The American Health Care Association (AHCA) is expanding quality improvement efforts related to its skilled nursing facility (SNF) members, which it began three years ago, the organization announced today. The next phase of the initiative will include a total of eight goals designed to improve overall organizational success, short-stay/post-acute care and long-term/dementia care.
“This is not a [public relations] effort,” AHCA President and CEO Mark Parkinson told members of the press today. “This is a real effort with significant goals that, if we achieve, will materially improve people’s lives. We’re not aspiring to adjectives. We’re aspiring to specific numbers and specific times.”
Goals related to overall organizational success:
- Increase staff stability by decreasing turnover among nursing staff by 15 percent, or achieve and maintain a turnover rate of 40 percent or less by March 2018.
- Have at least 25 percent of members measure and report long-stay resident and family satisfaction and/or short-stay satisfaction using the Core-Q survey.
- Reduce the number of unintended health care outcomes by March 2018.
Goals related to short-stay/post-acute care:
- Safely reduce the number of hospital readmissions within 30 days during a SNF stay by an additional 15 percent, or achieve and maintain a low rate of 10 percent by March 2018.
- Improve discharge back to the community by 10 percent, or achieve and maintain a high rate of at least 70 percent by March 2018.
- Have at least 25 percent of members adopt and use the mobility and self-care sections of the CARE tool and report functional outcome measures using LTC Trend Tracker.
Goals related to long-term/dementia care:
- Safely reduce the off-label use of antipsychotic medications in long-stay SNF residents by an additional 10 percent by December 2015 and 15 percent by December 2016;
- Safely reduce hospitalizations among long-stay residents by 15 percent, or achieve and maintain a low rate of 10 percent or less by March 2018.
David Gifford, MD, MPH, (right) AHCA senior vice president of quality and regulatory affairs, said that, in developing the goals, the organization “had to acknowledge that some people already are doing exceptionally well, and to get much better on some of these measures actually might not be a good thing, because no measure should be perfect and at zero.” Antipsychotic medications are necessary in some instances, for instance, as are hospital stays.
AHCA considered developing goals related to specific clinical conditions such as pressure ulcers but decided to take a broader, systemic approach, Gifford said. Also, for long-stay residents, AHCA discussed issues related to culture change, he said, but wasn’t able to find good metrics to measure progress.
Success to date
Since the launch of its quality initiative in 2012, AHCA members have reduced the off-label use of antipsychotic medications by 21.2 percent, greater than the national average of 19.4 percent and greater than AHCA’s own goal, set in 2012, of 15 percent.
“Although it’s easy just to talk in terms of percentages, behind each of those numbers are real lives,” Parkinson said. “So if you do the calculation, there are now 33,000 individuals in our facilities that, under the old rates, would have been receiving these medications but now no longer are.”
For hospital readmissions, AHCA members have seen a 14.2 percent reduction since 2011 through the third quarter of 2014. That reduction does not meet the organization’s goal of 15 percent, but Parkinson said he believes that more recent data, when available, will show that the goal has been reached.
“Once again, those are real lives,” Parkinson said. “It means that over 40,000 people have avoided a hospital readmission, which is really important, because hospital readmissions are an indicator of future mortality and future health problems. If you can take care of the person and not send them back to the hospital, it makes a big difference in their lives.”
Gifford said the organization used Centers for Medicare & Medicaid Services data, the Baldridge Excellence Framework, evidence from the literature, and input from others to develop the goals, which he described as achievable and meaningful. “We expect to hold our members accountable to it,” he said. “It’s going to be hard, but hopefully we will get dramatic improvement.” Gifford added that AHCA expects the goals will comply with the IMPACT Act.
AHCA members can view their progress using AHCA’s LTC Trend Tracker, a web-based data collection and benchmarking tool.
[Editor’s addendum: AHCA’s sister organization, the National Center for Assisted Living (NCAL), also extended its assisted living quality initiative for three years, NCAL announced May 12. Read more here.]