Nursing Home Compare quality measures were updated with data from quarter 2, 2007, in October. AFMC mailed the updated Nursing Home Quality Initiative (NHQI) facility table and graphs on December 4, 2007. View your facility's current information here.

Based on the updated quality measures, Arkansas continues to hold the nation's worst ranking for the reported use of restraints; however, Arkansas is making progress toward further restraint use reduction. Since the NHQI Advisory Group sponsored statewide restraint training this past fall, facility self-reports to AFMC indicate more homes are becoming restraint-free. View the four selected NHQI QM trending graphs and other national ranks for our state here.

The Arkansas Accord encourages long-term care providers to adopt person-directed care principles, more commonly referred to as "culture change." It simply means focusing on residents' emotional, social and intellectual needs -- as well as clinical management. The Arkansas Accord is your local resource to help get you started by overcoming perceived regulatory barriers to success. Accord tip sheets help explain the intent and potential of adopting certain changes and the regulations that support these changes. Visit the Arkansas Accord to post your success stories or ask a regulatory question.

Remember to re-set your STAR goals annually. Visit the STAR (Setting Targets - Achieving Results) Web site or call the NHQI team if you need help. Setting targets is one of the Advancing Excellence Campaign goals and can be a useful tool to help track your quality improvement progress. Bookmark it...www.nhqi-star.org .

Arkansas is 100% enrolled in the Advancing Excellence Campaign, showing that our state's long-term care providers are dedicated to quality. Visit www.nhqualitycampaign.org for resource material, and use your NHQI QM graphs or STAR graphs to track your progress toward the campaign goals.

The Arkansas Innovative Performance Program (AIPP) is developing an "In Service Training Toolkit" that will soon be distributed to long-term care facilities. The toolkit will provide all of the components needed for a successful training program. Training programs can make a significant difference in your facility's success -- but only if all levels of management agree about the importance of training and allocate the appropriate time and resources for it to be done well. Training is not a luxury, it is a must. Watch for more information on this valuable new resource.

Please join us in welcoming licensed administrator Brad Hartley to the AIPP team. As team leader, Brad brings many years of long-term care experience to AIPP, and we are excited to have him on board. The team now includes four RNs, three LPNs, two CNAs and a licensed administrator. The structure of our team is much like that of a long-term care facility. Visit www.afmc.org/aipp to learn more about AIPP and what we can offer.

AIPP recently partnered with the Arkansas Ombudsman Program to sponsor a seminar: Challenging Behaviors: They're Everybody's Business with guest speaker, Dr. Susan Wehry, geriatric psychiatrist. The training was well received throughout the long-term care industry and offered a different approach to some common behavioral issues. Watch for more AIPP regional training on the AFMC Calendar of Events.

Home Health Quality Improvement (HHQI) National Campaign Update: New December package on Patient Self-Management available. HHQI National Campaign CEUs (continuing education units) will not be available after February 29, 2008. If you have not joined the campaign or completed the Best Practice packets to receive your CEUs, do it now! To join the campaign, visit the Home Health Quality site at www.homehealthquality.org

Communication is key to counteracting some common barriers to improvement. A good communication process is aimed at identifying problems and developing appropriate interventions. The Communication Workbook can help you get started, and it's available at www.medqic.org. Click on Home Health, select Tools and scroll down to Communication Tools and Resources. Select it from the dropdown box, and then select the Communication Workbook.

Cross Setting Collaboration: The nationwide dilemma facing home health agencies (HHAs) as they work to prevent the repetitive cycle of hospital admissions and discharges of heart failure patients is examined at length in an article by Bracken and Toohey. Collaboration between disciplines is critical to providing the right care at the right time, every time. In order to have a strong system, you must invest time in building and maintaining one. Read more

The November Collaborative Area Learning Session (CALS) on November 15 drew 130 people representing 52 hospitals from across the state, to increase their quality improvement knowledge and share with their peers. Twelve hospitals displayed storyboards showing various successes. Access presentations and view pictures from a day that was full of valuable and practical information here.

Hospital Data Collection: Measure Designations are required to be set beginning with second quarter 2007 discharges' transmission date (November 15, 2007). Also, ICD Population and Sampling are expected ( but not required) to be set by third quarter 2007 discharges' transmission date (February 15, 2008). For helpful information about setting the Measure Designations and ICD Population and Sampling, take the 25-minute training here. (Access Program Management v1.0.)

Hospital mortality rates for acute myocardial infarction (AMI) and heart failure (HF) were reported last summer; public reporting of pneumonia (PN) mortality rates is planned for the summer of 2008. One immediate result: hospital staff have become increasingly aware of their own facility's rates and more focused on ways to improve them. The Institute of Healthcare Improvement has a white paper that could help: Move Your Dot: Measuring, Evaluating, and Reducing Hospital Mortality Rates (Part 1). The paper examines how an organization's performance is related to their mortality rates. Access this free resource from the IHI site here.

