Quality Assurance and Performance Improvement (QAPI)

Quality care is the heart of what we do, and QAPI is the road to get there! You may be thinking that is easier said than done. The resources below have been gathered to assist you in achieving your facility goals for quality care outcomes. Need another reason to better understand QAPI? As value-based payment becomes a reality, facilities are required to demonstrate the quality of care to consumers and payers, continuously improving efficiency and resident outcomes. Learn how you can get ahead of the game with helpful resources.

  • SNF QRP Measure Calculations and Reporting User's Manual Update (9/18)

    By CMS - September 14, 2018

    This manual presents methods used to calculate quality measures that are included in the Centers for Medicare & Medicaid Services (CMS) Skilled Nursing Facility (SNF) Quality Reporting Program (QRP). This manual provides detailed information for each quality measure (QM), including quality measure definitions, inclusion and exclusion criteria and measure calculation specifications.

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  • Antibiotic Stewardship: Fluoroquinolones and Black Box Warning Update (9/18)

    By CDC - September 06, 2018

    The U.S. Food and Drug Administration (FDA) Recently Strengthened its Black Box Warning About Fluoroquinolone Use

    Appropriate fluoroquinolone prescribing is important for patient safety. A recent study published in Clinical Infectious Diseases reports that fluoroquinolones are commonly prescribed for conditions when antibiotics are not needed at all, or when fluoroquinolones are not the recommended first-line therapy.

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  • Sept. 18 Opioid Dementia Care Call: Register Now

    By CMS - August 20, 2018

    During this call, gain insight on opioid use in the post-acute and long-term care setting. Also, learn about the impact of opioid use on persons living with dementia. Additionally, CMS shares updates on the progress of the National Partnership to Improve Dementia Care in Nursing Homes. A question and answer session follows the presentations.


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  • LTCSP Initial Pool Care Areas UPDATED (8/18)

    By CMS - August 06, 2018
    This includes four documents, one each for: record review, resident interview, resident observations, and resident representative interview. They walk through what the surveyors investigate/ask related to each care area during the initial pool to help determine which residents they will choose for in-depth investigations in the final sample. In other words, these screening tools trigger surveyors to either investigate further or not investigate further.
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  • Nursing Home Compare Claims-based Measures Technical Specifications Updated (8/18)

    By CMS - August 02, 2018
    This update contains the specifications for the Number of Hospitalizations per 1,000 Long-Stay Resident Days measure, including details on the numerator and denominator for the measure, exclusions, and the measure calculation methodology. The technical specifications will be updated with details on the risk-adjustment model prior to this measure being posted on Nursing Home Compare in October 2018. This update adds MDS variables to the risk-adjustment models of the short-stay, claims-based quality measure and updates the coefficients for each variable, based on data from October 1, 2016 to September 30, 2017.
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  • Five Star Technical User's Guide UPDATED (7/18)

    By CMS - July 25, 2018

    CMS created the Five-Star (5 Star) Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily. The Five-Star Quality Rating System Technical Users' Guide provides in-depth descriptions of the ratings and the methods used to calculate them. Updated July 2018.

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  • IMPACT Act QM Development: Transfer of Medication Profile TEP Report (7/18)

    By CMS - July 09, 2018

    TEP Summary Report Available: Development of Quality Measures for the Transfer of Health Information and Care Preferences Domain - Transfer of Medication Profile

    The technical expert panel (TEP) Meeting 4 summary report for the Development of Measures under the Transfer of Health Information and Care Preferences domain is now available. This report summarizes proceedings from a follow-up cross-setting TEP meeting, which included in-depth discussion and input on the following topics:

    ·         Revisions to the measure concept and measure specifications since the TEP last met

    ·         The draft cross-setting Transfer of Medication Profile measures for Skilled Nursing Facilities, Inpatient Rehabilitation Facilities, Long-Term Care Hospitals, and Home Health Agencies

    ·         The items used to calculate the quality measure

    ·         Importance and feasibility of Information to be included in the medication profile to meet the measure criteria

    ·         Items collecting routes of transfer of the medication profile

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  • Free AHRQ Antibiotic Stewardship Training: Is It Right for Your Facility?

    By AHRQ - June 27, 2018
    The AHRQ Safety Program for Improving Antibiotic Use: A National Program for Antibiotic Stewardship: 

    The Agency for Healthcare Research and Quality (AHRQ), in conjunction with the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality and NORC at The University of Chicago, created the AHRQ Safety Program for Improving Antibiotic Use to develop and implement a bundle of interventions designed to improve antibiotic stewardship and antibiotic prescribing practices across acute care, long-term care, and ambulatory care facilities across the United States.


