Transcript The Quality Indicator Survey Process (QIS) Care Providers of Minnesota Board of Directors Meeting March 15, 2007

The Quality Indicator
Survey Process
(QIS)
Care Providers of Minnesota
Board of Directors Meeting
March 15, 2007
QIS
• Developed by the University of Colorado,
University of Wisconsin (CHSRA),
Maverick Systems, and Alpine
Technologies under contact with Research
Triangle.
• Developed from 1998-2005, refinements
since.
Pilots to-date
• Piloted in 5 states between October 2005
and October 2006:
– California
– Connecticut
– Kansas
– Louisiana
– Ohio
Conducted over 170 QIS surveys for evaluation
Expansion of Pilots
• In December 2006 CMS sent out a solicitation to
all non-pilot states informing them of the
expansion of the QIS pilot.
• No specific number of additional states identified
• CMS estimates expansion into the expanded
states would commence in the fall of 2007
• MDH has applied for inclusion in the expansion
• The MDH application was supported by Care
Providers of Minnesota’s Regulatory Committee
and Executive Management Committee.
What is the QIS?
•
A different, more automated, data driven
method to survey for compliance with Federal
Regulations.
•
QIS Objectives:
1. Improve the consistency and accuracy of surveys
using a structured process
2. Comprehensively survey all regulations
3. Enhance documentation through automation
4. Focus survey resources on facilities with the largest
umber of quality concerns
5. Do it all within existing survey and certification
budgeted resources
Offsite Preparation
Entrance Conference
Facility Tour
Stage 1 Sample Selection
(3 Samples: MDS based, Admission, Census
Stage 1 Sample Review
(Resident, Family, & Staff interviews, Resident
Observations, Medical Record Reviews)
Facility-Level Investigations
Stage II Investigation
Medication Adm Observation
Identify care deficiencies and determine S/S of deficiencies
How Does the QIS Work?
• Offsite Survey Preparation
– Review of facility history, complaints, and
ombudsman reports (nothing new here)
– Surveyors pre-load all facility MDS’s into their
computers (new)
– No review of QM’s, QI’s, or OSCAR reports to
pre-select a resident sample (new)
Entrance Conference
• Roster/Sample Matrix (CMS 802) no
longer required
• Must provide resident census in
alphabetical order (incl room #’s and units)
• Must provide closed admission records
within one hour
Tour
• Brief overview of the facility
• Used to get a sense of the facility and
residents
• Not intended to augment the resident
sample or to begin investigations
Stage 1 Samples
• MDS Sample – includes all residents with
an MDS assessment within the past 6
months
• Census Sample – Random sample of 40
current residents
• Admission Sample – Random sample of
30 recent admissions
• Surveyor Sample – Initiated sample at
surveyors’ discretion
Advantages of Stage 1 Samples
• MDS Sample – covers all residents
(except very recent) but is only facilityreported information
• Census Sample – emphasizes long-stay
residents because it is crosssectional…primary observation information
• Random Admission Sample – captures
post-acute admissions
Resident Interviews
• Surveyors will use the Cognitive
Performance Scale (CPS) from the
downloaded MDS data to calculate which
residents are interviewable:
– CPS Score 1-3: Interviewable
– CPS Score 4-7: Family Interview Candidate
If resident has no MDS they will be listed as
interviewable until otherwise determined
Resident Interviews
• General Questions…
– Are you from here? Tell me about yourself?
How long have you been here? What food do
you like here?, etc.
• Required Structured Questions…
– Choices, Dignity, Activities, Building &
Environment, Participation in Care Plan,
Abuse, Interaction with others, Personal
property, Pain, ADL assistance, Food quality,
Hydration, Sufficient staff, Privacy, Exercise of
rights, Personal funds.
Resident Observations
• Cleanliness, Grooming, Oral health,
Incontinence, Dressing, Activities,
Contractures, Abuse, Skin, Restraints,
Pain, Hydration, Positioning, Accident
hazards, Siderails, Resident room
condition.
Overall Facility-Level Investigations
• Tasks completed on every survey:
– Resident Council representative interview (no
more group interview)
– Dining observation
– Kitchen/Food Services observation
– Infection control
– Demand billing
– Quality Assessment and Assurance review
Overall Facility-Level Investigations
• Tasks if triggered by Stage 1 Findings
(resident/family/staff interviews, resident observations, & medical record
reviews)
– Abuse Prohibition review
– Admission, Transfer, & Discharge review
– Environment
– Resident Funds
– Sufficient Staff
Then Everything Gets Dumped into
One Computer
• Each surveyor downloads documentation
from their tablet computers onto a flash
drive and combines all surveyor data onto
the Team Leader’s computer.
Data Driven
• The QIS Data Collection Tool (DCT)
calculates the Quality Care Indicators
(QCIs)
• There are a total of 160 QCIs and Facility
level tasks:
– 44 MDS (includes the 24 quality indicators)
– 68 Census
– 6 Administration
– 42 Facility
Data Driven
• The facility-specific QCIs are calculated
and compared to national rates
• If the rates exceed the established
thresholds, and in-depth investigation of
those care areas is conducted (State II)
• Stage II resident samples are selected by
system software
• State II investigation is required to
determine if there are deficient practices
Stage II
• Evaluate Care Practices in relation to Stage I
findings
• Resident-level and facility-wide
• Medication Administration Observation
• Use of Critical Element Pathways to structure
the investigative process (Activities, ADLs, ROM,
Behavior, B&B, Communication, Dental, Dialysis, Hospitalization,
Death, Nutrition, Hydration, Tube Feeding, Pain, Restraints,
Pressure Ulcers, Medications, Rehab and Community discharges,
Vents)
• Integrates information from multiple data
sources
• Rate severity for each resident where deficient
practice is found
Surveyor Team Meeting
• Discuss: Staff-to-resident interactions,
availability of staff and staffing patterns,
activities observed, characteristics of
resident population, meal times, scheduled
activities, and medication pass times,
residents with unmet needs.
• Surveyors will be assigned to observe
various meal times in dining areas and
resident rooms if deemed appropriate.
Regulatory Determination
• Combine Stage II findings across
residents by F-Tag
• Integrates survey team findings into a
single statement
• Uses documentation from Stage I and
Stage II findings
• Identifies deficiencies and determines
scope and severity
• Exit Conference
Offsite Preparation
Entrance Conference
Facility Tour
Stage 1 Sample Selection
(3 Samples: MDS based, Admission, Census
Stage 1 Sample Review
(Resident, Family, & Staff interviews, Resident
Observations, Medical Record Reviews)
Facility-Level Investigations
Stage II Investigation
Medication Adm Observation
Identify care deficiencies and determine S/S of deficiencies
Exit Conference
QIS Process Strengths
• Larger Sample Sizes – it requires a
sample of adequate size to infer anything
about the population…plus different
samples are used (admission, census,
mds, etc.)
• Comprehensive – past studies have
demonstrated that some surveyors
focused only on select deficiencies –
Structured approach requires surveyors to
examine all regulations
QIS Process Strengths
• Structured Approach – Systematic observations
and questions are comparable across all sites
and are replicable…providers could potentially
also used the tools to improve regulatory
compliance
• Enhanced Documentation – Information
collected throughout the process is collated by
computers for development of the 2567…Trail of
findings available to follow on-site decisionmaking
• Questions?