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Looking at the Numbers

Progress Over the Last Decade in Minnesota Nursing Home Quality Measures

Minnesota nursing homes improve physical restraints and pressure ulcer rates

* The rate drop for high risk pressure ulcers in Q4 2010 corresponds with the Minimum Data Set (MDS) 3.0 quality measure specification change which eliminated reporting of stage 1 pressure ulcers.

Since the Government Performance and Results Act (GPRA) required all federal agencies to move toward a performance-based, results-oriented government starting in 1999, the Centers for Medicare & Medicaid Services (CMS) has focused on decreasing the use of restraints and pressure ulcers in nursing homes to improve the quality and safety of resident care.

Minnesota ranks 15th in the nation for the lowest use of physical restraints and 5th lowest for the incidence of pressure ulcersOver the past 10 years, Minnesota nursing homes have made significant progress in reducing the use of physical restraints, from 5.06 to 1.15 percent (Q3 2002 to Q1 2012), and reducing the incidence of pressure ulcers, from 9.23 to 6.72 percent (Q3 2003 to Q3 2010).1 Minnesota ranks 15th in the nation for the lowest use of physical restraints and 5th lowest for the incidence of pressure ulcers.2

For more than a decade, nursing homes have benefitted from several national quality initiatives—Advancing Excellence in America’s Nursing Homes, Quality First, the Nursing Home Quality Initiative, the culture change movement, and technical support of the Medicare Quality Improvement Organization (QIO) program. As a Medicare QIO, Stratis Health has worked with Minnesota nursing homes since 2002 providing technical assistance to reduce use of physical restraints and pressure ulcers.

Today, Stratis Health continues to support nursing homes in their work to make improvements. Projects include:

  • Providing technical assistance as the Medicare QIO to reduce the use of physical restraints and pressure ulcers.
  • Partnering with the Oklahoma Foundation for Medical Quality to assist QIOs nationwide as they support their states’ nursing homes.
  • Leading a CMS demonstration project, with the University of Minnesota, to develop and test prototypes of a national Quality Assurance Performance Improvement (QAPI) program for nursing homes.
  • Leading a CMS Special Innovation Project to assist post acute care providers in Minnesota—focusing on skilled nursing facilities—to improve quality and coordination of care through the effective use of health information technology.
  • Reducing the use of psychotropic medications—a potential chemical restraint—in all settings of care for people with behavioral and psychological symptoms related to dementia, through the Partnership to Improve Dementia Care.

“We are able to apply evidence-based practices and the lessons of individualized care from our decade of success to continued improvement in nursing home resident care,” said Kristi Wergin, Stratis Health program manager. “Nursing homes now use better practices and equipment to prevent pressure ulcers. And instead of using restraints, they are becoming more focused on individualizing resident care by asking questions like ‘Why are residents falling or exhibiting behavioral symptoms?’”

Stratis Health conducts analytical work in support of assessing and improving health care quality and patient safety. This report was produced by Stratis Health in its role as the Medicare Quality Improvement Organization for Minnesota, under contract with CMS.
Data sources:
1. Source: CMS, aggregated data from MDS 2.0 and MDS 3.0.
2. Advancing Excellence in America’s Nursing Homes, latest available national data Q3 2010.