Over the past several months, I have written several articles about QAPI—Well, after much anticipation, CMS has finally announced the rollout of Quality Assurance and Performance Improvement (QAPI) materials to help nursing homes establish a foundation to support and sustain QAPI. This is the first step in meeting the Patient Protection and Affordable Care Act requirement for CMS to develop a technical assistance program to help nursing homes establish best practices in quality.

In a Survey and Certification Letter dated June 7, 2013 ( Ref: S&C: 13-37-NH),  CMS announced the rollout of introductory materials to help nursing homes establish a foundation to implement and sustain QAPI. These materials are now available to the public through the CMS QAPI website:  http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/qapidefinition.html

Available QAPI Tools include:

  1. QAPI Self-Assessment Tool – Use this tool as you begin work on QAPI, and then for annual or semiannual evaluation of your organization’s progress.  This tool should be completed with input from the entire QAPI team and organizational leadership.  This is meant to be an honest reflection of your progress with QAPI.  The results of this assessment will direct you to areas you need to work on in order to establish QAPI in your organization.  You may find it helpful to add notes under each item as to why you rated yourself a certain way.
  2. Guide for Developing Purpose, Guiding Principles, and Scope for QAPI – Use this tool to establish the purpose, guiding principles and scope for QAPI in your organization.  The team completing this worksheet should include senior leadership.  Taking time to articulate the purpose, develop guiding principles, and define the scope will help you to understand how QAPI will be used and integrated into your organization.  This information will also help your organization to develop a written QAPI plan.  Use these step-by-step instructions to create a separate document that may be used as a preamble to your QAPI plan.
  3. Guide for Developing a QAPI Plan – The QAPI plan will guide your organization’s performance improvement efforts.  Prior to developing your plan, complete the Guide for Developing Purpose, Guiding Principles, and Scope for QAPI.  Your QAPI plan is intended to assist you in achieving what you have identified as the purpose, guiding principles and scope for QAPI, therefore, this information is needed before you begin working on your plan.  This is a living document that you will continue to refine and revisit.  This plan should reflect input from caregivers representing all roles and disciplines within your organization.  Use these step-by-step directions to create your QAPI plan.
  4.  Goal Setting Worksheet – Goal setting is important for any measurement related to performance improvement. This worksheet is intended to help QAPI teams establish appropriate goals for individual measures and also for performance improvement projects. Goals should be clearly stated and describe what the organization or team intends to accomplish. Organizations may use this worksheet to establish goals by following the SMART formula.

Available QAPI Resources include:

  1. QAPI at a Glance– QAPI will take many nursing homes into a new realm in quality—a systematic, comprehensive, data-driven, proactive approach to performance management and improvement. This guide provides detailed information about the “nuts and bolts” of QAPI. We hope that QAPI at a Glance conveys a true sense of QAPI’s exciting possibilities. Your QAPI results are generated from your own experiences, priority-setting, and team spirit.
  2. Quality Improvement Organizations
    Each state is served by a Quality Improvement Organization that offers resources and tools for nursing homes.
  3. Advancing Excellence in America’s Nursing Homes
    Supported by CMS, the Commonwealth Fund, and others, The Advancing Excellence Campaign provides tools and resources to improve nursing home care in clinical and organizational areas.
  4. Agency for Healthcare Research and Quality
    The Department of Defense and the Agency for Healthcare Research and Quality developed the TeamSTEPPS program to optimize performance among teams of healthcare professionals and improve collaboration and communication.  The Long-Term Care version addresses issues specific to nursing homes.
  5.  Department of Veterans Affairs
    The National Center for Patient Safety supports and leads the patient safety activities for all VA medical centers and has developed tools including Root Cause Analysis investigations.
  6. Getting Better All the Time: Working Together for Continuous Improvement
    The Isabella Geriatric Center and Cobble Hill Health Center have developed a web manual on quality improvement approaches as a guide for nursing home caregivers. This is a particularly practical and lively resource that explains and illustrates performance monitoring and improvement approaches in ways that are understandable to most nursing home caregivers. Getting Better All the Time was written by Ann Wyatt, a social worker and nursing home administrator; it aims to present a model of quality improvement that integrates quality of care and quality life.
  7.  Implementing Change in Long-Term Care: A Practical Guide to Transformation
    This resource was prepared by Barbara Bowers and others with a grant from the Commonwealth Fund to the Pioneer Network. Although it deals with implementing culture change (not QAPI), it is a good resource on the change process.
  8.  Interact II
    An example of a more extensive set of tools, INTERACT II is a system of tools to improve how nursing home caregivers communicate around change in resident condition. This comprehensive set of tools could be considered a QAPI process toolkit as well.
  9.  Model for Improvement
    The Institute for Health Care Improvement uses the Model for Improvement as the framework to guide improvement work. This model, developed by Associates in Process Improvement, is a simple, yet powerful tool for accelerating improvement. Learn about the fundamentals of the Model for Improvement and testing changes on a small scale using Plan-Do-Study-Act (PDSA).
  10.  Picker Institute Publications
    These publications include a Long-Term Care Improvement Guide, commissioned in 2010 and a Patient-Centered Care Improvement Guide, commissioned in 2008, both by Susan Frampton and others. The website also carries information on current books related to person centered care that the Picker Institute recommends.

CMS is currently drafting QAPI regulation and facilities will be required to submit QAPI plans to CMS one year from promulgation of the final rule.  Please watch for future entries on these initiatives.