POSITIVE MOMENTUM:
IMPROVING THE QUALITY OF NURSING HOME CARE

A PROGRESS REPORT FROM
THE ALLIANCE FOR QUALITY NURSING HOME CARE

In July 2002, the Alliance for Quality Nursing Home Care (the Alliance) signed an historic pledge with other nursing home associations to improve the quality of care delivered in the nation's nursing homes. This voluntary initiative, called Quality First, is a five-year plan with a twofold mission:

1. Achieve excellence in the quality of care and services for patients in nursing homes
2. Strengthen public trust in nursing home care and service delivery

Quality First builds on the Bush Administration's quality initiative begun in 2002, which created measures of nursing home quality and a system to disclose outcomes. The underlying concept is simple: by reliably measuring quality and making the results available to the public, patients and their families will make better choices since the public will more easily identify poor providers, and all providers will be motivated to improve quality.

In launching Quality First, the Alliance sought to achieve the following results, among others:

• Improvement in compliance with federal and state regulations
• Improvement in clinical outcomes
• Positive consumer satisfaction ratings demonstrated through national, validated satisfaction surveys

In March 2006, the Alliance hosted an invitational conference focused exclusively on quality issues to disclose and discuss what member companies have achieved since Quality First's implementation, to identify the opportunities for improvement, and to target specific quality measures for intensive, focused improvement over the next 12 - 18 months. Following are specific findings released at the Alliance's 2006 quality conference.

Health Deficiencies: Alliance Facilities Have Improved More Dramatically Than Non-Alliance Facilities

According to data presented by David Zimmerman, Ph.D., from the University of Wisconsin, the Alliance facilities have improved compliance with nursing home quality regulations significantly between 2001 and 2005:

• Average health deficiencies:
  
  - Alliance facilities reduced average deficiencies by 11%, from 7.72 to 6.90
  
  - Non-Alliance facilities saw average deficiencies increase from 5.92 to 6.29
  
  
• Average health deficiency index, which equalize state-by-state variability in deficiency citation trends):
  
  - Alliance facilities reduced the average health deficiency index by 10%, from 1.25 to 1.12
  
  - Non-Alliance facilities saw the average health deficiency index increase slightly from .96 to .99
  
  
• Percent severe deficiencies:
  
  - Alliance facilities reduced their percent of severe deficiencies from 28.3% to 23.1%, a drop of 18%
  
  - Non-Alliance facilities saw a slight decrease in severe deficiencies from 20.9% to 20.5%, a drop of 2%

Clinical Measures: Alliance Facilities Are Making Dramatic Strides in Targeted Areas of Clinical Care

Data presented by Paul McGann, Ph.D., Medical Officer from the Centers for Medicare and Medicaid Services, and Steven Littlehale, Chief Clinical Office from LTCQ, Inc., point to significant improvement being made my the Alliance in targeted clinical areas.

According to Dr. McGann, Alliance companies, which were heavily represented in the "intense participants" category of a collaborative effort to improve quality in targeted areas, were very successful in improving care:

Source: CMS, March 2006, Presentation by Dr. Paul McGann

In addition, Littlehale demonstrated that, in four areas, the Alliance experienced more widespread improvement than non-Alliance facilities:

Customer Satisfaction: The Alliance Has Taken Precedent-Setting Steps to Establish a Baseline for Satisfaction Measurement

The Alliance companies have collaborated to establish a baseline for customer satisfaction, which they can use to evaluate outcomes internally, benchmark externally, and take action using an evidence-based approach.

Specifically, the Alliance has:

1. Engaged My Inner View (a national firm devoted exclusively to compiling data on customer satisfaction with health care through the use of tested and validated survey tools) to develop and administer a common satisfaction tool for all Alliance member companies
2. Developed specific tools for chronic care nursing home patients, their families, as well as for post-acute/short-stay patients
3. Created a first year benchmark

Janice Gulsvig from My Inner View reported the following year-one results:

Former/Short Stay Patient Satisfaction with care based on 9,293 surveys

• 28.8% Excellent
• 40.9% Good
• 15.4% Fair
• 14.9% Poor

Current Patient Satisfaction with care based on 3.356 surveys

• 31.6% Excellent
• 48.3% Good
• 14.9% Fair
• 5.2% Poor

Family Satisfaction with care based on 33,835 surveys

• 27.8% Excellent
• 52.6% Good
• 15.6% Fair
• 4.1% Poor

The Alliance compares favorably to other health care providers when former and current patients and their families are asked about satisfaction with the quality of care provided.

• Alliance overall satisfaction: 81%
• 2005 Gallup poll on quality of health care patients received: 79%

Summary and Next Steps

The Alliance companies have made substantial investments in quality, and the results are apparent in the positive trends reflected in the data shown above. While the companies are making progress, unquestionably work remains to be done. As a next step, the Alliance companies are working together to target specific areas of clinical quality and customer satisfaction for improvement over the next 12 - 18 months. Those quality improvement target areas will be made public as a way of meeting the Alliance's pledge to disclose information on quality activities and to hold itself accountable for the care and services delivered in its facilities.

The Alliance for Quality Nursing Home Care, Inc.
1001 Pennsylvania Avenue NW
Suite 600 South
Washington, DC 20004
(202) 742-6740

April 17, 2006