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.

  • CMS Will Conduct Focused Dementia Care and Focused Schizophrenia Surveys in FY 2019

    By CMS - October 25, 2018
    Focused Dementia Care Surveys: FY2019, CMS plans to have federal contract surveyors conduct additional focused dementia care surveys in some states. Due to concerns about facilities using an inappropriate process to diagnose residents with schizophrenia, we also expect to conduct a limited number of surveys focused on this issue.
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  • Free AHRQ Antibiotic Stewardship Training: Is It Right for Your Facility?

    By AHRQ - October 24, 2018

    While F881 (antibiotic stewardship program) citations remain low overall compared to other citations nationwide, as of Oct. 15, 2018, QCOR data, F881 is now the 10th most-cited new F-tag with a severity level of F or above. -Staff

    Register now to attend a one-hour webinar that explains how long-term care facilities can run an effective antibiotic stewardship program by joining a free, 12-month national project. Beginning in December, the AHRQ Safety Program for Improving Antibiotic Use will provide participating long-term care facilities with antibiotic use guidelines, expert coaching, online education, improvement tools and patient education materials to help prevent harms associated with antibiotics, such as Clostridium difficile. Participants also have the opportunity to earn continuing education credits. 


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  • CASPER Reporting User’s Guide for MDS Providers UPDATED (10/18)

    By QTSO - October 01, 2018
    Provides information and instructions pertaining to CASPER Reporting, including accessing Final Validation Reports.
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  • Nursing Home Staff Influenza Vaccinations Still Lag Behind Other Settings (9/18)

    By CDC - September 28, 2018

    Health care personnel working in long-term care settings, the majority of whom work as assistants or aides, have lower influenza vaccination coverage than do health care personnel working in all other health care settings, which puts the elderly in long-term settings at increased risk for severe complications for influenza. Implementing workplace strategies shown to improve vaccination coverage among health care personnel, including vaccination requirements and active promotion of on-site vaccinations at no cost, can help ensure health care personnel and patients are protected against influenza. 


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  • Nursing Home Compare Claims-based Measures Technical Specifications Updated (9/18)

    By CMS - September 24, 2018
    Revision: September, 2018 This update contains the specifications for the Number of Hospitalizations per 1,000 Long-Stay Resident Days measure, which is claims-based and risk-adjusted. This update also revises the MDS items included in the risk-adjustment models for the short-stay, claims-based quality measures, as well as the coefficients for the models.
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  • 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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  • 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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  • 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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  • 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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