1. Advancing Excellence in America’s Nursing Homes Making Nursing Homes Better Places to Live, Work and Visit!

2. Advancing Excellence in America’s Nursing Homes Campaign
Welcome and Introduction by Carol Benner National Director Advancing Excellence Campaign

3. Advancing Excellence in America’s Nursing Homes Campaign
Tammy Rolfe, RN, LNHA, MS HPM Field Operations Manager Advancing Excellence Campaign

4. Maryland Advancing Excellence Campaign Overview February 9, 2011

5. Campaign Overview Voluntary for nursing homes
Based on measurement of meaningful goals
National coalition of 29 organizations
Initially a two-year campaign started in 2006, incorporated in 2010!

6. What the Campaign Does
Provides free, practical and evidence-based resources to support quality improvement efforts in America’s nursing homes.
Committed to providing support to those on the frontlines of nursing home care.
 Promotes open communication and transparency among families, residents, and nursing home staff.
The Campaign works on 4 operating principles:
Helps nursing homes make a meaningful and measurable difference in the lives of residents and staff
Provides free, practical and evidenced-based technical assistance materials to nursing homes, staff and families
Evidence-based means that the resources have been tested and that they work.
Campaign believes that the front line worker including CNAs are critical to the QI process and has prepared specific resources for these staff
And, that consumers , residents and family should be brought into the quality improvement process in a manner that is open and transparent

7. 11 Founding Organizations
Alliance for Quality Nursing Home Care
American Association of Homes and Services for the Aging (AAHSA)
American Association of Nurse Assessment Coordinators (AANAC)
American College of Health Care Administrators (ACHCA)
American Health Care Association (AHCA)
American Medical Directors Association (AMDA)
Centers for Medicare & Medicaid Services (CMS) and its contractors, the Quality Improvement Organizations (QIOs) and State Survey Agencies
National Association of Health Care Assistants (NAHCA)
NCCNHR: National Consumer Voice for Long Term Care
The Commonwealth Fund
The Evangelical Lutheran Good Samaritan Society

8. Now 30 Steering Committee Members
Administration on Aging
Agency for Healthcare Research and Quality (AHRQ)
Alzheimer’s Association
American Academy of Nursing -- Expert Panel on Aging
American Association for Long Term Care Nursing (AALTC)
American Health Quality Association (AHQA)
Association of Health Facility Survey Agencies (AHFSA)
Assistant Secretary for Policy and Evaluation (ASPE)
Centers for Disease Control and Prevention (CDC)
Foundation of the National Association of Boards of Examiners of Long Term Care Administrators
Hartford Institute for Geriatric Nursing
Health and Human Services – Disability,
Aging and Long Term Care Policy Department (HHS)
National Association of Directors of Nursing Administration in Long Term Care (NADONA/LTC)
National Association of State Long-Term Care Ombudsman Programs (NASOP)
National Conference of Gerontological Nurse Practitioners (NCGNP)
National Gerontological Nursing Association (NGNA)
PHI
Pioneer Network
Service Employees International Union (SEIU)
Veteran’s Administration

9. Campaign Benefits Focuses on meaningful issues
Drives nursing homes to a culture of QI
Increases staff retention and focus
Improves customer satisfaction
Saves money due to improved quality and staff retention
Prepares for Pay-for-Performance
Brings stakeholders to the table
Complements other initiatives
To get these key national stakeholders to invest in AE,, someone had to be able to demonstrate the value of participating in a national campaign.
4 of the more compelling benefits of engaging in this particular Campaign are Increased Staff retention
Cost savings
,Improved customer satisfaction
And preparation for a pay-for-performance
I probably don’t need to say a lot about the importance of staff retention and customer satisfaction except to underscore that they can be among the most important drivers of quality.
And quality saves money. Perhaps not in the direct line items of your budget but certainly in the costs associated with poor quality – worker’s comp claims resulting from staff injuries, civil liability, to name a couple
Third, , as CMS continues to experiment with pay for performance models and demonstration, it is clear that any P4P will likely be based on measures that are clinical, compliance, and outcome oriented. Customer satisfaction may also be included in this group.
And, hopefully, as we move away from a survey to survey existence so that we can focus on continuous quality improvement, it’ll be to our benefit to have the key LTC stakeholders sitting around the table getting along than it will be to have them pointing fingers and competing with one another

