Marilyn Rantz, University of Missouri Sinclair School of Nursing, Columbia, Missouri, USA
J Nutr Health Aging. 2021;25(9):1124-1130. doi: 10.1007/s12603-021-1684-5.
To measure the impact of advanced practice nurses (APRNs) on quality measures (QM) scores of nursing homes (NHs) in the CMS funded Missouri Quality Initiative (MOQI) that was designed to reduce avoidable hospitalizations of NH residents, improve quality of care, and reduce overall healthcare spending.
A four group comparative analysis of longitudinal data from September 2013 thru December 2019.
NHs in the interventions of both Phases 1 (2012-2016) and 2 (2016-2020) of MOQI (n=16) in the St. Louis area; matched comparations in the same counties as MOQI NHs (n=27); selected Phase 2 payment intervention NHs in Missouri (n=24); NHs in the remainder of the state (n=406).
NHs in Missouri Intervention: Phase 1 of The Missouri Quality Initiative (MOQI), a Centers for Medicare and Medicaid (CMS) Innovations Center funded research initiative, was a multifaceted intervention in NHs in the Midwest, which embedded full-time APRNs in participating NHs to reduce hospitalizations and improve care of NH residents. Phase 2 extended the MOQI intervention in the original intervention NHs and added a CMS designed Payment Intervention; Phase 2 added a second group of NHs to receive the Payment. Intervention Only.
Eight QMs selected by CMS for the Initiative were falls, pressure ulcers, urinary tract infections, indwelling catheters, restraint use, activities of daily living, weight loss, and antipsychotic medication use. For each of the monthly QMs (2013 thru 2019) an unobserved components model (UCM) was fitted for comparison of groups.
The analysis of QMs reveals that that the MOQI Intervention + Payment group (group with the embedded APRNs) out-performed all comparison groups: matched comparison with neither intervention, Payment Intervention only, and remainder of the state.
These results confirm the QM analyses of Phase 1, that MOQI NHs with full-time APRNs are effective to improve quality of care.
衡量高级执业护士（APRNs）对医疗保险和医疗补助服务中心（CMS）资助的密苏里州质量倡议（MOQI）中护理院（NHs）质量措施（QM）评分的影响，该倡议旨在减少 NH 居民可避免的住院治疗，提高护理质量，并降低整体医疗保健支出。
对 2013 年 9 月至 2019 年 12 月期间的纵向数据进行四组比较分析。
MOQI 第一阶段（2012-2016 年）和第二阶段（2016-2020 年）干预措施中的 NHs（圣路易斯地区，n=16）；与 MOQI NHs 所在的同一县进行匹配比较（n=27）；密苏里州选定的第二阶段支付干预措施 NHs（n=24）；该州其余 NHs（n=406）。
密苏里州干预措施中的 NHs：密苏里州质量倡议（MOQI）第一阶段是 CMS 创新中心资助的一项研究计划，是中西部 NHs 的一项多方面干预措施，该计划在参与的 NHs 中嵌入全职 APRNs，以减少住院治疗并改善 NH 居民的护理。第二阶段将 MOQI 干预措施扩展到最初的干预 NHs，并增加了 CMS 设计的支付干预措施；第二阶段增加了第二组 NHs 以接受支付。干预仅。
CMS 为该计划选择了八项 QM，包括跌倒、压疮、尿路感染、留置导管、约束使用、日常生活活动、体重减轻和抗精神病药物使用。对于每个月度 QM（2013 年至 2019 年），都使用未观察到的组件模型（UCM）进行拟合，以比较组。
QM 分析结果表明，MOQI 干预+支付组（嵌入 APRNs 的组）表现优于所有对照组：与无干预、仅支付干预和州其余地区的对照组均无对照。
这些结果证实了第一阶段的 QM 分析，即密苏里州质量倡议中配备全职 APRNs 的 NHs 能够有效提高护理质量。
