Avera Eureka Health Care Center (Avera Eureka) has achieved the monthly National Nursing Home Quality Care Collaborative (NHQCC) Quality Measure Composite Score goal of 6.0 or less for the past 30 months. Achieving this monthly score is significant as only 10% of the nation’s nursing homes had a score of 6.0 or below at the collaborative start in 2015.
Avera Eureka was among the 45 percent (49) of nursing homes in the South Dakota Nursing Home Quality Care Collaborative working to achieve the 6.0 [or below] Quality Measure Composite Score goal over the past four years [2015 – 2019].
Carmen Weber, Avera Eureka Administrator, commented, “With so many changes and challenges in long-term care coming at us, being recognized for achieving the composite score goal month after month gives us satisfaction, pride and validation that we are doing great work.”
The Quality Measure Composite Score was developed as a means to look at quality from a systems perspective and is especially valuable in providing data to help drive improvement efforts. The South Dakota Nursing Home Quality Care Collaborative works with nursing homes to improve the 13 National Quality Forum endorsed, publicly reported, long stay quality measure scores by instilling quality and performance improvement practices, eliminating healthcare acquired conditions and dramatically improving resident satisfaction.
Weber added, “While numbers do not always tell the whole story of the care we strive to give, our quality measures are publicly available and funding is reflective of one’s quality measure scores. It is important, now more than ever, to take notice of these quality measures.”
Ahren Dosch, RN, Director of Nursing at Avera Eureka, values the support of the collaborative, “I have found that the Quality Measure Composite Score and the report that Great Plains QIN provides are essential to our game plan in guiding our quality improvement efforts. Every quality measure connects with another measure so when we improve in one quality measure, I’ve noticed another measure improves.”
As a high-performer, Avera Eureka’s Composite Score equals a 53 percent (lower is better) relative rate of improvement since the collaborative began in 2015. Among other notable quality measure successes is the Reduction of Anti-psychotic Medication quality measure by 79.6 percent and reduction of the Loss of Bowel and Bladder quality measure by 79 percent.
“When we focused on decreasing the number of unnecessary antipsychotic medications, we noticed less falls and less incontinence issues for our residents, thereby, improving three quality measures,” Dosch added. “I use the composite score report at our nurses and certified nursing assistant meetings, with department leaders and also share with families. I even post the report and try to meet quarterly with our MDS coder to review quality measures and the specifics of each measure.”
Dosch began her career as a Certified Nursing Assistant in Eureka, moved to a large acute care hospital and found herself back in her hometown. Her passion for her work is clear, “I truly the love the relationships with residents. Everybody here is somebody’s mom or grandmother. My goal is that when a family member leaves their family to enter a nursing home, they know they are in a good place and we will do the very best that we can in providing person-centered quality care.”
Weber agrees, “We have a great staff that is committed and passionate every day. Being involved in the South Dakota Great Plains Quality Care Collaborative has been well worth our time. We appreciate the resources, tools, education and technical support provided by Lori Hintz and the Great Plains QIN team.”
Great Plains QIN partners with nursing homes across the state and region to address system-wide issues and opportunities for improvement. Utilizing the Quality Assurance Performance Improvement (QAPI) training, tools and resources, staff support and prepare nursing homes for the upcoming changes in the regulations and provide a solid foundation for improvement efforts.