QAPI combines both traditional measures for improvement: Quality Assurance and Performance Improvement.  CMS has developed a general framework for implementing this enhanced quality improvement program in long term care, referred to as “the five key elements.”

Element 1: Design and Scope –the program must be ongoing and comprehensive, addressing all systems of care (clinical care, quality of life and resident choice), management practices/departments.

Element 2: Governance and Leadership – the nursing home is expected to develop a culture of leadership seeking input from all staff members, residents and their families. Provide appropriate training on the QAPI process as well as sufficient time/tools to meet expectations of the process.

Element 3: Feedback, Data Systems and Monitoring – the nursing home is expected to put systems in place to monitor care/services and collect data.

Element 4: Performance Improvement Projects – When areas of improvement are identified through element number 4, the nursing home will make a concentrated effort to clarify issues or problems and develop a plan to improve care and services.

Element 5: Systematic Analysis and Systemic Action – the facility team will use a data based approach to identify root causes of problems to enable them to make comprehensive changes in the delivery of services to enhance quality of life and care of their residents.

The therapy team is key player in the QAPI process, often able to address clinical problems early and prevent functional declines that can have a negative impact on quality of life of the residents in the nursing home.


Cherie Rowell

Corporate Quality Liaison