Quality Assurance Performance Improvement (QAPI) Improvement ... •Proactive approach to performance management and improvement ... improvement or correction plan

  • Published on

  • View

  • Download


<ul><li><p>9/18/2013</p><p>1</p><p>Quality Assurance Performance Improvement (QAPI)</p><p>Linking Survey and Quality</p><p>2</p><p>Whats New</p><p> New Regulations</p><p> CMS and contractors working on </p><p>materials</p><p> New Publication QAPI at a Glance</p><p>Copyright Providigm, LLC. 2013</p><p>3</p><p>Sources</p><p> Centers for Medicare and Medicaid Services. S&amp;C: 13-05-NH "Preview of Nursing Home Quality Assurance &amp; Performance Improvement (QAPI) Guide - QAPI at a Glance." , 14 December 2012</p><p> "QAPI at a Glance: A Step by Step Guide to Implementing Quality Assurance and Performance Improvement (QAPI) in Your Nursing Home (DRAFT)." Centers for Medicare and Medicaid Services, University of Minnesota, Stratis Health, December 2012</p><p>Copyright Providigm, LLC. 2013</p></li><li><p>9/18/2013</p><p>2</p><p>4Copyright Providigm, LLC. 2013</p><p>5</p><p>The New Regulation</p><p> The ACA provision at Section 6102 requires nursing homes to develop a </p><p>compliance and ethics program </p><p>including (at part c) a Quality Assurance and Performance </p><p>Improvement Program [QAPI]. </p><p>Copyright Providigm, LLC. 2013</p><p>6</p><p>The New Regulation</p><p> This provision specifies that the Secretary (delegated to CMS) must establish standards relating to quality assurance and </p><p>performance improvement and must implement a program that will provide technical assistance to facilities on the </p><p>development of best practices in order to meet such standards. </p><p>Copyright Providigm, LLC. 2013</p></li><li><p>9/18/2013</p><p>3</p><p>7</p><p>The New Regulation</p><p> This new provision significantly expands the level and scope of facility </p><p>activities in order not only to correct </p><p>defects but also to constantly monitor all care and services in order to </p><p>continually improve performance</p><p>Copyright Providigm, LLC. 2013</p><p>8</p><p>What is Quality Assurance Performance </p><p>Improvement (QAPI)</p><p> QAPI is a data-driven and pro-active approach to quality improvement. Activities of this comprehensive approach are </p><p>designed to involve all members of an organization to continuously identify opportunities for improvement, address gaps </p><p>in systems through planned interventions in order to improve the overall quality of care and services delivered to nursing home </p><p>residents.</p><p>Copyright Providigm, LLC. 2013</p><p>9</p><p>Purpose of QAPI</p><p> To greatly enhance each nursing homes processes of assessing their </p><p>quality of care and services</p><p> Continually correcting defects and </p><p>improving their performance </p><p>outcomes </p><p>Copyright Providigm, LLC. 2013</p></li><li><p>9/18/2013</p><p>4</p><p>10</p><p>CMS Contract</p><p> Evaluate current tools that may be useful for providers</p><p> Develop a web-based resource library for providers and consumers:</p><p> Examples of QAPI frameworks</p><p>Core components and best practices</p><p> Survey procedures and worksheets</p><p> Initiate rollout November 2012</p><p>Copyright Providigm, LLC. 2013</p><p>11</p><p>Current QA Regulation</p><p> Current regulation for Quality Assurance in Nursing Homes requires </p><p>only a limited group of staff members </p><p>to be involved in a Quality Committee.</p><p>DON</p><p>A physician</p><p> Three members of the staff</p><p>12</p><p>Current Regulation Basis for QAPI</p><p> QAPI uses existing Quality Assessment and Assurance regulation and </p><p>guidance as a foundation</p><p> QAPI uses a systems approach to </p><p>actively pursue quality not just respond </p><p>to external requirements</p><p> May be already using parts of the </p><p>process</p><p>Copyright Providigm, LLC. 2013</p></li><li><p>9/18/2013</p><p>5</p><p>13</p><p>Whose Job is Quality?</p><p> Quality is a team sport. All members of an organization must participate in </p><p>quality. Everyone has some degree of </p><p>responsibility to quality from the top of the organization to bottom. Quality is </p><p>not just the responsibility of a </p><p>committee or those who attend a meeting.