1. QAPI “Quality Assurance Performance Improvement for Nursing Homes” LeadingAge Wyoming Spring Conference May 23, 2013

2. What Do You Want to Learn Today?

3. Today’s Objectives 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?

4. Why Quality Care Focus? 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!

5. 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

6. The BIG Picture The ultimate goal is to provide person- centered care – to focus on the person living in the nursing home

7. 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

8. 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:  I.D. opportunities for improvement  Address gaps in systems or processes  Develop and implement improvement or corrective plan  Continuously monitor effectiveness of interventions QA + PI = QAPI

9. Five QAPI Plan Framing Elements Governance and Leadership Quality of Care. Quality of Life. Resident Choice. Systematic Analysis and Systemic Action Feedback, Data Systems and Monitoring Performance Improvement Projects Design and Scope

10. 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 1

11. 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 2

12. 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 3

13. 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 4

14. 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 5

15. 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

16. Where do Nursing Homes Begin? QAPI Tools and Resources – 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

17. QAPI-At-A-Glance = Step by Step Guide

18. QAPI Self-Assessment

19. QAPI Plan Outline

20. Goal Setting Worksheet

21. QAPI Resources CMS link for QAPI – Website: http://cms.gov/Medicare/Provider- Enrollment-and- Certification/SurveyCertificationGenInfo/QAPI.ht ml (Just Google: nursing home QAPI)http://cms.gov/Medicare/Provider- Enrollment-and- Certification/SurveyCertificationGenInfo/QAPI.ht ml – Mountain Pacific Quality Health Pat Fritz, Nursing Home Project Manager – 307-568-2797 – pfritz@wyqio.sdps.org pfritz@wyqio.sdps.org

23. 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 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

24. Thank You! Questions? 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