Department Announces Release of RFA: On-Time Quality Improvement for Long-Term Care

Albany, N.Y., August 3, 2007 - As part of its continuing commitment to reduce the prevalence of pressure ulcers in nursing home residents, the New York State Department of Health has released a Request for Applications (RFA) to implement an evidence-based quality improvement model that prevents the development of pressure ulcers. Eligibility for funding under the RFA is limited to nursing homes with pressure ulcer rates for high-risk residents that average 10 percent or more.

"New York's overall national rank for pressure ulcers in nursing homes is not where it should be," Health Commissioner Richard F. Daines, M.D., said today. "There is a lot of room for improvement, and our nursing home residents deserve our best efforts." Pressure ulcers are sometimes referred to as bedsores.

The Department announced the "War on the Sore" late last year. Since that time, the Department has worked closely with nursing homes, provider associations, researchers and the federal government to identify evidence-based quality improvement models that produce sustainable decreases in prevalence and incidence of pressure ulcers among nursing home residents.

One such model is the "On-Time Quality Improvement for Long-Term Care," developed by Dr. Susan Horn and colleagues at the Institute of Clinical Outcomes Research and additional colleagues at Health Management Strategies, with financial support from the federal Agency for Healthcare Research and Quality (AHRQ) and the California Health Care Foundation. It has been implemented, tested and refined in more than 35 nursing homes across the nation. This approach to nursing home-acquired pressure ulcer prevention has produced an average decrease of 33 percent in prevalence rates in the nursing homes that implemented the model.

The On-Time model integrates clinical guidelines and clinical information into each nursing home's daily routines and processes for assessment, care planning, care delivery, communication and reassessment using health information technology. It facilitates timely information flow that informs weekly monitoring of resident status and on-going care planning. The communication mechanisms used in the On-Time model are effective and efficient and provide staff with current and accurate information on each at-risk resident on a weekly basis.

Up to 12 nursing homes that commit to implement the model for all of their chronic or long-stay beds will be selected to participate, with $600,000 allocated to this initiative. Awards are capped at $49,999 and are intended primarily to subsidize the costs of the health information technology that must be purchased to implement the On-Time model. Applications for funds will be accepted on a continuous basis after September 3, 2007, until all funds have been awarded or October 15, 2007, which comes first.

In lieu of an applicant information meeting, DOH is offering an interactive live Webcast on Wednesday, August 8 at 1:30-3:30 p.m. Eastern Daylight Time. Nursing homes that wish to join in the Webcast must register at The Webcast is free with no limit on the number of staff that a nursing home can register. Developers of the On-Time Quality Improvement model and staff from nursing homes that have implemented it will present additional information on the model during the Webcast. There will also be multiple opportunities for nursing home staff to ask questions about the On-Time model and the RFA.

The RFA may be downloaded from the DOH Web site at:

The "War on the Sore" informational letter to nursing homes can be found on the DOH Web site at: