QAPI“Quality Assurance Performance

Improvement for Nursing Homes”

LeadingAge WyomingSpring Conference

May 23, 2013

What Do You Want to Learn Today?

Today’s Objectives

• Provide the regulatory mandate information• Describe the elements of QAPI• Highlight QAPI-At-A-Glance• Discuss tools and resources that support QAPI• Where are we today with QAPI evolution?

Why Quality Care Focus?

• The government demands it!• Acute care providers demand it!• 5-STAR Ratings demand it!• Families demand it!• Your success depends on it!• Residents deserve it!

What is QAPI?SEC. 6102. Accountable Care Act (March 2010)ACCOUNTABILITY REQUIREMENTS FOR SKILLED

NURSING FACILITIES AND NURSING FACILITIESNursing Home QAPI is requiredLegislation requires CMS to establish QAPI

program standards and provide technical assistance to nursing homes

Identify training needs for LTC surveyorsDemonstration project to create a model QAPI

Plan

The BIG Picture

The ultimate goal is to provide person-

centered care – to focus on the person living in the nursing

home

The BIG Picture

• Quality Assurance and Performance Improvement (QAPI) does not refer to a program; rather, this is the way we should do our work

• The ability to think, make decisions and take action at the system level is required for sustainable QAPI success

• Comprehensive approach to ensuring high quality care

• Data-driven, proactive approach to improve the quality of life, care and services in nursing homes

• Involves members at all levels of the organization to: I.D. opportunities for improvement Address gaps in systems or processes Develop and implement improvement or corrective plan Continuously monitor effectiveness of interventions

QA + PI = QAPI

Five QAPI Plan Framing Elements

Governance and Leadership

Quality of Care. Quality of Life. Resident Choice.

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5

Systematic Analysis and Systemic Action

Feedback, Data Systems and Monitoring

Performance Improvement Projects

Design and Scope

1

Design and Scope

Characteristics of how QAPI is designed and thescope of what it includes:

Ongoing and comprehensive program across the full range of services and departments

Addresses clinical care, quality of life, residentchoice, and care transitions

Aims for safety and high quality clinicalinterventions while emphasizing choice

Utilizes best available evidenceWritten plan

1

Governance & Leadership

Leadership actively engaged with setting expectations and priorities, including:Systematic approach to gather input from staff,

residents, family, stakeholdersAdequate resources-time, money, otherOngoing and consistent staff trainingAccountability for process and resultsBalance culture of safety and rightsNon-punitive culture

2

Feedback, Data System, and Monitoring

Systems to monitor a wide range of care and service, drawing from multiple sources:Data from staff, residents, stakeholders, othersUse of goals, thresholds, and benchmarksAbility to analyze, interpret, and translate data

into meaningful and actionable informationUsing data to systematically prioritize and select

performance improvement projects (PIPS) appropriate for the nursing home

3

Performance Improvement Projects

Conduct Performance Improvement Projects (PIPs) to improve care or services in areas relevant to your residents: Gather information systematically to clarify

issues and identify opportunitiesTest and implement changesUse data to determine whether goals were

accomplished

4

Systematic Analysis & Systematic Action

Create real impact and long-lasting improvement as the result of QAPI through:Take into consideration all aspects of the organization

when making changesAddress variations in practice and causes of errors at

the system level instead of at the individual levelLink outcomes of QAPI efforts to policies and

procedures, staff orientation and ongoing education, performance expectations, strategic planning

5

What did the Demonstration Project Teach us?

Value of having tools to help guide and teach systems thinkingOffers framework and structureHelps critical steps from being skipped

QAPI is not a magic wandThe impact comes in the implementation

QAPI needs a strong champion(s) but it cannot be one person’s jobLeadership sets the tone and provides resourcesThe work is done by a variety of teams

Where do Nursing Homes Begin?

• QAPI Tools and Resources– QAPI-At-A-Glance– QAPI Facility Self-Assessment– Define facility guiding principles and scope– Development of a QAPI plan– Learn how to create/develop PIPs

• Alignment with state and national initiatives– 10SOW & National Nursing Home Quality Care Collaborative– Advancing Excellence In America’s Nursing Homes

Campaign– Partnership for Dementia Care

QAPI-At-A-Glance = Step by Step Guide

QAPI Self-Assessment

QAPI Plan Outline

Goal Setting Worksheet

QAPI Resources

• CMS link for QAPI– Website:

http://cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/QAPI.html (Just Google: nursing home QAPI)

– Mountain Pacific Quality Health• Pat Fritz, Nursing Home Project Manager

– 307-568-2797– pfritz@wyqio.sdps.org

National Nursing Home Quality Care Collaborative Teams from Wyoming

• Star Valley Care Center• Bonnie Bluejacket Memorial

Nursing Home• Poplar Living Center• Shepherd of the Valley Care

Center• CRMC-TCU• Kindred Healthcare-Cheyenne• Kindred Healthcare-Rawlins• Kindred Healthcare-Wind River• Douglas Care Center• Rocky Mountain Care-Evanston• Pioneer Manor

• St. John’s Nursing Home• South Lincoln Nursing Center• Westward Heights Care Center• Ivinson Hospital-ECU• Laramie Care Center• New Horizon’s Care Center• Weston County Health Services• Deseret Healthcare of Saratoga• Goshen Care Center• Platte County Memorial Nursing

Home• Worland Healthcare• Castle Rock Convalescent Center

Thank You!

Questions?

This material was prepared by Mountain-Pacific Quality Health, the Medicare Quality Improvement Organization for Montana, Wyoming, Hawaii and Alaska, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency for the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 10SOW-MPHQHF-WY-IPC-13-37