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  • Nursing Home Compare & PBJ Updates: Long-stay Resident Hospitalization Rate to Be Added to NHC / Five Star; Non-Nursing Staff for PBJ to Be Posted; Health Inspection Freeze to End (6/18)

    By CMS - June 22, 2018
    • In October 2018, the long-stay hospitalization measure will be posted on the Nursing Home Compare website as a long-stay quality measure. In the spring of 2019, this quality measure will be included in the Five Star Quality Rating System.  Additionally, in July 2018 we will update the other claims-based quality measures reported on the Nursing Home Compare website.
    • To increase transparency, CMS will begin posting the number of hours worked by other staff (i.e., non-nursing) in July 2018. Facilities are required to submit hours for all other staff as listed in Table 1 of the PBJ Policy Manual. We will also distinguish between hours submitted for direct employees and contract staff. 
    • In October 2019, CMS will resume posting the average number of citations per inspection for each state and nationally. CMS is monitoring outcomes of the new inspection process and plans to resume health inspection rating calculations (i.e., end the freeze) in the spring of 2019. CMS will communicate more details about this prior to its implementation.



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  • Q4 2017 Antipsychotic Medication Use Data Report From CMS (6/18)

    By CMS - June 06, 2018

    National Partnership to Improve Dementia Care in Nursing Homes: Antipsychotic Medication Use Data Report

    In 2011Q4, 23.9 percent of long-stay nursing home residents were receiving an antipsychotic medication; since then there has been a decrease of 36.6 percent to a national prevalence of 15.1 percent in 2017Q4. Success has varied by state and CMS region, with some states and regions having seen a reduction of greater than 40 percent.


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  • Study: 3+ Daily Doses of Central Nervous System Meds Impact Fall Risk (6/18)

    By AHRQ/PubMed - June 03, 2018

    Central nervous system medication burden and serious falls in older nursing home residents. Hanlon JT, Zhao X, Naples JG, et al. J Am Geriatr Soc. 2017 Jun;65(6):1183-9. Epub 2017 Feb 2. 

    CNS medication burden, approximately 3 + standardized daily doses, was associated with an increased risk of serious falls in nursing home residents with recent fall. Clinicians should be vigilant for opportunities to discontinue or decrease the doses of individual CNS medications and/or consider non-pharmacological alternatives. Such interventions that reduce use of CNS medications in nursing homes could reduce fall rates but further research is needed to confirm this.

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  • Hourly Rounding: Why It Should Be Part of Your QAPI Process

    By Linda Shell, DNP, MA, RN, DNS-CT - May 22, 2018

    Clinical staff are incredibly busy completing the tasks that are expected of them every day. It seems there is never enough time to get everything done. As the demand for high-quality care continues to rise, nurse leaders will need to look to the research to identify evidence-based approaches to improving clinical outcomes, increasing customer satisfaction, and maximizing staff efficiency. These best practices are often generated in acute care settings but can be used in long-term care with great success.

    One evidence-based approach that offers value for long-term care settings is hourly rounding. Hourly rounding is the process of ensuring that a resident is checked each hour by a member of staff to ensure he or she is safe, well positioned, and needs are met. Since the first study on hourly rounding was done, the practice has been implemented in numerous clinical settings, including long-term care, in the new-admission process and in programs for preventing falls, reducing call light use, and monitoring residents with changes in condition.

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  • Survey Comparative Data Resources - Updated (5/18)

    By CMS - May 07, 2018

    CMS has updated two resources with survey comparative data: QCOR and the Full Text of Statements of Deficiencies file.

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  • PBJ Public Use Files: 3Q 17 Data Available (4/18)

    By CMS - April 23, 2018
    CMS releases quarterly Payroll-Based Journal (PBJ) public-use files that currently include nursing hours and resident census data for every nursing home in the United States. 
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  • Perspectives of Clinicians at SNFs on 30-Day Hospital Readmissions: A Qualitative Study (4/18)

    By PubMed - April 09, 2018
    Unplanned 30-day hospital readmissions are an important measure of hospital quality and a focus of national regulations. Skilled nursing facilities (SNFs) play an important role in the readmission process, but few studies have examined the factors that contribute to readmissions from SNFs, leaving hospitalists and other hospital-based clinicians with limited evidence on how to reduce SNF readmissions. We interviewed 28 clinicians at 15 SNFs. The interviews covered 24 patient readmissions. SNF clinicians described a range of procedural, technological, and cultural contributors to unplanned readmissions. Commonly cited causes of readmission included a lack of coordination between emergency departments and SNFs, poorly defined goals of care at the time of hospital discharge, acute illness at the time of hospital discharge, limited information sharing between a SNF and hospital, and SNF process and cultural factors.SNF clinicians identified a broad range of factors that contribute to readmissions. Addressing these factors may mitigate patients' risk of readmission from SNFs to acute care hospitals.
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