Project protect: pneumococcal vaccination in Washington State nursing homes.

BACKGROUND: Pneumonia is the third most frequent cause of hospitalization among Medicare beneficiaries in Washington State. While a vaccine against pneumococcal disease has been available since 1977, the 1999 Behavioral Risk Factor Surveillance System estimates that less than 60% of adults aged 65 years and older in Washington State have been vaccinated. METHODS: To assess the prevalence of pneumococcal vaccination policies, we surveyed all Washington nursing homes in 1999 and again in 2001 to assess changes during the intervening period. Following the policy surveys, to estimate the pneumococcal vaccination rate, we conducted assessments of a random sample of residents of Washington nursing homes. RESULTS: Use of standing orders/written pneumococcal vaccination policies by nursing homes increased by 14% from 58% in 1999 to 72% in 2001. The pneumococcal vaccination rate for residents of nursing homes increased from 47% in 2000 to 61% in 2002. Both increases were statistically significant. The odds of a resident receiving a pneumococcal polysaccharide vaccine (PPV) in a nursing home having standing orders or other written guidelines are estimated to be two-and-a-half times greater than for residents in facilities without any PPV guidelines (2000: OR = 2.59; 95% CI, 1.54-4.34; 2002: OR = 3.19; 95% CI, 1.68-6.01). CONCLUSION: Increased use of standing orders/written policies has contributed to higher rates of pneumococcal vaccination in Washington State nursing homes.

Approaches to quality improvement in nursing homes: lessons learned from the six-state pilot of CMS's Nursing Home Quality Initiative.

BACKGROUND: In November 2002, the Centers for Medicare & Medicaid Services (CMS) launched a Nursing Home Quality Initiative that included publicly reporting a set of Quality Measures for all nursing homes in the country, and providing quality improvement assistance to nursing homes nationwide. A pilot of this initiative occurred in six states for six months prior to the launch. METHODS: Review and analysis of the lessons learned from the six Quality Improvement Organizations (QIOs) that led quality improvement efforts in nursing homes from the six pilot states. RESULTS: QIOs in the six pilot states found several key outcomes of the Nursing Home Quality Initiative that help to maximize the potential of public reporting to leverage effective improvement in nursing home quality of care. First, public reporting focuses the attention of all stakeholders in the nursing home industry on achieving good quality outcomes on a defined set of measures, and creates an incentive for partnership formation. Second, publicly reported quality measures motivate nursing home providers to improve in certain key clinical areas, and in particular to seek out new ways of changing processes of care, such as engaging physicians and the medical director more directly. Third, the lessons learned by QIOs in the pilot of this Initiative indicate that certain approaches to providing quality improvement assistance are key to guiding nursing home providers' desire and enthusiasm to improve towards a using a systematic approach to quality improvement. CONCLUSION: The Nursing Home Quality Initiative has already demonstrated the potential of public reporting to foster collaboration and coordination among nursing home stakeholders and to heighten interest of nursing homes in quality improvement techniques. The lessons learned from this pilot project have implications for any organizations or individuals planning quality improvement projects in the nursing home setting.