New "Beta-Blocker for AMI" Fact Sheet on MedQIC: Studies reveal earlier treatment of AMI with beta-blockers greatly improves outcomes. Find out more here.

Hospital Outpatient Quality Data Reporting Program (HOP QDRP): Information has been added under a new tab section on the public site of quality net at www.qualitynet.org. This section includes: How to Participate, Forms, Measures, Deadlines, and Support information. The pledge form to sign up is available under Forms, and the deadline to return the pledge is January 31, 2008. The address to send the pledge form to is not included on this site, but is: HOP QDRP, c/o FMQAI, 5201 West Kennedy Blvd., Suite 900, Tampa, FL 33609-1822. Go straight to the new tab section here.

File specifications have changed for submitting HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) data, beginning with the submission of January 2008 HCAHPS data. View the notification here.

2008 PQRI provisions announced in the Medicare Physician Fee Schedule Final Rule: The 2008 Medicare Physician Fee Schedule (MPFS) Final Rule, effective for services on or after January 1, 2008, is on display in the Federal Register. The rule identifies 119 measures CMS has selected for eligible professionals to use to report quality-of-care information under the 2008 Physician Quality Reporting Initiative (PQRI). The PQRI provisions begin on page 653. A summary of these provisions is available from CMS here.

Cultural competency and disparities: With more ill and injured people unable to speak English, hospitals, clinics and rescue squads are turning to picture boards to bridge the communication gap with easily understood images. The large, double-sided panels let patients point to icons showing their problem -- such as pain, a burn, breathing trouble or a fall -- as well as the part of the body that is affected. They also can point to their native language in a list so an appropriate interpreter can be located. The use of picture boards was featured in USA Today; check it out here.

Patient adherence: Adherence, rather than compliance, has become the preferred term, defined by the World Health Organization as "the extent to which a person's behavior [in] taking medication...corresponds with agreed recommendations from a health care provider." (World Health Organization, 2003). Adherence requires the person's agreement to the recommendations for therapy. To find out more, visit "Adult Medication: Improving Medication Adherence in Older Adults" at www.adultmeducation.com.

An estimated 20% of all new prescriptions go unfilled while the rate of prescription refills that are not picked up is even higher. Pharmacists saw better than an 11% increase in the number of prescriptions at their stores -- and most likely their cash registers, too -- when physicians started using electronic prescribing systems, according to a recently released announcement about a study conducted by the giant drugstore chain Walgreen Co., the electronic prescribing exchange SureScripts and data-miner IMS Health. Read the article here.

MRSA infections on the rise: For more information for clinicians about community-associated MRSA (Methicillin-resistant Staphylococcus aureus), log on here.

New asthma guidelines: The National Heart Lung and Blood Institute has issued guidelines for the diagnosis and management of asthma. For the 2007 Summary Report, click here.

A recent CDC report examines use of electronic medical record (EMR) systems by office-based physicians in 2006, as well as their plans to install new EMR systems or replace their current systems within the next three years. View the report at www.cdc.gov/nchs/data/ad/ad393.pdf.

The American Medical Informatics Association set out to assess clinicians' satisfaction with -- and self-reported improvement in efficient CIS use resulting from -- one-on-one advanced proficiency training. The study findings show that the one-on-one training had the greatest positive effect on the use of the electronic medical record. For more information, visit PubMedCentral here.

HIT and the smaller practice: Many physicians in small group practices are not sufficiently convinced of the value of EMR systems to make the time and money investment necessary for the transformation to occur. This article explores some of the reasons why HIT (health information technology) has not been as prevalent in the medical industry as similar technology in other industries, and what it will take to move forward. To find out more, read the full article here.

Medicare rewarding e-health use: For the first time, the Medicare program will pay bonuses to doctors and other health care providers for using electronic health records and e-prescribing in 2008. Find out more here.

The eHealth Initiative recently released its "Blueprint: Building Consensus for Common Action," a document with prescriptions for speeding the adoption of health information technology throughout the health care sector. AFMC was one of nearly 200 organizations that took part in developing and providing feedback for this document. Find out more and download the Blueprint at www.ehealthinitiative.org/blueprint/.

New standards for e-prescribing: The Centers for Medicaid and Medicare Services published a rule proposing new standards for electronic prescribing under the Medicare Part D drug benefit program. More information is available here.

Sincerely,

Arkansas Foundation for Medical Care

E-mail: qualitybrief@afmc.org

Phone: 1-877-375-5700

Web: http://www.afmc.org