Question

Why did CMS introduce QAPI Programs, and what are some steps in formation of these programs (look at the F tags associated with these programs for some help on this)?

What are Performance Improvement Plans, and what are some tools that can be used to measure performance improvements (look at statistical tools as well as observational tools that can be used by staff).

Answer 1

CMS is Centers for Medicare and Medicaid Services .

The formation of QAPI :-

The existing Quality Assessment and Assurance (QAA) provision at 42 CFR, Part 483.75(o) specifies the QAA committee composition and frequency of meetings in nursing facilities and requires facilities to develop and implement appropriate plans of action to correct identified quality deficiencies. This provision provides a rule but not the details as to the means and methods taken to implement the QAA regulations. CMS is now reinforcing the critical importance of how nursing facilities establish and maintain accountability for QAPI processes in order to sustain quality of care and quality of life for nursing home residents.

In March 2010, Congress passed the Affordable Care Act. The Provisions set forth at Section 6102 (c) of the Affordable Act provide the opportunity for CMS to mobilize some of the best practices in nursing home QAPI and to identify technical assistance needs in advance of a new QAPI regulation. The provision states that the Secretary (delegated to CMS) shall establish and implement a QAPI program for facilities that includes development of standards (regulations) and provision of technical assistance on the development of best practices in order to meet such standards. This new provision significantly expands the level and scope of required QAPI activities to ensure that facilities continuously identify and correct quality deficiencies as well as sustain performance improvement.

Beginning in September 2011, CMS launched a prototype QAPI program in a small number of homes. The demonstration provided us with best practices for helping facilities upgrade their current quality programs. We then combined results from the demonstration with consumer, provider, and stakeholder feedback to establish QAPI tools and resources.

# QAPI is the coordinated application of two mutually-reinforcing aspects of a quality management system: Quality Assurance (QA) and Performance Improvement (PI). QAPI takes a systematic, comprehensive, and data-driven approach to maintaining and improving safety and quality in nursing homes while involving all nursing home caregivers in practical and creative problem solving.

1. QA is the specification of standards for quality of service and outcomes, and a process throughout the organization for assuring that care is maintained at acceptable levels in relation to those standards. QA is on-going, both anticipatory and retrospective in its efforts to identify how the organization is performing, including where and why facility performance is at risk or has failed to meet standards.

2. PI (also called Quality Improvement - QI) is the continuous study and improvement of processes with the intent to better services or outcomes, and prevent or decrease the likelihood of problems, by identifying areas of opportunity and testing new approaches to fix underlying causes of persistent/systemic problems or barriers to improvement. 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.

Five key elements of QAPI are :-

- Design and scope

- Governance and leadership

- Feedback , Data system and Monitoring

- Performance improvement project

- Systematic analysis and systemic action

# Performance improvement plan - A performance improvement plan (PIP), also known as a performance action plan, is a tool to give an employee with performance deficiencies the opportunity to succeed. It may be used to address failures to meet specific job goals.

Some tools that can be used to measure performance improvements are :

Key performance indicators and metrics

Performance appraisal

360degree feedback

Flowcharts

Check sheets

Histograms: Data over a period of time; distribution

Cause-and-effect diagrams (Fishbone; Ishikawa): Used with a team; Get all the knowledge of a team

Pareto charts

Scatter diagrams: Two variables; relationship/correlation/no relationship

Control charts