to support the efforts of long-term care (LTC) teams by introducing innovative ideas that make resident care more efficient and effective, all in a 30-minute timeframe. These topic-focused trainings tailored to LTC providers are now available on-demand to accommodate busy schedules.

Preventing Adverse Events in Nursing Homes: Working Together to Keep Residents Safe, Part 1

Join Jennifer Pettis, MS, RN, CNE, WCC, associate director for NICHE, and Comagine Health for the first segment of a two-part deep dive into common adverse events in nursing homes and the personal and financial costs of these incidents.

Preventing Adverse Events in Nursing Homes: Working Together to Keep Residents Safe, Part 2

Join Jennifer Pettis, MS, RN, CNE, WCC, associate director for NICHE, and Comagine Health for the second segment of a two-part series on adverse events. In Part 2, Ms. Pettis discusses tools for examining facility protocols and investigating adverse events as well as evidence-based prevention practices.

Clinical Pearls of Transdermal Fentanyl (Duragesic®) and Other Opioids: A Pharmacist’s Perspective

Join Rebecca DeMoss, PharmD, of PharMerica and Comagine Health to gain a pharmacist’s perspective on prescribing patterns, monitoring and “pearls of wisdom” for maintaining resident safety (and yours) when these medications are used.

Care Planning for Suicidal Threats, Self-Harming Behaviors and Other Urgent Behavioral Health Concerns

This session, featuring Janet Holboke, MSW, LCSW, older adult behavioral health specialist at Greater Oregon Behavioral Health Inc., defines emergent vs. non-emergent mental health concerns, offers a variety of staff training and care plan strategies for residents with recurrent behavioral health emergencies, and identifies strategies for working with community mental health treatment partners.

Navigating Crucial Conversations in the COVID Era

Join Elizabeth Ross with Compassus Hospice and Comagine Health for tips and guidance on how to navigate end-of-life conversations during stressful times, including the COVID-19 pandemic.

Boosting Your Mental Health During a Crisis

Join Dr. M. Alexis Kennedy, trauma researcher at UNLV and founder of Compassion Recharge, for part 1 of a two-part series on mental health as she explores practical steps for boosting your resilience and wellness amid COVID-19 burnout.

Recharging Compassion and Minimizing Burnout

Join Dr. M. Alexis Kennedy, trauma researcher at UNLV and founder of Compassion Recharge, for part 2 of a two-part series on mental health as she explores practical steps for boosting your resilience and wellness amid COVID-19 burnout.

Medication Management to Prevent, Detect and Report Adverse Drug Events

Join William Simonson, PharmD, BCGP, FASCP, independent consultant clinical pharmacist, and Comagine Health as we explore strategies for preventing, detecting, reporting and minimizing the potential consequences of adverse drug events (ADEs).

COVID and Beyond — Delirium Best Practices

Join Donna Marie Fick, PhD, RN, FGSA, FAAN, Elouise Ross Eberly professor at The Pennsylvania State University College of Nursing and director of the Penn State Center for Geriatric Nursing Excellence, to gain knowledge and tools that essential caregivers can use at the bedside to recognize and manage symptoms of delirium.

Keys to Flu Vaccine Promotion: Resources for Communicating the Importance of the Flu Vaccine to Patients, Clients and Employees

During this special hour-long session, representatives from Immunize Nevada and the Nevada State Immunization Program discuss best practices for providers for how to make a strong flu vaccine recommendation, address common flu vaccine misconceptions, and offer information for how to encourage flu vaccination in your health care facility and in the workplace.