Content contained in this newsletter may have been previously published in prior issues of the QCC newsletter.  
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The Florida Nursing Home
Quality Care Connection
This QCC Newsletter is your monthly National Nursing Home Quality Care Collaborative (NNHQCC) in Florida member update that provides information on the latest activities. It is a quick reference for information on links to improvement tools, resources, news, best practices, and success stories. 
Do You Have a Certified Medical Director (CMD) on Staff?
Have you thought about the role of the medical director in your facility lately? One of the challenges in the delivery of care to residents is to sort out their care and medical needs. A team approach is the best way for a nursing home to provide care to its residents. Front-line staff provide direct care, nurses and therapists provide necessary and medically-prescribed care, and the attending physician responds to the resident's medical needs. What about the facility's medical director? What is its role and how should this fit into your facility?
Practically speaking, the role of the medical director varies from facility to facility. In trying to ascertain the specifics of this role it is instructive to look at the Centers for Medicare & Medicaid Services (CMS) State Operations Manual, F-Tag 501 .

The requirements of this Tag state that:
  1. The facility must designate a physician to serve as medical director.
  2. The medical director is responsible for:
  • i. Implementation of resident care policies, and,
  • ii. Coordination of medical care in the facility.

Why should nursing homes adhere to these requirements? To answer this question, we should try to find data to support the effectiveness of medical directors in nursing homes. Fortunately, such data exists in relation to CMDs.
In 2009, Fredrick N. Rowland, PhD, MD, CMD, published an article in the Journal of the American Medical Directors Association entitled, "Impact of Medical Director Certification on Nursing Home Quality of Care. " The study examined a standardized quality score among facilities with fully certified medical directors and found a 15 percent improvement in quality. The conclusion was that, "the presence of CMDs is an independent predictor of quality in U.S. nursing homes. " Still, the study was not perfect. The control group probably contained facilities with CMDs that had not been reported as such, which would have diluted the impact of the study. It is therefore quite possible that CMDs have a greater impact on quality in nursing facilities.
What can a facility do to assist their medical director in obtaining their CMD? First, they should encourage and support membership in The Society for Post-Acute and Long-Term Care Medicine (AMDA). Second, they should support membership in their state 's AMDA chapter (Florida Society for Post-Acute and Long-Term Care Medicine [FMDA] in Florida). Finally, they should encourage their medical director to complete the Core Curriculum on Medical Direction ( ). Let's all work to close the loop on delivering the highest quality of care to the residents of nursing facilities. Value the role of your medical director and support that person in obtaining a CMD.
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QAPI Corner
STEP 10: Plan, Conduct, and Document Performance Improvement Projects (PIPs)

Careful planning of PIPs include identifying areas to work on through your comprehensive data review which are meaningful and important to your residents. It is important to focus on your PIPs by defining the scope, so they do not become overwhelming.

You and your team may:
  • Consider each PIP a learning process.
  • Determine what information you need for the PIP.
  • Determine a timeline and communicate it to the Steering Committee.
  • Identify and request needed supplies or equipment.
  • Select or create measurement tools as needed.
  • Prepare and present results.
  • Use a problem solving model like Plan-Do-Study-Act (PDSA).
  • Report results to the Steering Committee.

During a PIP , you will try out some changes and then see whether or not they made a difference in the area you were trying to improve. In the PLAN stage, the team learns more about the problem, plans how improvement would be measured, and plans for any changes that might be implemented. In the DO stage, the plan is carried out, including the measures that are selected. In the STUDY phase, the team summarizes what was learned. In the ACT phase, the team and leadership determine what should be done next. The change can be adapted (and re-studied), adopted (perhaps expanded to other areas), or abandoned. 

For more information on this topic, read page 17 of QAPI at a Glance .
Next month: Getting to the "Root" of the Problem
HSAG Resource Spotlight
Care coordination resources aim to improve transitions of care and lower unnecessary hospital readmissions. Learn more.
In addition to the NNHQCC Change Package v2.2., the Centers for Medicare & Medicaid Services (CMS) has just released an important new resource: All Cause Harm Prevention in Nursing Homes Change Package.
This package is a compendium of successful practices of high performing nursing homes, illustrating how they prevent harm while honoring each resident's rights and preferences.
This material was prepared by Health Services Advisory Group, the Medicare Quality Innovation Network-Quality Improvement Organization for Arizona, California, Florida, Ohio, and the U.S. Virgin Islands, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No.