The extraordinary public health crisis of the global COVID-19 pandemic presented an unprecedented opportunity for the Centers for Medicare & Medicaid Services (CMS) and its network of Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) to provide real-time support to health care providers and Medicare beneficiaries. The pandemic upended the health care system and affected every aspect of providers’ and beneficiaries’ lives and the provision of care.
Nursing homes have been the focal point of CMS quality work throughout 2020. The global COVID-19 pandemic created an urgent call to implement quality improvement leadership to protect lives and improve care of Medicare beneficiaries. QIN-QIOs responded rapidly to local conditions and provided vital support and technical assistance across the country. Quality improvement principles were tested in real time, as QIN-QIOs helped nursing homes plan, implement, evaluate and continually adjust their infection prevention and control strategies. These practices will continue to serve nursing home teams and the residents they care for beyond the pandemic.
Four elements of this year’s work helped demonstrate the CMS approach to quality improvement leadership through the pandemic:
• The Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes (the Toolkit) assembles promising practices at the state and local level and shares them with health care providers nationwide.
• CMS-CDC Fundamentals of COVID-19 Prevention for Nursing Home Management provided timely web-based training on topics related to infection prevention and control during the pandemic.
• The web-based CMS-CDC Fundamentals Training Self-Assessment Questionnaire helped time-stressed providers quickly access targeted trainings and maximize their learning time.
• CMS Targeted Nursing Home Training for Frontline Staff and Management were developed for nursing home managers and frontline staff to share knowledge around ways to protect, provide care and prevent the spread of COVID-19.
Challenge: The global COVID-19 pandemic created an extraordinary public health crisis throughout the U.S. health care system. Frail and elderly nursing home residents proved especially vulnerable to the virus. The impact on nursing home care teams was immediate and overwhelming, as outbreaks required rapid and informed responses to implement emergent infection prevention and control measures to mitigate spread of COVID-19. Local providers needed quick access to reliable, accurate information, tools and resources and updates on state and local conditions.
Action: CMS leadership collaborated with Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) to gather timely information and distribute these resources nationally to improve infection control, enhance provider knowledge, share resources and improve nursing home care.
Results: QIN-QIOs worked with CMS to create the nationally distributed Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes (the Toolkit). The Toolkit is comprised of innovative ideas and practices from frontline health care providers, state COVID-19 task forces, health care organizations, associations and experts, and is intended to serve as a catalog of resources dedicated to addressing the specific challenges facing nursing homes as they combat COVID-19.
The Toolkit is hosted online by CMS and includes a broad range of resources and information on critical infection and prevention topics including cleaning and disinfection, COVID-19 testing, workforce and staffing, cohorting, infection control “strike teams,” nursing home communications and actions to improve access to and use of personal protective equipment (PPE). Submissions were provided by state and local government agencies, providers and stakeholder groups from all 50 states, the District of Columbia, Puerto Rico and Guam. Updated biweekly to distribute the most current information, 10 versions were produced and distributed in the first year of the contract. The Toolkit was promoted widely via CMS press releases, newsletters, QIN-QIOs and social media.
With broad national reach, the Toolkit kept local and innovative practices in the forefront of nursing home care during the pandemic and ensured access to clear and timely information to nursing homes and health care providers across urban, suburban and rural settings.
Challenge: The COVID-19 pandemic created an urgent need for infection prevention and control training for nursing home providers as they implemented emergency mitigation strategies to protect nursing home residents and to maintain safe and effective work environments.
Action: CMS collaborated with Quality Innovation Network-Quality Improvement Organizations(QIN-QIOs), the Centers for Disease Control and Prevention (CDC) and other agencies, organizations and stakeholders to create a robust, relevant, timely and comprehensive approach to nursing home infection prevention and control training.
Results: Nursing Home Trainings were a collaboration of leading experts who shared evidence-based crisis intervention practices and long-term strategies to meet the evolving challenges of nursing home care during the COVID-19 pandemic. The trainings were initially presented as live events. The continued availability of these highly rated trainings online provided more flexibility to accommodate the time constraints that health care providers were facing. Training topics evolved to meet new challenges as the pandemic continued, and to maintain an integrated and responsive focus on quality improvement leadership throughout the pandemic.
