CMS-10622 QIN-QIO Focus Group Guide

CMS Independent Evaluation Center (IEC) OMB No. xxxx-xxxx

Focus Group Moderator Guide: Nursing Home QIN-QIO Task Leads Expires xx/xx, 20xx

Appendix A4: Focus Group Moderator Guide for QIN-QIO Nursing Home Task Leads

Introduction (10 min)

Good morning/afternoon/evening. Thank you for participating in this discussion of the Nursing Home Collaborative Program. My name is _________ and I’m the moderator, my colleagues _____________ will be taking notes. We are from Booz Allen Hamilton and are conducting this focus group on behalf of the Independent Evaluation Center (IEC). In particular, we would like to learn about the strengths and challenges working with the NNHQCC program, the usefulness of tools for measuring changes in nursing home systems and quality measures, and about partnership and coordination. Your insights will help us to better understand the context, inputs and processes of the Nursing Home Collaborative program and gain more insights about the evaluation of the program.

Before we start, let me suggest some things to make our discussion more productive. Because we will be recording for an accurate record, it is important that you speak up and that you only speak one at a time. We don’t want to miss any of your comments. Please note that your name, title and organization will not be linked to any of the reports generated from this discussion. In this way, we will maintain your confidentiality. In addition, we ask that you also respect the confidentiality of everyone in this room. Please don’t repeat who said what when you leave this room.

The entire session will last for about an hour. I will ask questions and listen to what you have to say. I will not participate in the discussion. So please feel free to respond to each other and to speak directly to others in the group. We want to hear from all of you. We are interested in both majority and minority viewpoints, common and uncommon experiences. So I may sometimes act as a traffic cop by encouraging someone who has been quiet to talk or by asking someone to hold off for a few minutes.

If it is ok with all of you, we will turn on the recorder and start now.

[DO NOT READ]

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Before my first question, I need to tell you this interview has been approved by the Office of Management and Budget (OMB) as required by the Paperwork Reduction Act. The OMB approval number for this interview is 0938-XXXX.

Let’s start with introductions. Please tell us your name and where you’re from.

1. Recruiting (10 minutes)

1. I want to start by asking about the recruiting task because it is a big part of the contract. Please share your experiences with recruiting nursing homes to participate in the program.

[Probes:]

• What were the selling points of the QIO program that worked well?

• When nursing homes turned down the offer to participate, what types of reasons did they give?

• What proportion of nursing homes in Collaborative 1 stayed with Collaborative 2?

  • What were the reasons for nursing homes not continuing with the NNHQCC program?

2. How did you recruit the peer coaches?

[Probe:]

• What advice would you offer for QIOs having difficulty recruiting peer coaches?

3. How did you go about recruiting residents and family members? How did you get word out to residents and family members about participating?

4. What were the most challenging aspects about recruiting? What could be done to help make it less challenging?

2. Strengths and Challenges of QIN-QIO Program (20 minutes)

5. Let’s talk about the Collaborative approach; what do you think are the strongest features of this approach for advancing the QIO nursing home program goals? What’s working from this approach?

[Probes:]

• How useful is the Change Package? Do you know if nursing homes used the “Change Bundles” to reduce antipsychotic use, increase mobility, and reduce HACs?

• How are you using the Composite Score? (Do you find uses other than aiming for favorable changes in the overall score?)

• Have you found any issues or problems with using the Composite Score? For example, do you observe preoccupation with the score to the exclusion of system changes?

• How are you using the Peer Coaches? Residents/family members?

6. Did you have other challenges in working with the Collaborative program?

[Probes:]

• Are there parts of the Change Package that seem unrealistic in the field? Which parts?

  • Operational challenges (e.g. NHs not able to master QM tools);

  • Logistical challenges (e.g. problems disseminating resources)

  • Environmental challenges (e.g. turnover of NH staff and peer coaches)

  • Resource challenges

• What could have helped to make this less challenging? Do you have plans for overcoming these challenges in the next Collaborative?

3. Collection and Use of Measures (10 minutes)

I’d like to get your input on the measures you collect and how you use them.

7. Besides the quality measures and Composite Scores, were there other indicators you used to gauge if nursing homes were making positive changes? For example, did you monitor if they had regular meetings about quality improvement, or making better use of data?

[Probe:]

• Were there any other ways you followed their progress?

8. Were you able to monitor whether nursing homes were using QAPI methods and techniques, like PDSA? [IF YES] What methods do you use for this purpose?

[Probes:]

• Do you collect data and results from improvement monitoring tools that nursing homes use?

• [IF YES] Do you use these data? How do you use it?

• Do you collect other data showing impact and effectiveness that are not reflected in quarterly reports?

9. Could you monitor whether nursing homes were making systematic changes like lowering staff turnover and using consistent staffing for residents? [IF YES] What methods do you use for this purpose?

[Probe for individual system changes]

• Consistent/permanent staff assignment

• Improved communications

• Effective leadership

• Improved regulatory compliance

• Use of clinical models

• Use of quality of life indicators

[Probe]

• Can you tell us about a nursing home you worked with that was able to make a systematic change through applying methods and techniques from the Collaborative?

4. Partnership and Coordination (8 minutes)

10. When planning your activities did you collaborate with Tasks C.1 or C.3.10 and C.3? [IF YES] How did that process work? How did you feel about that process?

11. Was there any coordination with the other states in the QIN for developing activities, tools or resources? [IF YES] How much had to be tailored or changed for your purposes?

12. Did you coordinate or partner with other quality improvement programs in your state? [IF YES] Which ones? How did you feel about the value gained from partnering for the effort/time needed to develop and maintain the partnership?

5. Thank You and Wrap Up (2 minutes)

Thank you for your time and for sharing your experiences. Your comments are very helpful and insightful. Enjoy the rest of the conference.

The time required to complete this information collection was estimated to average 60 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, I can provide you with the mailing address. Would you like this address?

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You may send comments to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

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