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The MOQI seeks to reduce avoidable hospitalization among nursing home residents by placing an advanced practice registered nurse (APRN) within the care team with the goal of early identification of resident decline. In addition to the APRN, the MOQI involves nursing home teams focused on use of tools to better detect acute changes in resident status, smoother transitions between hospitals and nursing homes, end-of-life care, and use of health information technology to facilitate communication with peers. As a result of the innovation, resident hospitalizations declined. Funding for this innovation was originally provided to the University of Missouri via a Centers for Medicare & Medicaid Services (CMS) demonstration grant. Given the success of the innovation, when the grant funding expired, the model and lessons learned from the initiative were transferred to NewPath Health Solutions, LLC, to ensure continued dissemination.

Innovation Patient Safety Focus

The patient safety focus of this innovation is to prevent avoidable hospitalizations among nursing home residents by placing a dedicated APRN within the nursing home, supported by an interdisciplinary team of long-term care specialists, to identify when a resident may be experiencing a functional decline. Statistically significant decreases in hospitalizations were achieved.

Evidence Rating


Resources Used and Skills Needed

When implementing this innovation, several key resources were critical to success:

  • Funding is required to support the inclusion of a dedicated APRN on the clinical team.
  • Ongoing engagement and commitment of leadership to ensuring an organization-wide focus are crucial.
  • The APRNs and nursing home leaders were supported by a nurse project supervisor, an INTERACT/QI coach, a health information coordinator, a care transitions coach with a Master of Social Work, and a medical director. Support was also provided by researchers with expertise in QI, care coordination, advance care planning, informatics, and transitional care. Support included educational resources for staff and assistance with QI efforts.3
  • Access to resources such as the INTERACT tools, education programs, and HIEs provide systematic approaches for nursing home staff.

Use By Other Organizations

This innovation has been implemented at over 16 nursing homes in Missouri (as part of the original program). Since the innovation was transferred to NewPath Health Solutions, LLC, it has expanded into five nursing homes in Florida and six more nursing homes in Missouri.

Developing Organizations

Date First Implemented

Perspectives on Safety
Anjali Joseph

Anjali Joseph, PhD, EDAC, is a Spartanburg Regional Healthcare System Endowed Chair in Architecture and Health Design. Molly M. Scanlon, PhD, FAIA, FACHA, is the Director at Phigenics, LLC. We spoke with them about how healthcare built environments have been temporarily modified during the COVID-19 pandemic and what learnings may be used moving forward.


This piece discusses areas where the healthcare built environment may contribute to the risk of COVID-19 transmission, mitigating strategies, and how the pandemic may impact the built environment moving forward.

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