Call to action: APRNs in U.S. nursing homes to improve care and reduce costs

• Published in: Nursing outlook 2017-11, Vol.65 (6), p.689-696
• Main Authors: Rantz, Marilyn J., Birtley, Nancy M., Flesner, Marcia, Crecelius, Charles, Murray, Cathy
• Format: Article
• Language: English
• Subjects: Advanced Practice Nursing; Health Care Costs; Hospitalization; Humans; Long-term care facilities; Medicare; Missouri; Missouri Quality Initiative; Models, Nursing; Nurse practitioners; Nurse's Role; Nursing; Nursing Homes; Quality of Health Care; United States
• ISSN: 0029-6554; 1528-3968
• DOI: 10.1016/j.outlook.2017.08.011

Centers for Medicare and Medicaid Innovation Center sponsored the initiative to reduce avoidable hospitalizations among nursing facility residents. Missouri Quality Initiative (MOQI) designed inter-professional model in nursing homes with advanced practice registered nurses (APRNs). MOQI APRN model was implemented for 4 years in 16 nursing homes in a metro area of the Midwest. Hospitalizations were reduced (40% all-cause, 58% potentially avoidable), emergency room visits (54% all-cause, 65% potentially avoidable), Medicare expenditures for hospitalizations (34% all-cause, 45% potentially avoidable), and Medicare expenditures for emergency room visits (50% all-cause, 60% potentially avoidable) for long-stay nursing home residents. Success of the MOQI model reinforces decades of research demonstrating that care provided by APRNs is cost-effective, safe, and associated with positive health outcomes and patient satisfaction. Nursing homes can implement and benefit by hiring APRNs. However, changes in the Code of Federal Regulation (CFR 483.40) are necessary to improve patient access to care and encourage hiring APRNs in US nursing homes. •Missouri Quality Initiative (MOQI) has been successful in reducing hospitalizations and expenditures for long-stay nursing home residents.•MOQI implemented interprofessional model in long-term care facilities with advanced practice registered nurses (APRNs) at the forefront.•The success of the MOQI model reinforces decades of research demonstrating that care provided by APRNs is cost-effective, safe, and associated with positive health outcomes and patient satisfaction.•Changes in regulations are necessary to improve patient access to care and encourage the use of APRNs in nursing homes nationwide.