The Quality Improvement Program for Missouri's Long - Term Care Facilities (QIPMO) is committed to Missouri's Elderly.
The "Aging-in-place" model allows older adults to receive health care in their preferred place of living, eliminating the need for a more restricted living space, such as a nursing home.
TigerPlace is a specially designed elder housing project initiated by the MU Sinclair School of Nursing, working to provide elders a better quality of life.
The University of Missouri MDS and Quality Research Team is an interdisciplinary group committed to conducting research that will help nursing homes in Missouri deliver high quality services to residents. The Team began work in 1993 and members have had funding for their work since 1994 through the Missouri Division of Aging, the Health Care Financing Administration, the National Institute for Nursing Research, the Agency for Health Care Policy Research, and other agencies and foundations. The goal of the team is to improve quality of care for nursing home residents. The team specifically focuses on the use of the MDS data for quality improvement and monitoring resident outcomes of care.
In the area below you will find a list of recently added MDS and Quality research articles.
OBJECTIVES: To compare the cost to the Medicare and Medicaid programs between a community-based long-term care program called “Aging in Place” (AIP) and nursing home care.
DESIGN: A retrospective cohort design where AIP participants were matched to nursing home residents on admission quarter, age, ADL, and cognitive status and followed for 12 months. SETTING and PARTICIPANTS: A total of 39 nursing home residents in the same and neighboring counties in the Midwest were matched with 39 AIP participants.
INTERVENTION: The AIP program consisted of a combination of Medicare home health, Medicaid home and community-based services (HCBS), and intensive nurse care coordination.
MEASUREMENT: Total cost to payor using Medicare and Medicaid claims databases.
RESULTS: Controlling for high inpatient Medicare cost in the six months prior and the 10 most frequently occurring chronic conditions, multiple regression was used to estimate the relationship of the AIP program on Medicare and Medicaid costs. Total Medicare and Medicaid costs were $1591.61 lower in the AIP group (p < .01) when compared to the nursing home group over a 12 month period.
CONCLUSION: The provision of nurse coordinated HCBS and Medicare home health services has potential to provide savings in the total cost of health care to the Medicaid program while not increasing the cost of the Medicare program.
Key words: older adults, long-term care, care coordination, home and community-based care, Medicaid costs, Medicare costs
Depression affects approximately 30% to 40% of nursing home residents but frequently goes unrecognized. Using the Missouri Minimum Data Set, we aimed to determine whether changes in clinical status, other than mood changes, were associated with new depression diagnosis in residents 65 and older without a recorded depression diagnosis. Of 127,587 potential participants, 14,371 met inclusion criteria and were not depressed at baseline (Time 0). At the next quarterly assessment (Time 1), 1,342 (9.3%) had acquired a new diagnosis of depression. Residents with new depression were significantly younger and less cognitively impaired. Nearly 30% had a decline in activities of daily living (ADL) performance. The multivariate model predicting depression showed that increased verbal aggression, urinary incontinence, increased pain, weight loss, change in care needs, cognitive decline, and ADL decline significantly increased the likelihood of new depression diagnosis. The pattern of decline identified here may provide additional clues to the presence of underlying depression.
Ongoing problems with nursing home care mandates understanding nursing home staff's perspectives on innovative quality improvement programs. This follow-up study used focus groups to examine the experiences of staff who participated in a clinical trial that involved Quality Indicator (QI) feedback reports, quality improvement training, and APN consultation. The authors found that QI reports provided staff with a benchmark to judge their care and a means to track problems; APN consultation was essential for staff to learn best practices; and staff questioned the validity of the QI reports, which hindered them from seeking new solutions to problems identified in the QI reports. Findings indicate that innovative QI programs and APN consultation can positively influence nursing home quality improvement efforts and improve care.