QAPI- Part 2
Learning Objectives
• List key hospice QAPI activities
• Describe elements of a good tracking and
trending report
• Identify the critical components of a
performance improvement project
QAPI Part 1
QAPI Activities
• Quality Assessment
– Collect quality data across both clinical and
non-clinical operational areas
– Use data to track quality measures over time
– Monitor of quality indicators at regular intervals
• Performance Improvement
– Use industry benchmarks and/or internal targets (and
patient-identified goals at the patient-level) to identify
opportunties to improve
– Take action when performance falls below target for two
periods or more
– Implement performance improvement projects as needed
2
Selecting Measures
• Have a plan or framework for quality
measurement
– Clinical quality
– Non-clinical operations
• Have a rationale for each measure
– Why are you tracking?
– What will you do with the information?
• Consider using industry-vetted measures
QAPI Part 1
Hospice Data Sources for QAPI
• Patient charts
• Billing Records
• Incident reports
• Human resources
files
• Infection reports
• Financial Reports
• Satisfaction surveys
• Volunteer Records
4
Important Points About
Data Collection
• Incorporate data collection for QAPI into existing
processes and procedures
– Example: Patient elements incorporated into assessments
and/or care plan
• SYSTEMATIC: Collect the same way every time
– Process measures are a good way to start
• Frequency of data collection
– Approved by governing body
– Based on timeframe that indicator is expected to change
5
Using the Data - Actionable Reporting
• Graphs or tables
• Track and trend over time
• Relative to a benchmark or target
6
Identify Opportunities for Improvement
When to take action
• Quality assessment indicates a “gap” between
actual and desired performance
• Survey deficiencies
• Management want to improve
• Staff suggestions
7
What action to take
• Individual patient
– Change interventions
– Revisit goal
– Continue to monitor
• Hospice-level
– Investigate causes
– Consider a Performance Improvement Project (PIP)
– Assure that improvement is sustained
8
PIP Overview
• Conducted by a team
– Include all relevant disciplines
– Different people for each project
• Designed to:
– Investigate the reasons for the current level of
performance
– Determine the best way to improve performance
– Measure improvements and assure they are sustained
9
Performance Improvement Projects
• Appoint a PIP team
• Investigate causes of current outcomes or
performance
• Develop and implement plan for improvement
– Pilot testing with small # of cases or limited time
• Document the project activities and results
10
Abbreviated PIP – How they work
• Smaller team
• Review literature or best practice information
• Write a plan for improving performance
• Implement the plan
• Monitor results for one month (or two)
• “Tweak” the process if necessary and continue to
monitor
11
Pt.-level example: Symptom Management
• Collect symptom severity
data on each assessment
• Collect patient goal
• Monitor severity over
time and relative to the
goal
• Adjust interventions to
reach goal and/or assist
patient in refining the
goal
Symptom
3/2/08
3/3/0
8
3/6/08
Anxiety
Moderate
Mild
Mild
Dyspnea
Mild
None
Mild
10
9
8
7
6
5
4
3
2
1
0
6
4
3
Admit
QAPI Part 1
Patient
Goal: 3
Day 3
First
week
3
Last
week
Hospice-level example:
Aggregated clinical data
% of patients
uncomfortable on
admission
Percentage of patients uncomfortable on admission
who were more comfortable within 2 days
(Labels indicate # patients included)
National Average 82%
100%
80%
60%
35
30
40%
20%
0%
1Q2007
QAPI Part 1
32
28
2Q2007
3Q2007
4Q2007
Hospice-level example:
Non-clinical operations
100
90
80
70
60
50
40
30
20
10
0
85.6
79.5
72.2
68.1
32.5
20.4
1st Qtr
QAPI Part 1
15.6
2nd Qtr
21.2
3rd Qtr
4th Qtr
%Reviews
completed on
time (target 95%)
%Employee
turnover (target
20% max)