10. Phase 2 of the Advancing Excellence Campaign Started January 1, 2010 and will end December 31, 2011

11. Phase 2 Jan 2010 – Dec 2011 Revised and reordered goals
Data – driven targets for nursing homes and LANEs
New and refreshed website – better navigation
Two new goals: Advance Care Planning and Staff Satisfaction
Updated resources
New CNA and consumer one-pagers
Merged NHQI-STAR website with Advancing Excellence website
Easier access to data
So, what’s new and different in Phase 2? LOTS –
First, we’ve revised all of the goals. We found that nursing homes that selected a goal AND THAT SET TARGETS improved even faster than those that just selected a goal. We’ve added target setting to all of the goals.
Targets are based on percentiles – we want all nursing homes, states and the nation to improve by 10 percentiles. (We’ll explain percentiles in a minute). This amount of improvement is indeed statistically possible if everyone works hard.
We’ve reordered the goals so that the reflect the order of working the goals that a nursing home might logically choose. For example, the first thing a nursing home needs to do is stabilize its workforce so we put staff turnover and consistent assignment first.
We have redesigned the website and made it easier to navigate.
We’ve combined the two pain goals into one goal with 2 parts (long and short stay) and we’ve added 2 new goals – Staff satisfaction and Advance Care Planning.
We’ve added standardized measurement tools for determining staff turnover and consistent assignment. And,
We are recognizing nursing homes that participated in Phase 1 and who sign up for Phase 2 as CHARTER members of the Campaign.

12. Phase 2 Goals Staff Turnover Consistent Assignment Restraints
Pressure Ulcers
Pain (long and short-stay)
Advance Care Planning
Resident/Family Satisfaction
Staff Satisfaction

13. What’s New with the Advancing Excellence Campaign?

14. What is New In The Campaign
Celebrated our 4th Birthday
We incorporated / applied for non-profit status
Post MDS 2.0 & QM – Clinical Tools posted11/1
Reached Critical Mass
Moved from recruitment to performance with the Accelerating LANE Performance Challenge and Critical Access Nursing Homes Pilot
Star Map – We have some very active LANEs

15. LANE Participation in Advancing Excellence Fall 2010
More than 50% nursing home participation
Accelerating LANE Performance States
Critical Access Nursing Home State
Changing LANEs Project

16. Accelerating LANE Performance Summary of Grant Proposals
24 Proposals from 15 States Submitted
22 Proposals from 15 States Selected
Goal Focus Breakdown:
6 on Staff Turnover (Goal 1)
4 on Consistent Assignment (Goal 2)
1 on Restraint Reduction (Goal 3)
4 on Pressure Ulcers (Goal 4)
3 on Pain (Goal 5)
3 on Advance Care Planning (Goal 6)
1 on Resident and Family Satisfaction (Goal 7)
8 on Recruitment 16

17. MDS 3.0 Transition – Timeline
MDS 2.0 retired on September 30, 2010
MDS 3.0 implemented October 1, 2010
Quality Measures (QMs) will only be calculated through 3rd Qtr 2010
3rd Qtr 2010 data will be posted after early 2011
QMs freeze and go dark!

18. MDS 3.0 Transition – QM’s New quality measures are planned!
NQF reviewing 28 MDS 3.0-based quality measures
Will have to collect MDS 3.0 data and test the measures
New measures anticipated to go public in spring 2012

19. In the Interim…..
Nursing homes will not be able to compare to national or state averages
Internal quality improvement is essential
Advancing Excellence has QI tools available

20. Resources

21. Tools Available for Campaign Goals
GENERAL RESOURCES
DATA TRACKING & TRENDING
WEB
1- Staff Turnover
Guide, Intervention Table, Fact Sheets, Tool Kits,
Calculator
Yes
2 – Consistent Assignment
Guide, Webinar, Video, Fact sheets
3 – Restraints
Guide, Intervention Table, Fact Sheets, CMS Letter, Webinar
Tracking Tool
11/1
4 – Pressure Ulcers
Guide, Intervention Table, Webinar, Fact sheets, Video
5 – Pain
Guide, Webinar, Fact sheets, Video
6 – Advance Care Planning
Guide, Fact sheets
7 – Resident/Family Satisfaction
Guide, Survey tool list, Fact sheets, Webinars
Data entry
8 – Staff Satisfaction
Guide, Survey tool list, Fact sheets 21

22. Focus on “Organization Goals”
The AE Campaign encourages nursing homes to focus on the following organizational goals:
Consistent assignment.
Staff turnover.
Advance care planning.
Satisfaction: resident, family, and staff.
Improvement in these areas will support and reinforce improvement in the clinical areas.
Data entry of the organizational goals on the Web site is essential for benchmarking.
While QM/QI reports are unavailable, the tracking tools can be used to track your own data.

