Background: Nursing facility (NF) quality of care is the subject of many innovations. The Centers for Medicare and Medicaid Services (CMS) allows for public comparison of quality measures. New Mexico (NM) consistently explores how to improve care in these areas. There are 70 NFs in NM; half are scattered in isolated rural areas. The shortage of NFs and their lack of access to a unified learning platform exacerbates poor quality outcomes. Project ECHO (Extension for Community Health Outcomes) is an evidence- based training and mentorship platform for health professions in underserved areas. Through an innovative partnership with the NM Human Services Department (HSD) and managed care organizations (MCOs), the Medicaid Quality Improvement and Hospitalization Avoidance (MQIHA) ECHO was deployed as part of a multi-pronged approach to build a community of NM NFs focused on improving quality. The onset of the Covid-19 pandemic disproportionately affected NFs, making it crucial to provide the latest scientific and public health (PH) updates to NM NFs. The MQIHA ECHO was repurposed to strengthen the Covid response of NFs and to serve as a forum for NF staff to directly interact with PH experts.
Purpose: We present a unique Value Based Purchasing (VBP) partnership between the NM HSD, MCO, NFs, and Project ECHO to improve outcomes and reduce avoidable hospitalizations in NM NFs. The MQIHA ECHO uses a blend of case discussions and focused didactics to target the CMS quality measures selected by VBP workgroup. During the summer of 2020, content was pivoted to Covid related topics to provide a useful forum for the NF participants.
Description: MQIHA ECHO held eight Covid dedicated sessions during the summer of 2020 with an average 43 unique participants (13-64) per session, representing an average 22 facilities (10-34). Program evaluation used standard continuing education (CE) feedback forms. Participants included directors of nursing, administrators, and center directors, with an occasional social worker and infection preventionist. Participants ranked the sessions very good to excellent in the areas of meeting stated objectives (89%), relevance of presentation to objectives (93%), and opportunities to ask questions (95%). When asked what they liked best about the sessions, comments included: “we have experts discussing … fields of expertise”; “lots of time for questions”; “discussion forum”; “ability to provide and solicit feedback as a group”; and “all of it”. A limitation of using CE feedback forms was low response rate (8-18%).
Conclusions: MQIHA ECHO feedback has been consistently positive. Participants regularly rate the content excellent and very good, highlighting the importance of this community for their wellbeing. The program’s ability to rapidly incorporate changing PH recommendations and on demand topics ensures continued interest and success of this collaboration.