</p><p>14</p><p>Develop a Steering Committee A team to provide QAPI leadership</p><p> Overall responsibility to develop and modify the plan, review information, set priorities for PIPs</p><p> Charters teams to work on particular </p><p>problems</p><p> Reviews results and determines next steps</p><p> Learn and use systems thinking</p><p>Copyright Providigm, LLC. 2013</p><p>15</p><p>Develop a Steering Committee</p><p> Must include top leadership</p><p> Engage medical director in QAPI</p><p> Adapt QA committee to steering </p><p>committee</p><p>May need to meet more often</p><p> Include more people</p><p> Establish permanent and time-limited </p><p>work groups that report to it</p><p>Copyright Providigm, LLC. 2013</p></li><li><p>9/18/2013</p><p>6</p><p>QUALITY ASSURANCE &amp; PERFORMANCE IMPROVEMENT</p><p>Copyright Providigm, LLC. 2013</p><p>17</p><p>QAPI and National Goals</p><p> Improve Care for Individuals</p><p> Improve Health for Populations</p><p> Reduce per capita Costs in healthcare </p><p>delivery system</p><p>Copyright Providigm, LLC. 2013</p><p>18</p><p>Quality Assurance</p><p>QA is a process of meeting quality standards and assuring that care reaches an acceptable level. Nursing homes typically set QA thresholds to comply with regulations. They may also create standards that go beyond regulations. QA is a reactive, retrospective effort to examine why a facility failed to meet certain standards. QA activities do improve quality, but efforts frequently end once the standard is met.</p><p>Copyright Providigm, LLC. 2013</p></li><li><p>9/18/2013</p><p>7</p><p>19</p><p>Quality Assurance</p><p> Quality assurance involves measuring </p><p>and tracking indicators to find out where the facility is performing well, </p><p>and where there are opportunities for </p><p>improvement.</p><p>Two functions that go hand in hand</p><p>21</p><p>Performance Improvement</p><p>PI (also called Quality Improvement - QI) is a pro-active and continuous study of processes with the intent to prevent or decrease the likelihood of problems by identifying areas of opportunity and testing new approaches to fix underlying causes of persistent/systemic problems. PI in nursing homes aims to improve processes involved in health care delivery and resident quality of life. PI can make good quality even better.</p><p>Copyright Providigm, LLC. 2013</p></li><li><p>9/18/2013</p><p>8</p><p>22</p><p>Performance Improvement</p><p> PI is a proactive and continuous studyof processes with the intent to prevent </p><p>or decrease the likelihood of problems </p><p>by identifying areas of opportunity and testing new approaches to fix </p><p>underlying causes of </p><p>persistent/systemic problems.</p><p>23</p><p>Performance Improvement</p><p> PI in nursing homes aims to improve processes involved in health care </p><p>delivery and resident quality of life. PI </p><p>can make good quality better.</p><p>24</p><p>Performance Improvement</p><p> Performance improvement is the reaction and correction to an </p><p>opportunity to improve. </p></li><li><p>9/18/2013</p><p>9</p><p>25</p><p>Quality Assurance and Performance Improvement -Comparison</p><p>Copyright Providigm, LLC. 2013</p><p>QUALITY ASSURANCE PERFORMANCE IMPROVEMENT</p><p>MotivationMeasuring compliance with </p><p>standards</p><p>Continuously improving systems and </p><p>processes</p><p>Means Valid measurement PDSA Cycles</p><p>Attitude Required, comprehensive Chosen, specific </p><p>Focus Outcomes Systems and Processes</p><p>Scope Resident Care All Services</p><p>Responsibility QA Staff All Staff</p><p>26</p><p>QA+PI=QAPI</p><p> Data driven</p><p> Proactive approach to performance </p><p>management and improvement</p><p> Systematic</p><p> Comprehensive</p><p> Improves quality of life, care and </p><p>services</p><p> All levels of the organization</p><p>Copyright Providigm, LLC. 2013</p><p>27</p><p>QA+PI=QAPI</p><p> Identify opportunities for improvement</p><p> Address gaps in systems or processes</p><p> Develop and implement an </p><p>improvement or correction plan</p><p> Continuously monitor effectiveness of </p><p>interventions</p><p>Copyright Providigm, LLC. 2013</p></li><li><p>9/18/2013</p><p>10</p><p>USING THE QIS METHODOLOGY TO IMPLEMENT QAPI</p><p>Linking Survey and Quality</p><p>29</p><p>QIS Provides the </p><p>Framework for a Quality </p><p>Assurance and </p><p>Performance Improvement </p><p>System</p><p>30</p><p>What can be done with QIS</p><p> Continuous Survey Readiness</p><p> Continuous Quality Assurance</p><p> Performance Improvement</p></li><li><p>9/18/2013</p><p>11</p><p>31</p><p>Quality Assurance </p><p>Four Fundamental Steps</p><p>1. Develop scientifically valid quality </p><p>metrics</p><p>2. Establish minimum quality standards</p><p>3. Systematically evaluate quality using </p><p>metrics</p><p>4. Verify that quality meets minimum </p><p>standards</p><p>32</p><p>Scientifically ValidQIS Metrics Quality of Care and </p><p>Life Indicators (QCLIs)</p><p># Residents in Sample</p><p>With Negative Response</p><p>= RATE (%)</p><p># Total Residents in Sample </p><p>(less relevant exclusions)</p><p>33</p><p>Metrics Validated</p><p>Against Regulation483.15(b) - Self-Determination and Participation The resident has the right to--</p><p>(1) Choose activities, schedules, and health care consistent with his or her interests, assessments, and </p><p>plans of care; </p><p>(2) Interact with members of the community both inside </p><p>and outside the facility; and </p><p>(3) Make choices about aspects of his or her life in the </p><p>facility that are significant to the resident.</p><p>Source: State Operations Manual, Appendix PP - Guidance to Surveyors for Long Term </p><p>Care Facilities, (Rev. 70, 01-07-11)</p></li><li><p>9/18/2013</p><p>12</p><p>34</p><p>Establish MinimumQuality Standards - Thresholds</p><p> The QCLI rate established to govern the decision of whether to conduct an </p><p>in-depth Stage 2 review or </p><p>investigation</p><p> Value is absolute, not relative</p><p> Rate is facility-level</p><p>35</p><p>Systematically</p><p>Evaluate Quality</p><p>Stage 1Stage 1 Stage 1</p><p>Stage 2</p><p>Quality Committee</p><p>Intervene</p><p>Intervene</p><p>Intervene</p><p>36</p><p>Continuously</p><p>Assess at a sustainable rate so that continuous use is achieved. This produces </p><p>the best results.</p></li><li><p>9/18/2013</p><p>13</p><p>37</p><p>Use Two - Stage Approach</p><p> Stage 1 preliminary investigations</p><p> Mandatory Facility Level Tasks</p><p> Stage 2 in-depth investigations</p><p>Copyright 2011 Providigm, LLC</p><p>38</p><p>The Five Elements of QAPI</p><p>1. Design and Scope</p><p>2. Governance and Leadership</p><p>3. Feedback, Data Systems and </p><p>Monitoring</p><p>4. Performance Improvement Projects </p><p>(PIPs)</p><p>5. Systematic Analysis and Systemic Action</p><p>Copyright Providigm, LLC. 2013</p><p>39</p><p>QAPI Strategic Framework</p><p>Copyright Providigm, LLC. 2013</p></li><li><p>9/18/2013</p><p>14</p><p>1. Design and Scope</p><p>2. Governance and Leadership</p><p>3. Feedback, Data Systems </p><p>and Monitoring</p><p>4. Performance Improvement Projects (PIPs)</p><p>5. Systematic Analysis and </p><p>Systemic Action</p><p>The Five Elements of QAPI</p><p>1. Design and Scope</p><p>2. Governance and Leadership</p><p>3. Feedback, Data Systems </p><p>and Monitoring</p><p>4. Performance Improvement Projects (PIPs)</p><p>5. Systematic Analysis and </p><p>Systemic Action</p><p>The Five Elements of QAPI</p><p>42</p><p>1. Design and Scope</p><p> A QAPI program must be ongoing and comprehensive, dealing with the full </p><p>range of services offered by the </p><p>facility, including the full range of departments</p><p> When fully implemented, the program should address clinical care, quality of </p><p>life, resident choice, and care </p><p>transitions</p><p>Copyright Providigm, LLC. 2013</p></li><li><p>9/18/2013</p><p>15</p><p>43</p><p>1. Design and Scope</p><p> The Program aims for safety and high quality </p><p>with all clinical interventions while </p><p>emphasizing autonomy and choice in daily life </p><p>for residents (or residents agents)</p><p> The Program utilizes the best available </p><p>evidence to define and measure goals</p><p> Nursing homes will have in place a written </p><p>QAPI plan adhering to these principles. </p><p>Copyright Providigm, LLC. 2013</p><p>1. Design and ScopeQAPI</p><p>QAPI is Ongoing and Comprehensive </p><p>dealing with full range of services </p><p>offered by the facility, including the full </p><p>range of departments.</p><p>When fully implemented the QAPI </p><p>program, should address all systems of </p><p>care and management practices, and </p><p>always include Clinical Care, Quality of </p><p>Life, and Resident Choice. </p><p>It aims for safety and high quality with all </p><p>clinical interventions while emphasizing </p><p>autonomy and choice in daily life for </p><p>residents (or residents agents).</p><p>QIS</p><p>QIS, covers the whole regulation. Used</p><p>routinely, it is ongoing. Covers all </p><p>regulatory care areas and services and </p><p>departments.</p><p>QIS looks at systems of care required by</p><p>Federal Regulation including individual </p><p>resident care and facility wide care </p><p>systems which incorporates Quality of </p><p>Life, Quality of Care and Resident Choice.