23. Data Entry and Measurement
Goal
How Often
Who Enters
Baseline
End Date
1. Turnover
Monthly NH
2010
12/31/11
2. Consistent Assignment
3. Restraints
QTR
MDS1
Q1 2010
4. Pressure Ulcers
12/31/31
5. Pain
6. Advance Care Planning
Quarterly
7. Resident Satisfaction
8. Staff Satisfaction
For more information, see Final Goal Technical Information
1 Final QM for goal will be Q because of MDS 3.0 implementation

24. For more information, see Final Goal Technical Information
National Targets
National
State NH
1. Turnover
<= 65% CNA
10 percentile
Consistent
Assignment
>= 85% no more
than 8 staff/week
3. Restraints
<= 2%
4. Pressure Ulcers
<= 9%
5. Pain
<= 2% Long-stay
<=16% Short-stay
6. Advance Care
Planning
>=75% (Admissions, Re- Adm, Qtr Care Conf)
7. Resident Satisfaction
>= 85%
8. Staff Satisfaction
>= 75%
For more information, see Final Goal Technical Information

25. Local Area Network of Excellence LANE’s

26. How the Campaign Works – The Role of the LANE
National Steering Committee
Policy
Framework
Resources
Statewide LANES
Local Leadership and Guidance
Recruitment
Education
NURSING HOME
Focus on Meaningful Issues
Implementation of Interventions

27. Local Area Networks of Excellence (LANEs)
Learning networks
Coalitions of nursing home stakeholders
Partnerships
Collaboratives
Diverse organizations, often with different agendas, come together to improve quality of care and life for residents.

28. LANE Roles and Responsibilities
Provides statewide leadership to coalition of stakeholders
Raises and maintain awareness about the campaign
Recruits nursing homes
Provides technical assistance
Communicates key campaign messages
Acts as a “change agent” to improve

29. Core LANE Members
Nursing home associations (AHCA and AAHSA affiliates)
Quality Improvement Organizations (QIOs)
State Survey Agencies
Ombudsmen
Culture Change Coalitions
Other: Individuals or Organizations
DONs, Medical Directors, Administrators, CNAs, Geriatric Nurses, Alzheimer Associations, AAA’s, Residents, Families

30. What Makes a LANE Successful?
Vibrant, Committed Leadership (Convener)
Regular meetings
Inclusion of statewide leaders
Good attendance by all members
Shared goals
Regular agenda that reviews progress (data) and plans next steps
Celebration of success and recognition of achievement

31. Maryland’s LANE Is looking to re-energize
You are looking at the data and responding to the quality improvement needs of your state!
GREAT WORK!

32. Maryland’s LANE Conveners
Your LANE Co-Convener is:
Isabella Firth
x 226
Your LANE QIO Contact Is:
Janet Robinson
Jacqueline Bell-Hairston

33. Maryland’s Data: Phase 1 & 2 of the Advancing Excellence Campaign

34. Advancing Excellence Phase 1 Performance Summary – Maryland
National
Maryland
Recruitment
47.4%
56.1%
Pressure Ulcers
11.8%
12.9%
Restraints
3.7%
2.7%
Chronic Pain
3.6%
1.5%
Acute Pain
19.5%
Data are from the AE Campaign website as of 9/09. The pressure ulcer QM is for residents at high risk for developing pressure ulcers. Recruitment data is from website’s real-time clickable map. For the clinical measures, lower numbers are better; for recruitment and target setting, higher numbers are better. 34

35. Advancing Excellence Phase 2 Performance Summary - Maryland
National
Maryland
Recruitment
43.5%
39.8%
Pressure Ulcers
10.8%
11.9%
Restraints
2.8%
2.1%
Chronic Pain
3.1%
1.4%
Acute Pain
18.6%
13.9%
Data are from the AE Campaign website as of 11/10. Clinical measures are QMs from Q The pressure ulcer QM is for residents at high risk for developing pressure ulcers. Recruitment data is from website’s real-time clickable map. For the clinical measures, lower numbers are better; for recruitment higher numbers are better. 35 35

36. Phase 2 Enrollment Statistics – Maryland as of 1/26/11
Phase 2 (October 22, December 31, 2011)
Maryland
Nation
Participating nursing homes: 92
6828
Percentage of participating nursing homes
39.8%
43.5%
Ranking of goals selected by nursing homes  
  #1 = Goal 4 Pressure Ulcers   #2 = Goal 7 Res/Fam Satisfaction
 #3 = Goal 8 Staff Satisfaction   #4 = Goal 5 Pain
#5 = Goal 3 Restraints   #5 = Goal 1 Staff Turnover   #6 = Goal 6 Advance Care Planning   #8 = Goal 2 Consistent Assignment
  #1 = Goal 5   #2 = Goal 4   #3 = Goal 7   #4 = Goal 1   #5 = Goal 8   #6 = Goal 3   #7 = Goal 2   #8 = Goal 6
Participating consumers: 49
2811
Participating nursing home staff: 36
1409 36 36

37. Take Away Action Steps
Visit the Campaign website frequently to check out new resources
Download the tools and use them regularly in your QI efforts
Enter your data into the website at prescribed intervals
Get involved with your LANE
Get your residents and staff registered and involved with the campaign

38. 2 Future Maryland Webinar’s
A Review of Selected Advancing Excellence Campaign Tools
March 30th Consistent Assignment and Staff Turnover Tools – 11am-noon
April 20th Pressure Ulcer and Restraint Tool – 11am - noon

39. Thank You!
Tammy Rolfe
(207)