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    Quality Assurance Performance Improvement (QAPI)

    Linking Survey and Quality

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    Whats New

    New Regulations

    CMS and contractors working on

    materials

    New Publication QAPI at a Glance

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    Sources

    Centers for Medicare and Medicaid Services. S&C: 13-05-NH "Preview of Nursing Home Quality Assurance & Performance Improvement (QAPI) Guide - QAPI at a Glance." , 14 December 2012

    "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

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    The New Regulation

    The ACA provision at Section 6102 requires nursing homes to develop a

    compliance and ethics program

    including (at part c) a Quality Assurance and Performance

    Improvement Program [QAPI].

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    The New Regulation

    This provision specifies that the Secretary (delegated to CMS) must establish standards relating to quality assurance and

    performance improvement and must implement a program that will provide technical assistance to facilities on the

    development of best practices in order to meet such standards.

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    The New Regulation

    This new provision significantly expands the level and scope of facility

    activities in order not only to correct

    defects but also to constantly monitor all care and services in order to

    continually improve performance

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    What is Quality Assurance Performance

    Improvement (QAPI)

    QAPI is a data-driven and pro-active approach to quality improvement. Activities of this comprehensive approach are

    designed to involve all members of an organization to continuously identify opportunities for improvement, address gaps

    in systems through planned interventions in order to improve the overall quality of care and services delivered to nursing home

    residents.

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    Purpose of QAPI

    To greatly enhance each nursing homes processes of assessing their

    quality of care and services

    Continually correcting defects and

    improving their performance

    outcomes

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    CMS Contract

    Evaluate current tools that may be useful for providers

    Develop a web-based resource library for providers and consumers:

    Examples of QAPI frameworks

    Core components and best practices

    Survey procedures and worksheets

    Initiate rollout November 2012

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    Current QA Regulation

    Current regulation for Quality Assurance in Nursing Homes requires

    only a limited group of staff members

    to be involved in a Quality Committee.

    DON

    A physician

    Three members of the staff

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    Current Regulation Basis for QAPI

    QAPI uses existing Quality Assessment and Assurance regulation and

    guidance as a foundation

    QAPI uses a systems approach to

    actively pursue quality not just respond

    to external requirements

    May be already using parts of the

    process

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    Whose Job is Quality?

    Quality is a team sport. All members of an organization must participate in

    quality. Everyone has some degree of

    responsibility to quality from the top of the organization to bottom. Quality is

    not just the responsibility of a

    committee or those who attend a meeting.

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    Develop a Steering Committee A team to provide QAPI leadership

    Overall responsibility to develop and modify the plan, review information, set priorities for PIPs

    Charters teams to work on particular

    problems

    Reviews results and determines next steps

    Learn and use systems thinking

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    Develop a Steering Committee

    Must include top leadership

    Engage medical director in QAPI

    Adapt QA committee to steering

    committee

    May need to meet more often

    Include more people

    Establish permanent and time-limited

    work groups that report to it

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    QUALITY ASSURANCE & PERFORMANCE IMPROVEMENT

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    QAPI and National Goals

    Improve Care for Individuals

    Improve Health for Populations

    Reduce per capita Costs in healthcare

    delivery system

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    Quality Assurance

    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.

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    Quality Assurance

    Quality assurance involves measuring

    and tracking indicators to find out where the facility is performing well,

    and where there are opportunities for

    improvement.

    Two functions that go hand in hand

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    Performance Improvement

    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.

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    Performance Improvement

    PI is a proactive and continuous studyof 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.

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    Performance Improvement

    PI in nursing homes aims to improve processes involved in health care

    delivery and resident quality of life. PI

    can make good quality better.

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    Performance Improvement

    Performance improvement is the reaction and correction to an

    opportunity to improve.

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    Quality Assurance and Performance Improvement -Comparison

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    QUALITY ASSURANCE PERFORMANCE IMPROVEMENT

    MotivationMeasuring compliance with

    standards

    Continuously improving systems and

    processes

    Means Valid measurement PDSA Cycles

    Attitude Required, comprehensive Chosen, specific

    Focus Outcomes Systems and Processes

    Scope Resident Care All Services

    Responsibility QA Staff All Staff

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    QA+PI=QAPI

    Data driven

    Proactive approach to performance

    management and improvement

    Systematic

    Comprehensive

    Improves quality of life, care and

    services

    All levels of the organization

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    QA+PI=QAPI

    Identify opportunities for improvement

    Address gaps in systems or processes

    Develop and implement an

    improvement or correction plan

    Continuously monitor effectiveness of

    interventions

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    USING THE QIS METHODOLOGY TO IMPLEMENT QAPI

    Linking Survey and Quality

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    QIS Provides the

    Framework for a Quality

    Assurance and

    Performance Improvement

    System

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    What can be done with QIS

    Continuous Survey Readiness

    Continuous Quality Assurance

    Performance Improvement

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    Quality Assurance

    Four Fundamental Steps

    1. Develop scientifically valid quality

    metrics

    2. Establish minimum quality standards

    3. Systematically evaluate quality using

    metrics

    4. Verify that quality meets minimum

    standards

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    Scientifically ValidQIS Metrics Quality of Care and

    Life Indicators (QCLIs)

    # Residents in Sample

    With Negative Response

    = RATE (%)

    # Total Residents in Sample

    (less relevant exclusions)

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    Metrics Validated

    Against Regulation483.15(b) - Self-Determination and Participation The resident has the right to--

    (1) Choose activities, schedules, and health care consistent with his or her interests, assessments, and

    plans of care;

    (2) Interact with members of the community both inside

    and outside the facility; and

    (3) Make choices about aspects of his or her life in the

    facility that are significant to the resident.

    Source: State Operations Manual, Appendix PP - Guidance to Surveyors for Long Term

    Care Facilities, (Rev. 70, 01-07-11)

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    Establish MinimumQuality Standards - Thresholds

    The QCLI rate established to govern the decision of wh