Transcript Click to Add Title Here - Pennsylvania Association of

QAPI
Quality Assurance Performance Improvement
11th Scope of Work Goals
Your Quality Innovation Network
 West Virginia, Delaware, Pennsylvania, New Jersey and
Louisiana have pooled resources for a combined force of
quality improvement
 Still have local contacts for local support that are responsive
to your unique state needs and stakeholder projects
http://www.qualityinsights-qin.org
Quality Assurance Performance
Improvement (QAPI)
 Mandated as part of the Affordable Care Act
 Expands current regulations for QAA
 Sets expectation for a sound, basic plan for QAPI that will
support systems of care and quality of life in every nursing
home
 Final Rule expected….
Definitions
 Quality Assessment – an evaluation of a process to determine
if a defined standard of quality is being achieved
 Quality Assurance – the organizational structure, processes
and procedures designed to ensure that care practices are
consistently applied
 Quality Improvement (Process or Performance Improvement)
– an ongoing interdisciplinary process that is designed to
improve the delivery of services and resident outcomes
What is QAPI?
Quality Assurance
Performance Improvement
 Measuring compliance with
standards
 Inspection
 Required, reactive
 Outliers, “bad apples”
Individuals
 Medical provider
 Few staff responsible
 Continuously improving
process to meet standards
 Prevention
 Chosen, proactive
 Processes or systems
 Resident care
 All staff responsible
QAPI Features
 Using data not just to identify problems but to identify
opportunities for improvement and setting priorities
 Building on residents’ own goals for health, quality of life and
daily activities
 Incorporating caregivers broadly in a shared QAPI mission
 Developing Performance Improvement Project (PIP) teams
with specific “charters”
 Undertaking a systemic change to eliminate problems at the
source
 Developing a feedback and monitoring system to sustain
continuous improvement
5 Elements of QAPI
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Design and Scope – ongoing and comprehensive
Governance and Leadership
Feedback, Data Systems and Monitoring
Performance and Improvement Projects
Systemic Analysis and Systemic Action
5 Elements of QAPI
 Design and Scope
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Comprehensive and ongoing plan
Includes all departments and functions
Addresses safety, quality of care, quality of life, resident choice
Based on best available evidence
Written QAPI plan
5 Elements of QAPI
 Governance and Leadership
– Systemic approach to gather input from staff, residents and
stakeholders – buy-in and support
– Sufficient resources – money, time, staff, etc.
– Ongoing and consistent staff training on QAPI
– Non-punitive culture
– Sustainability
5 Elements of QAPI
 Feedback, Data monitoring Systems and Monitoring
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Multiple sources, including resident and staff
Benchmarking and targeting
Adverse events
Establish goals
Ability to analyze, interpret and translate data into meaningful
actionable information
5 Elements of QAPI
 Performance Improvement Projects
– Prioritize topics
– Improve care or services in areas identified as needing improvement
– Gather information systematically to clarify issues or problems
5 Elements of QAPI
 Systematic Analysis and Systemic Action
– Organized approach to determine how an identified problem may be
caused
– How did the system cause the problem
– Improvement of systems and processes
– Use of PDSA, RCA to improve systems and prevent future adverse
events
“Not all change is improvement,
but all improvement is change.”
Donald Berwick, MD
Former CMS Administrator
Elements of the Model
What Are We Trying to Accomplish?
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Improvement requires setting goals or AIMs
Agreeing on the aim is crucial
Goals or AIMs keep everyone on track
They define the desired result or purpose
Are guides to action
Setting Stretch Goals (AIMS)
 Examples:
– Reduce the injury rate for residents in our household by 50 percent in
12 months
– Reduce the use of antipsychotic medications by 50 percent in 12
months
– Reduce complaints about meals by 75 percent in 12 months
– Improve Pain LS QM by 25 percent in 3 months
– Improve Pneumonia Vaccine rate by 50 percent in 6 months
How Will We Know a Change is an
Improvement
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Measurement for learning and process improvement
Starting point for comparison of data
Systematic gathering of information
Gather objective data free from bias or opinion
Personal observations may influence the results by seeing
what we want to see or what we expect to happen
Data Collection
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What type of data do we need
How can we collect data with minimum effort
Seek usefulness, not perfection
Set a time period for data collection
Collect baseline data
Examples
 Where in the process can we get this data to determine why
we have a high Antipsychotic LS QM rate?