</p><p>QIS was designed around resident </p><p>centered care. QIS care areas also look at </p><p>clinical interventions, choices, resident </p><p>rights, accidents, choices, and activities.</p><p>1. Design and Scope</p><p>QAPI</p><p>Utilizes the best available evidence to </p><p>define and measure goals.</p><p>Nursing homes will have in place a </p><p>written QAPI plan.</p><p>QIS</p><p>In depth investigation in QIS is tied to </p><p>CMS QCLIs and thresholds. If thresholds </p><p>are exceeded, there is a high likelihood </p><p>of non compliance and quality issues.</p><p>QIS can be used in QAPI plan.</p></li><li><p>9/18/2013</p><p>16</p><p>46</p><p>Quality Indicator SurveyFull Range of Services</p><p> Based on the methodology of the Quality Indicator Survey</p><p> Stage 1</p><p> Stage 2</p><p>Designed to cover the entire regulation</p><p>47</p><p>QCLI DictionaryQuality of Life,Care and Resident </p><p>Choices</p><p>Copyright 2011 Providigm, LLC</p><p>48</p><p>QCLI Dictionary</p></li><li><p>9/18/2013</p><p>17</p><p>49</p><p>ThresholdsDefine and Measure Goals</p><p>1. Design and Scope</p><p>2. Governance and Leadership</p><p>3. Feedback, Data Systems </p><p>and Monitoring</p><p>4. Performance Improvement Projects (PIPs)</p><p>5. Systematic Analysis and </p><p>Systemic Action</p><p>The Five Elements of QAPI</p><p>51</p><p>2. Governance and Leadership</p><p> The governing body and/or administration of the nursing home </p><p>develops and leads a QAPI program </p><p>that involves leadership working with input from facility staff, as well as from </p><p>residents and their families and/or </p><p>representatives. </p><p>Copyright Providigm, LLC. 2013</p></li><li><p>9/18/2013</p><p>18</p><p>52</p><p>2. Governance and Leadership</p><p> The governing body assures the QAPI program is </p><p>adequately resourced to conduct its work. This </p><p>includes: </p><p>designating one or more persons to be accountable for QAPI; </p><p>developing leadership and facility-wide training on QAPI; </p><p>and ensuring staff time, equipment, and </p><p>technical training as needed for QAPI. </p><p>Copyright Providigm, LLC. 2013</p><p>53</p><p>2. Governance and Leadership</p><p> They are responsible for establishing policies to sustain the QAPI program despite changes in personnel and turnover. </p><p> The governing body and executive leadership </p><p>are also responsible for setting expectationsaround safety, quality, rights, choice, and respect by balancing both a culture of safety </p><p>and a culture of resident-centered rights and choice. </p><p>Copyright Providigm, LLC. 2013</p><p>54</p><p>2. Governance and Leadership</p><p> The governing body ensures that while staff are held accountable, there exists </p><p>an atmosphere in which staff are not </p><p>punished for errors and do not fear retaliation for reporting quality </p><p>concerns. </p><p>Copyright Providigm, LLC. 2013</p></li><li><p>9/18/2013</p><p>19</p><p>2. Governance and LeadershipQAPI</p><p>Administration leads QAPI with input from staff, </p><p>residents, families.</p><p>QAPI program must be adequately resourced, </p><p>designating a person accountable for QAPI, </p><p>develops facility wide training and provides </p><p>training and equipment as needed for QAPI.</p><p>Establish policies to sustain the QAPI program </p><p>despite changes in personnel and turnover</p><p>Set priorities for improvement.</p><p>Balance a culture of safety and a culture of </p><p>resident-centered rights and choice.</p><p>Ensures that while staff are held accountable, </p><p>there exists an atmosphere in which staff are not </p><p>punished for errors and do not fear retaliation for </p><p>reporting quality concerns.</p><p>QIS</p><p>QIS integrates interviews obtaining input from </p><p>residents, family and staff. Use on an ongoing </p><p>basis, provides continuous feedback. </p><p>As QIS is available as a QA tool, CMS maintains </p><p>thresholds and measurement, updates, forms, </p><p>resources and materials.</p><p>QIS process is sustained despite turnover in staff. </p><p>Staff can be educated and with turnover, re-</p><p>educated as needed. Multiple staff members can </p><p>be trained in the process. </p><p>QIS thresholds assist in identifying care areas </p><p>where in-depth investigation is needed and </p><p>based on investigation, priorities set for </p><p>improvement. </p><p>QIS assesses resident safety, rights and choice </p><p>and in-depth investig...</p></li></ul>


View more >