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MU program to improve nursing home care reduces hospitalizations by nearly 50 percent, saving major dollars for Medicare

Advanced practice nurses play key role in reducing hospitalizations, improving resident care

December 5th, 2017

Story Contact: Sheena Rice, 573-882-8353,

COLUMBIA, Mo. – Researchers from the University of Missouri Sinclair School of Nursing are continuing to see success in their work to improve quality of care in nursing homes. In 2016, a federal report found that the Missouri Quality Initiative for Nursing Homes (MOQI) reduced potentially avoidable hospitalizations by 48 percent and reduced hospitalizations from all causes by 33 percent. This reduced total Medicare expenses by $1,376 per person, saving 33 percent of the costs of all-cause hospitalizations and 40 percent of potentially avoidable hospitalizations.

Launched in 2012, MOQI is a partnership among MU, CMS and state Medicaid programs initiated to improve care at 40 nursing facilities in the St. Louis area. The program is led by Marilyn Rantz, a Curators Professor of Nursing, and a team of MU faculty and staff.

“MOQI’s success can be attributed to having an advanced practice registered nurse (APRN) working full time in each of the nursing homes,” Rantz said. “If APRNs were working in every nursing home in the state—helping residents and staff recognize and manage health changes early—this would save millions of dollars each year. There would be far more in savings than the initial cost of hiring these skilled nurses.”

Based on MOQI’s latest results, Rantz estimates that if APRNs were able to work in each one of Missouri’s 500 nursing homes that would reduce Medicare costs for the more than 39,000 nursing home residents by approximately $53.9 million each year. This is an investment worth making in Missouri and across the country, she said.

Overall, the report on MOQI’s progress found evidence of the initiative’s effectiveness in reducing hospital inpatient admissions, emergency room visits and hospitalization-related Medicare expenses. The second phase of the initiative is now underway, with researchers looking to help other nursing homes in Missouri and other states implement the successful program.

Rantz’s pioneering work in nursing homes’ care quality spans more than 30 years. She is regarded as a premier international expert in quality measurement in nursing homes and research programs to improve the quality of care of older people.

Other MU nursing school researchers involved in the project include:
Greg Alexander, professor
Cathy Murray, project coordinator
Jessica Mueller, program coordinator
Lori Popejoy, associate professor
Amy Vogelsmeier, associate professor

MU researchers from other colleges and schools include:
Colleen Galambos, professor in the College of Human Environmental Sciences School of Social Work
Greg Petroski, biostatistician in the Medical Research Office

“I am so proud of the Mizzou researchers leading this successful initiative to help nursing home patients,” said Judith Fitzgerald Miller, dean of the Sinclair School of Nursing. “To be a leader in achieving results in this project demonstrates our commitment to improving nursing homes and care of older adults not only in Missouri, but across the nation.”

Subcontractors on the grant are Primaris, a federally designated organization that works to improve health care quality and affordability for Missouri residents, and Missouri Health Connections, a non-profit organization that creates secure health information networks to connect patients and providers in the state.

The final report was released by the Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services (CMS) and prepared by RTI International. It is available to the public here: