Green House Projects Use Clinical Benchmarking Tool to Tell Their Quality Story
The Green House Project® is a radically new and innovative approach intended to deinstitutionalize long-term care. Residents are referred to as "elders"; the Greenhouse (GH) model is elder-centered, with elders having their own private room and bath. Their size, design, staffing patterns and organization are intended to offer a more intimate home-like environment where elders can receive assistance and support with activities of daily living and clinical care, without the assistance and care becoming the focus of their existence.
Since its inception, there have been many anecdotal stories about elders and their families expressing more satisfaction with living and being cared for in a GH as compared to life in the traditional nursing home. But, the challenge for the GH project staff has been to determine if measurable outcomes such as falls, pressure ulcers, depression, and functional decline improve for elders living in GHs. In order to be able to tell the quality story from a quantitative perspective, they contracted with EQUIP for Quality to provide a Web-based quality improvement and clinical benchmarking tool.
In addition to making this tool available to all GH Projects (and their related legacy skilled nursing facility) for quality improvement and elder care-planning, the EQUIP staff provides a Quarterly Quality Watch Report to GH staff using Minimum Data Set (MDS) data that the GH Projects submit to EQUIP. The purpose of the report is to provide evidence of improved outcomes and quality of care within the GH model.
The first report was submitted last month, and was based on data from 32 GHs representing 297 elders and 996 non- GH residents for the three-month period of April 1 through June 20, 2009. EQUIP uses national MDS data to compare GH and non-GH rates. In doing so, the report identifies success areas (where GHs have significantly lower rates than the CMS national average) and areas that need improvement (where GHs have significantly higher rates than the CMS national average).
There were seven success areas in the second quarter of 2009: Prevalence of tube feeding, Worsening late loss ADL, Bedfast, Worsening locomotion, Physical restraints, Prevalence of little or no activity, and Pressure ulcers (high risk). These findings point to the successes of the GH model of care in maintaining functional status and quality of life for the elders.
There were five areas where GH units performed better than the related skilled nursing facilities in the second quarter of 2009: Incidence of cognitive impairment, Worsening late loss ADLs or functional decline, Bedfast, Worsening locomotion, and Prevalence of anti anxiety/hypnotic use.
Stay tuned for updates on the quality story as more GHs open and use EQUIP, and as time progresses and successes become more evident.
Author: Kristen Phillips – NYAHSA, kphillips@nyahsa.org