Chapter 22 Quality Assurance and Performance Improvement

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TABLE 22.1 Comparison Between Quality Assurance and Performance Improvement Quality Assurance

Motivation Means

Attitude Focus

Scope Responsibility

Measuring compliance with standards

Inspection Required, reactive

Outliers: “bad apples” Individuals

Medical provider Few

QA + PI = QAPI

Source: Centers for Medicare & Medicaid Services, US Department of Health and Human Services, Health Resources and Services Ad- ministration. QAPI at a glance. www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/Downloads/ QAPIAtaGlance.pdf. Accessed September 10, 2015.

establishing and maintaining the QAPI process. The following describes the framework of QAPI: ●

is an ongoing process; ● adds PI to QA;

●

goal is improvement of the quality care of the resident;

●

continuously challenges a facility to raise the level of performance;

●

intended for use by all employees (staff, adminis- tration, residents, families);

● ● encourages education and training of staff;

provides for clear messaging to surveyors as to what changes have been made because of QAPI in the last year by all employees;

●

helps ensure that all employees are aware of changes made and if goals were met;

●

encourages good management and critical and innovative thinking;

●

provides a format for how to review and evaluate systems (eg, root cause analysis); and

●

provides resources such as tools but requires each facility to develop their own processes.

As the nutrition expert, the RDN is uniquely quali- fied to ensure that resident quality of care and quality of life related to nutrition, food, and dining is a primary focus for the facility. Health care facilities and

regulations emphasize customer satisfaction, positive clinical outcomes, and overall cost- efficiencies. Recent health care reform has been the catalyst in transforming quality into an identifiable, measurable, and continual improvement entity. With all this in mind, QAPI pro- vides a long-term proactive strategy to improve care and satisfaction, increase utilization, strengthen produc- tivity, and enhance cost-effectiveness throughout the organization (1).

BACKGROUND OF QUALITY ASSURANCE AND PERFORMANCE

IMPROVEMENT QAPI was mandated within the ACA, passed in 2010. Box 22.2 (see page 328) gives the timeline for QAPI development. In June 2013, CMS announced the release of materials for use by nursing facilities in establishing the basis to support and sustain QAPI. This was the first step in meeting the ACA requirement for CMS to develop a technical assistance program to help nursing homes establish best practices in quality. The CMS website for QAPI (http://go.cms.gov/ Nhqapi) has tools, resources, and training materials available for nursing home providers, residents, resi- dents’ families, and advocates for increasing nursing home quality (2).

The existing Quality Assessment and Assurance (QAA) provision from the Code of Federal Regulations

Performance Improvement

Continuously improving processes to meet standards

Prevention

Chosen, proactive Processes or systems

Resident care All