QAPI
“Quality Assurance Performance
Improvement for Nursing Homes”
LeadingAge Wyoming
Spring Conference
May 23, 2013
What Do You Want to Learn Today?
Today’s Objectives
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Provide the regulatory mandate information
Describe the elements of QAPI
Highlight QAPI-At-A-Glance
Discuss tools and resources that support QAPI
Where are we today with QAPI evolution?
Why Quality Care Focus?
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The government demands it!
Acute care providers demand it!
5-STAR Ratings demand it!
Families demand it!
Your success depends on it!
Residents deserve it!
What is QAPI?
SEC. 6102. Accountable Care Act (March 2010)
 ACCOUNTABILITY REQUIREMENTS FOR SKILLED
NURSING FACILITIES AND NURSING FACILITIES
 Nursing Home QAPI is required
 Legislation requires CMS to establish QAPI
program standards and provide technical
assistance to nursing homes
 Identify training needs for LTC surveyors
 Demonstration project to create a model QAPI
Plan
The BIG Picture
The ultimate goal is to
provide personcentered care – to
focus on the person
living in the nursing
home
The BIG Picture
• Quality Assurance and Performance
Improvement (QAPI) does not refer to a
program; rather, this is the way we should do
our work
• The ability to think, make decisions and take
action at the system level is required for
sustainable QAPI success
QA + PI = QAPI
• Comprehensive approach to ensuring high quality
care
• Data-driven, proactive approach to improve the
quality of life, care and services in nursing homes
• Involves members at all levels of the organization to:
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I.D. opportunities for improvement
Address gaps in systems or processes
Develop and implement improvement or corrective plan
Continuously monitor effectiveness of interventions
Five QAPI Plan Framing Elements
Systematic Analysis and
Systemic Action
Performance
Improvement Projects
Design and Scope
Feedback, Data Systems and
Monitoring
Governance and Leadership
Quality of Care. Quality of Life. Resident Choice.
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Design and Scope
Characteristics of how QAPI is designed and the
scope of what it includes:
 Ongoing and comprehensive program across the full range
of services and departments
 Addresses clinical care, quality of life, resident
choice, and care transitions
 Aims for safety and high quality clinical
interventions while emphasizing choice
 Utilizes best available evidence
 Written plan
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Governance & Leadership
Leadership actively engaged with setting
expectations and priorities, including:
Systematic approach to gather input from staff,
residents, family, stakeholders
Adequate resources-time, money, other
Ongoing and consistent staff training
Accountability for process and results
Balance culture of safety and rights
Non-punitive culture
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Feedback, Data System,
and Monitoring
Systems to monitor a wide range of care and
service, drawing from multiple sources:
Data from staff, residents, stakeholders, others
Use of goals, thresholds, and benchmarks
Ability to analyze, interpret, and translate data
into meaningful and actionable information
Using data to systematically prioritize and select
performance improvement projects (PIPS)
appropriate for the nursing home
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Performance Improvement
Projects
Conduct Performance Improvement Projects
(PIPs) to improve care or services in areas
relevant to your residents:
 Gather information systematically to clarify
issues and identify opportunities
Test and implement changes
Use data to determine whether goals were
accomplished
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Systematic Analysis &
Systematic Action
Create real impact and long-lasting improvement as
the result of QAPI through:
Take into consideration all aspects of the organization
when making changes
Address variations in practice and causes of errors at
the system level instead of at the individual level
Link outcomes of QAPI efforts to policies and
procedures, staff orientation and ongoing education,
performance expectations, strategic planning
What did the Demonstration Project
Teach us?
 Value of having tools to help guide and teach
systems thinking
Offers framework and structure
Helps critical steps from being skipped
 QAPI is not a magic wand
The impact comes in the implementation
 QAPI needs a strong champion(s) but it cannot be
one person’s job
Leadership sets the tone and provides resources
The work is done by a variety of teams
Where do Nursing Homes Begin?
• QAPI Tools and Resources
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QAPI-At-A-Glance
QAPI Facility Self-Assessment
Define facility guiding principles and scope
Development of a QAPI plan
Learn how to create/develop PIPs
• Alignment with state and national initiatives
– 10SOW & National Nursing Home Quality Care
Collaborative
– Advancing Excellence In America’s Nursing Homes
Campaign
– Partnership for Dementia Care
QAPI-At-A-Glance = Step by Step Guide
QAPI Self-Assessment
QAPI Plan Outline
Goal Setting Worksheet
QAPI Resources
• CMS link for QAPI
– Website: http://cms.gov/Medicare/ProviderEnrollment-andCertification/SurveyCertificationGenInfo/QAPI.ht
ml (Just Google: nursing home QAPI)
– Mountain Pacific Quality Health
• Pat Fritz, Nursing Home Project Manager
– 307-568-2797
– pfritz@wyqio.sdps.org
National Nursing Home Quality Care
Collaborative Teams from Wyoming
• Star Valley Care Center
• Bonnie Bluejacket Memorial
Nursing Home
• Poplar Living Center
• Shepherd of the Valley Care
Center
• CRMC-TCU
• Kindred Healthcare-Cheyenne
• Kindred Healthcare-Rawlins
• Kindred Healthcare-Wind River
• Douglas Care Center
• Rocky Mountain Care-Evanston
• Pioneer Manor
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St. John’s Nursing Home
South Lincoln Nursing Center
Westward Heights Care Center
Ivinson Hospital-ECU
Laramie Care Center
New Horizon’s Care Center
Weston County Health Services
Deseret Healthcare of Saratoga
Goshen Care Center
Platte County Memorial Nursing
Home
• Worland Healthcare
• Castle Rock Convalescent Center
Questions?
Thank You!
This material was prepared by Mountain-Pacific Quality Health, the Medicare
Quality Improvement Organization for Montana, Wyoming, Hawaii and Alaska,
under contract with the Centers for Medicare & Medicaid Services (CMS), an
agency for the U.S. Department of Health and Human Services. The contents
presented do not necessarily reflect CMS policy.
10SOW-MPHQHF-WY-IPC-13-37