Quality Assessment Performance Improvement Learning Objectives

1
Quality Assessment Performance ImprovementLearnin
g Objectives

• Define Quality Assessment Performance
  Improvement (QAPI)
• State the goal of QAPI
• Describe the key components of a hospice QAPI
  program

2
QAPI Regulation - 2008

• Patient-focused and outcome oriented
• Goal is to monitor quality/performance, find
  opportunities for improvement, and improve
• Focus is on achieving patient/family desired
  outcomes
• Explicitly related to other regulations

3
Desired Outcomes in Hospice vs. Other Healthcare
Setting

• Hospice
• Comfortable dying
• Safe dying
• Self-determined life closure
• Effective grieving

• Other healthcare settings
• Cure of illness
• Improved functionality (including ADLs)

4
QAPI regulation

• Condition of Participation (CoP)
• 42 CFR 418.58
• Five standards
• Program scope
• Program data
• Program activities
• Performance improvement activities
• Executive responsibilities

5
Other CoPs that integrate QAPI
6
The QAPI CoP says

• The hospice must develop, implement, and maintain
  an effective, ongoing, hospice-wide, data-driven
  QAPI program.
• The hospices governing body must ensure that the
  program
• reflects the complexity of its organization and
  services
• involves all hospice services (including those
  services furnished under contract or
  arrangement)
• focuses on indicators related to palliative
  outcomes and
• takes actions to demonstrate improvement in
  hospice performance.
• The hospice must maintain documentary evidence of
  its QAPI program and be able to demonstrate its
  operation to CMS.

7
Standard (a) Program Scope

• The program must at least be capable of showing
  measurable improvement in indicators related to
  improved palliative outcomes and hospice
  services.
• The hospice must measure, analyze, and track
  quality indicators, including adverse patient
  events, and other aspects of performance that
  enable the hospice to assess processes of care,
  hospice services, and operations

8
Standard (b) Program Data

• The program must use quality indicator data,
  including patient care, and other relevant data,
  in the design of its program.
• The hospice must use the data to do the
  following
• Monitor the effectiveness and safety of services
  and quality of care.
• Identify opportunities and priorities for
  improvement.
• The frequency and detail of the data collection
  must be approved by the hospices governing body

9
Standard (c) Program Activities

• The hospices performance improvement activities
  must
• Focus on high risk, high volume, or problem-prone
  areas.
• Consider incidence, prevalence and severity of
  problems in those areas.
• Affect palliative outcomes, patient safety, and
  quality of care
• Performance improvement activities must track
  adverse patient events, analyze their causes, and
  implement preventive actions and mechanisms that
  include feedback and learning throughout the
  hospice.
• The hospice must take actions aimed at
  performance improvement and. After implementing
  these actions, the hospice must measure its
  success and track performance to ensure that
  improvements are sustained.

10
Standard (d) Performance Improvement Projects

• Beginning February 2, 2009, hospices must
  develop, implement and
• evaluate performance improvement projects.
• The number and scope of distinct performance
  improvement projects conducted annually, based on
  the needs of the hospices population and
  internal organizational needs, must reflect the
  scope, complexity, and past performance of the
  hospices services and operations.
• The hospice must document what performance
  improvement projects are being conducted, the
  reasons for conducting these projects, and the
  measureable progress achieved on these projects.

11
Standard (e) Executive Responsibilities

• The hospices governing body is responsible for
  ensuring the following.
• That an ongoing program for quality improvement
  and patient safety is defined, implemented and
  maintained, and is evaluated annually.
• That the hospice-wide quality assessment and
  performance improvement efforts address
  priorities for improved quality of care and
  patient safety, and that all improvement actions
  are evaluated for effectiveness.
• That one or more individual(s) who are
  responsible for operating the quality assessment
  and performance improvement program are
  designated

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QAPI Functions
13
Patient-level QAPI

• Collect data on patient status and outcomes
• Assessment/reassessment (418.54)
• Care plan (418.56)
• Use the data to measure and improve quality of
  care and outcomes for that patient (418.56)

14
Patient levelThe Cycle of Care
15
Hospice-level QAPI

• 418.58 (a) Program Scope
• The hospice must measure, analyze, and track
  quality indicators, including adverse patient
  events and other aspects of performance that
  enable the hospice to assess processes of care,
  hospice services and operations.
• 418.54 (e) Patient outcome measures
• Assessment must Include data elements to be used
  for outcome measurement
• Data must be used in the aggregate for the
  hospices QAPI program

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Hospice-level QAPI