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Part III Standards for Compliance TRACKING KEY PERFORMANCE

WITH DASHBOARDS A dashboard is “a system to track key performance indicators within an organization. It is meant to be designed so that it is easy to read and quick to under- stand, providing signals of where things are going well and where there are problems to address.” To make sure that milestones are being met and outcome mea- sures reflect whether goals are being met, the dash- board should include short-term indicators (8).

Regular monitoring of data is critical for effective decision-making in any organization. A dashboard is an ideal way to prioritize the most important indicators for a particular organization and encourage regular monitoring of the results related to issues within nutri- tion and dining services.

Dashboards may be simple text documents, data spreadsheets, or sophisticated graphs developed with computer programs. Data results are reported for mul- tiple time periods to show trends over time and include benchmarks or goals to put performance into context. The dining service’s dashboard ideally fits onto one page, showing only a select set of the most important indicators to monitor. Sub-dashboards may then be created so that users can “drill-down” to see more detailed data on a specific issue. Dashboards typically employ a system of visual alerts—such as red-yellow- green stoplight coloring, speedometers, or thermome- ters—that help to draw viewers’ attention to data results indicating an area for concern (8).

Utilization of dashboards can assist the RDN to assess and maintain CMS regulatory compliance and monitor/improve clinical outcomes. Dashboards are a key tool to communicate progress toward goals. When using dashboards, the RDN will be able to align program incentives to dashboard metrics. The RDN will be able to use the quality dashboard and QAPI program to improve nutrition outcomes within the nursing home program.

ADDITIONAL USEFUL WEBSITES/

RESOURCES AND TOOLS CMS-created tools and resources for QAPI can be accessed and downloaded on the CMS QAPI website (https://www.cms.gov/Medicare/Provider-Enrollment- and-Certification/QAPI/nhqapi.html). In addition to developing standards through regulation, CMS also provides technical assistance for facilities to develop best practices for meeting the standards. One of the best practice resources is the National Nursing Home

Quality Care Collaborative Change Package. The Change Package provides successful strategies, con- cepts, and action steps collected from high-performing facilities in five states.

One of the tools on the CMS QAPI website is the

Process Tool Framework. This tool lists the five QAPI elements (the building blocks of QAPI) and the tools and resources that align with each in one document. These elements are explained under “QAPI at a Glance” on the CMS QAPI website (https://www.cms. gov/Medicare/Provider-Enrollment-and-Certification/ QAPI/nhqapi.html). Since QAPI implementation includes all staff, copies of this guidebook can be placed in common and community areas throughout the facility. The guidebook breaks QAPI into 12 action steps. Every step involves continuing education, team- work, and using data to identify gaps and opportunities.

Quality improvement organizations (QIOs) are another free resource for technical assistance. Don’t wait for the final regulation implementing QAPI or until you are actively working on process improve- ments. A best practice that is already a stated standard is ongoing data-driven process improvement. Nursing homes (NHs) can contact their state’s QIO for assis- tance. Along with QIOs, literature review, and evidenced-based tools and resources, the Change Package is intended to provide technical assistance for implementing the best practices to meet the QAPI reg- ulation when it is issued.

Resources for Assistance with Quality Assurance and

Performance Improvement CMS provides a list of the following QAPI resources on their website (https://www.cms.gov/Medicare/ Provider-Enrollment-and-Certification/QAPI/qapire-

sources.html) (9): ●

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Advancing Excellence in America’s Nursing Homes

Supported by CMS, the Commonwealth Fund, and others, the Advancing Excellence Cam- paign provides tools and resources to improve nursing home care in clinical and organiza- tional areas (www.nhqualitycampaign .org/).

● Agency for Healthcare Research and Quality ➤➤

The Department of Defense and the Agency for Healthcare Research and Quality devel- oped the TeamSTEPPS program to optimize performance among teams of health care professionals and improve collaboration and communication. The Long-Term Care version addresses issues specific to nursing homes (www.ahrq.gov/professionals/