The trainings were grouped into three primary categories:
• CMS-CDC Fundamentals of COVID-19 Prevention for Nursing Home Management offered training on 13 infection prevention and control topics that nursing home teams should master to manage the COVID-19 pandemic.
• Comprehensive National Nursing Home Trainings presented a condensed, accelerated model of training on essential topics.
• CMS Targeted COVID-19 Training for Frontline Nursing Home Staff and Management is the newest training series, developed with insights gained during the COVID-19 pandemic to create a series of scenario-based trainings to share knowledge around ways to protect, provide care and prevent the spread of COVID-19.
Leading experts from CMS, CDC, academia, research institutes and QIN-QIOs helped to develop and present the trainings and provided on-the-ground experience and research-driven strategies. The Nursing Home Trainings provided crucial responsiveness to the national emergency and ensured delivery of vital information that would directly affect and enhance the care of vulnerable and elderly nursing home residents during the public health crisis.
As of September 2020, 6,274 unique nursing homes have participated in the CMS-CDC Fundamentals and the Comprehensive National Nursing Home training series. The trainings received an overall satisfaction score of 96 percent. Ninety-six percent of respondents indicated that they were likely to apply the training to their work. Through the continued availability of these highly rated trainings online, the reach will extend and reinforce quality improvement through the pandemic and beyond.
Challenge: In response to the COVID-19 pandemic, CMS, the Centers for Disease Control and Prevention (CDC) and Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) collaborated to create a series of infection prevention and control trainings for nursing home teams. Health care providers needed a way to sort through critical topics and quickly access trainings to match their knowledge gaps.
Action: CMS created an online tool for providers to identify their training needs and to generate a customized list of trainings.
Results: The CMS-CDC Fundamentals of COVID-19 Prevention Training Self-Assessment Questionnaire is an interactive assessment tool that helped nursing home teams identify trainings most relevant to their situations. The Self-Assessment was also available in graphic form. After completing the survey, a customized list was emailed to each user, which linked to the self-directed training modules. The response to the Self-Assessment was overwhelmingly positive, as busy providers valued this tool to help focus their training to areas of highest need.
On-demand, pre-recorded trainings are available on www.QIOProgram.org and include:
Establishing an Infection Prevention Program in a Nursing Home, with an Emphasis on COVID-19
Is Your Nursing Home Ready to Handle the Demands of the COVID-19 Pandemic? Assessing Readiness: Advice from the CDC
COVID-19 Surveillance to Enable Early Detection and Response to Outbreaks: National Healthcare Safety Network (NHSN) Mandatory Data Collection
COVID-19 Testing
Cohorting Strategies
Cleaning Environmental Surfaces and Shared Equipment
Creating a COVID-19 Recovery Center
Personal Protective Equipment (PPE) Strategies for COVID-19 Care
Accepting New Patients During an Active Pandemic: Considerations for Both Transfers from Hospitals and Admissions from the Community
Telehealth in Nursing Homes
Transparency: Resident and Family Notification. Department of Health and Other Notifications
Clinical Care: Managing COVID-Positive Residents
Managing Staffing Challenges
Nursing homes have been the focal point of CMS quality work throughout this year. The unprecedented global COVID-19 pandemic created an urgent call to implement quality improvement leadership to protect lives and improve care of Medicare beneficiaries. QIN-QIOs created a system of nimble response to local conditions and provided vital support and technical assistance across the country. Quality improvement was tested in real time, as QIN-QIOs helped nursing homes plan, implement, evaluate and continually adjust data-driven strategies to serve nursing homes and to create value in health care for nursing home residents that will continue throughout and beyond the pandemic.
One way of measuring program-level success is evaluating that number of views each of the training assets achieved. Looking across the various modalities used to deliver learnings (e.g., live-webcasts, views of recorded webcasts, number of instances an on-demand training was accessed, etc.) the Nursing Home Training series in its entirety achieved 31,449 views between May 28, 2020 and September 17, 2020.
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