Heightening Person-Centered Care Processes in the Delivery of Nursing Restorative Care.

The objective of the current study was to investigate the perspectives of nursing home (NH) providers regarding the requirements to achieve reimbursement for nursing restorative care (NRC) services and propose recommendations to state agencies to assist NH providers to conduct NRC programs that are person-centered and able to achieve full reimbursement. Methods included a survey of NH providers in one state and a stakeholder focus group to discuss survey findings and develop recommendations. Key findings are that NH providers perceive value to residents from the provision of NRC; providers do not associate these benefits with the stringent reimbursement requirements; and NHs often provide NRC that is individualized, based on resident goals and activity tolerance, as well as realistic given competing demands on staff, even when doing so means giving up reimbursement for NRC services.

A Statewide Model for Assisting Nursing Home Residents to Transition Successfully to the Community.

Minnesota's Return to Community Initiative (RTCI) is a novel, statewide initiative to assist private paying nursing home residents to return to the community and to remain in that setting without converting to Medicaid. The objective of this manuscript is to describe in detail RTCI's development and design, its key operational components, and characteristics of its clients and their care outcomes. Data on client characteristics and outcomes come from the Minimum Data Set, staff assessments of clients and caregivers, and Medicaid eligibility files.

Does the Volume of Post-Acute Care Affect Quality of Life in Nursing Homes?

Although short-stay, post-acute nursing home stays are increasing, little is known about the impact of volume of post-acute care on quality of life (QOL) within nursing homes. We analyzed data from the 2010 Minnesota QOL and Consumer Satisfaction survey ( N = 13,433 residents within 377 facilities) and federal Minimum Data Set to determine the influence of living in a facility with an above-average proportion of post-acute care residents on six domains of resident QOL. In bivariate analyses, an above-average proportion of Medicare-funded post-acute care had a significant negative influence on four domains (mood, environment, food, engagement) and overall facility QOL.

Pay-for-performance policy and data-driven decision making within nursing homes: a qualitative study.

Introduction: Health systems globally and within the USA have introduced nursing home pay-for-performance (P4P) programmes in response to the need for improved nursing home quality. Central to the challenge of administering effective P4P is the availability of accurate, timely and clinically appropriate data for decision making. We aimed to explore ways in which data were collected, thought about and used as a result of participation in a P4P programme.

Minnesota's provider-initiated approach yields care quality gains at participating nursing homes.

Minnesota's Performance-Based Incentive Payment Program uses a collaborative, provider-initiated approach to nursing home quality improvement: up-front funding of evidence-based projects selected and designed by participating facilities, with accountable performance targets. During the first 4 rounds of funding (2007-10), 66 projects were launched at 174 facilities. Using a composite quality measure representing multiple dimensions of clinical care, we found that facilities participating during this period exhibited significantly greater gains than did nonparticipating facilities, in both targeted areas and overall quality, and maintained their quality advantage after project completion.

Facility and market factors affecting transitions from nursing home to community.

Background: Research into nursing home transitions has given limited attention to the facility or community contexts.

Objective: To identify facility and market factors affecting transitions of nursing home residents back to the community.

Research Design: Multilevel models were used to estimate effects of facility and market factors on facility-level community discharge rates after controlling for resident demographic, health, and functional conditions.

Targeting residents for transitions from nursing home to community.

Objective: To analyze nursing home utilization patterns in order to identify potential targeting criteria for transitioning residents back to the community.

Data Sources: Secondary data from minimum data set (MDS) assessments for an annual cohort of first-time admissions (N=24,648) to all Minnesota nursing homes (N=394) from July 2005 to June 2006.

Study Design: We conducted a longitudinal analysis from admission to 365 days.

Minnesota's Nursing Facility Performance-Based Incentive Payment Program: an innovative model for promoting care quality.

Purpose: Minnesota's Nursing Facility Performance-Based Incentive Payment Program (PIPP) supports provider-initiated projects aimed at improving care quality and efficiency. PIPP moves beyond conventional pay for performance. It seeks to promote implementation of evidence-based practices, encourage innovation and risk taking, foster collaboration and shared learning, and establish a solid case for investing in better quality from the perspective of the state, providers, and consumers.

Medicaid nursing home pay for performance: where do we stand?

Purpose: Nursing home pay-for-performance (P4P) programs are intended to maximize the value obtained from public and private expenditures by measuring and rewarding better nursing home performance. We surveyed the 6 states with operational P4P systems in 2007. We describe key features of six Medicaid nursing home P4P systems and make recommendations for further development of nursing home P4P.

A quality-based payment strategy for nursing home care in Minnesota.

This article describes a pay-for-performance system developed for Minnesota nursing homes. In effect, nursing homes can retain a greater proportion of the difference between their costs and the average costs on the basis of their quality scores. The quality score is a derived and weighted composite measure currently composed of five elements: staff retention (25 points), staff turnover (15 points), use of pool staff (10 points), nursing home quality indicators (40 points), and survey deficiencies (10 points).