QAPI- Part 2Learning 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

2

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

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

• Incident reports

• Infection reports

• Satisfaction surveys

• Billing Records

• Human resources files

• Financial Reports

• Volunteer Records4

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

6

Using the Data - Actionable Reporting

• Graphs or tables

• Track and trend over time

• Relative to a benchmark or target

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 suggestions7

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

10

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

11

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

Pt.-level example: Symptom Management

6

43 3

0123456789

10

Admit Day 3 Firstweek

Lastweek

Patient Goal: 3

• 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 3/3/08 3/6/08

Anxiety Moderate Mild Mild

Dyspnea Mild None Mild

QAPI Part 1

Percentage of patients uncomfortable on admission who were more comfortable within 2 days

(Labels indicate # patients included)

30283235

0%

20%

40%

60%

80%

100%

1Q2007 2Q2007 3Q2007 4Q2007

% o

f p

atie

nts

u

nco

mfo

rtab

le o

n

adm

issi

on

National Average 82%

QAPI Part 1

Hospice-level example: Aggregated clinical data

85.679.5

72.268.1

20.415.6

21.2

32.5

0

10

2030

40

50

60

7080

90

100

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

%Reviewscompleted ontime (target 95%)

%Employeeturnover (target20% max)

QAPI Part 1

Hospice-level example: Non-clinical operations