 Who is ordering antipsychotic medications
 Has there been a change in staffing that is causing an increase
in antipsychotic med usage
 How do we know non-pharmacological interventions for
pain/behaviors are effective
 Are most transfers to a hospital made by a covering MD
Prioritize PIPS
 Review QM report, NH Compare, pharmacy report
 Staff, resident and family surveys
 Begin with problems you feel are easy to solve then move to
more complicated issues
 Not all problems require a PIP
PIP Team
 “Charter” a team
 Specific written plan to explore the problem
 PIP Team –staff closest to the issue
– i.e. small group activities – include NAs and activity aides
 What happened to allow the problem to occur
 What change in the process can we make to prevent the
problem in the future
Model for Improvement
What are we trying to
accomplish?
How will we know that a
change is an improvement?
What change can we make that
will result in improvement?
Act
Plan
Study
Do
PDSA Cycle
 PLAN – Plan the test, make predictions about what will
happen and why
 DO – Carry out the plan on a small scale, document problems
and unexpected observations
 STUDY – Analyze the data, compare the data to your
predictions
 ACT – Decide next steps of adopting change or plan next test
Pilot Test
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Test your action on a small scale
Test over a short time period
Observe the consequences
Did staff like the new solution
Evaluate
How Will We Know that a Change is an
Improvement?
 Three types of measures:
– Outcome measures – voice of the customer – resident, family, staff
– Process measures – the parts/systems performing as planned
(residents with decrease antipsychotics, wt. loss, falls)
– Balancing measures – looking at system from different direction, have
improved changes caused new problems in another part of the system
(reducing antipsychotics causing activity disruption, has change in
meal times caused therapy and/or department issues)
What Change Can We Make That Will
Result in Improvement
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All changes do not lead to improvement
Improve work flow – weekly skin checks
Optimize inventory – adequate adaptive utensils for meals
Error Proofing – calibrate scale for accurate weights
Test the Change
 Increase your belief that the change will result in
improvement
 Opportunity for learning from “failures”
 Learn how to adapt the change to conditions in different
environments
 Minimize resistance to implementation
Attributes of Changes that are Readily
Adopted*
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The change has a clear advantage over the current system
The change is compatible with the current system and values
The change is easy to try and reverse
Understanding and adapting the change requires minimal
complexity
 The change and its impact can be observed
*From Everett Rogers “Diffusion of Innovations”
Quality Improvement
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Quality improvement is not an extra thing to do
Monitor your QM report, staff and resident surveys, etc.
Know and understand your numbers
Share data with staff
Quality improvement will improve your quality measure rates
Quality improvement will improve resident, staff and family
satisfaction
QAPI Summary
 All of QAPI may not be new to your home
 Think of your entire home as you assess your QAPI efforts
 Involve staff directly working in a process in order to improve
that process
 Communication about QAPI should continue throughout your
entire home
 Solicit resident and family viewpoints about their quality
experience
Composite Score Content
 13 long-stay quality measures from Casper data
 Measures: Falls with injury, UTI, Pain, Pressure Ulcer,
Incontinence, Foley catheter, Physical Restraints, ADL, Wt.
loss, Depression, Antipsychotic Meds
 Flu and Pneumococcal vaccines
 All represent larger systems within long-term care settings
 Sum of 13 numerators divided by sum of 13 denominators
and multiplied by 100 = Composite Score
NNHQCC Composite Measure Score
 Goal based on nearly 10% of nursing homes nationally having
a composite score of 6 or less – Best Practice
 Improving processes to impact QMs and achieve score of 6 or
below may impact nursing home Star rating
 QIN-QIO will assist you in improving processes
Centers for Medicare & Medicaid Services
(CMS)
Transforming nursing homes through
continuous attention to quality of care
and quality of life
QAPI Resources:
http://go.cms.gov/nhqapi
11th Scope of Work 5-Year Goals for
Nursing Homes
 Achieve a score of six or better on the Nursing Home Quality
Composite Measure Score
 Improve the mobility of long-stay residents
 Decrease unnecessary use of antipsychotic medications
 Decrease healthcare-associated infections and other
healthcare-acquired conditions
 Decrease potentially avoidable hospitalizations
 Actively participate in Learning and Action Network
Collaborative
 Goals are purposely designed for cross-setting improvement
opportunities
Thank You
Toni Daly, RN, Project Coordinator
Phone: 1.877.346.6180, ext. 7843
E-mail: [email protected]
Penny Imes, RN, Project Coordinator
E-mail: [email protected]
Phone: 1.877.346.6180, ext. 7644
This material was prepared by Quality Insights, the Medicare Quality Innovation Network-Quality Improvement Organization for West Virginia, Pennsylvania, Delaware, New Jersey and Louisiana under
contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.
Publication number QI-C2-120814