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Quality Indicator Survey (QIS) Design and Development

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Presentation on theme: "Quality Indicator Survey (QIS) Design and Development"— Presentation transcript:

1 Quality Indicator Survey (QIS) Design and Development
Martha Powell, PhD Assistant Research Professor Division of Health Care Policy and Research September 13, 2012

2 Presentation Overview
University of Colorado’s role in implementation and analysis of QIS Development and Implementation of the QIS Threshold development and review QIS in Indiana University of Colorado Anschutz Medical Campus

3 CU’s Role Software design and testing
Stage 1 and Stage 2 revisions/improvements Desk Audit Reports Threshold analysis Help Desk Onsite support for SA/RO University of Colorado Anschutz Medical Campus

4 Survey Process Traditional QIS Both shaped by OBRA ‘87
Paper forms, prelim sample from QM/QI, tour used to supplement sample, comp review then focused reviews QIS Computer assisted (tablets), random samples, wide variety of indicators, prelim invest then in-depth for selected areas Both shaped by OBRA ‘87 University of Colorado Anschutz Medical Campus

5 History of QIS Pre-cursor to QIS (Quality Indicator Survey) developed to serve as standard to gauge effectiveness of survey process improvements Development involved Univ. of Wisconsin, Univ. of Colorado, and programming contractors Pilot Tests (field, alpha, beta), then Demonstration and Evaluation National Implementation—phased approach University of Colorado Anschutz Medical Campus

6 QIS Basics Computer-assisted (tablets), 2 stages
Stage 1: Preliminary Investigations Random sampling Structured protocols Stage 2: In-depth investigations Facility tasks (e.g., Kitchen, Infection Control & Immunization Review) Surveyor Initiation option Typically four surveyors onsite for 5 days University of Colorado Anschutz Medical Campus

7 Stage 1 Census Sample (N=40): Admission Sample (N=30):
Resident Interview/Observation Staff Interview Record Review Family Interview (n=3) Admission Sample (N=30): recently-admitted residents MDS Sample: assessments from prior 180 days University of Colorado Anschutz Medical Campus

8 QCLIs Quality of Care and Quality of Life Indictors
Examples of QCLIs: Underweight and No Supplements, Eating Decline Since Admission, Hospitalization within 30 days of Admission Computed from Stage 1 and MDS samples/data Facility rate is calculated and compared to pre-set threshold If facility rate exceeds threshold, the care area (e.g., Nutrition, ADL, Hospitalization) is triggered for a Stage 2 investigation (e.g., 4 residents out of 40 have Stage III/IV pressure ulcers—10% facility rate—exceeds 5% threshold) University of Colorado Anschutz Medical Campus

9 Thresholds Rates – threshold = 10% (example rate)
For a census sample of 40, 10% would be 4 residents, so 5 would be needed to exceed threshold For an admission sample of 30, 10% would be 3 residents, so 4 would be needed to exceed threshold Threshold for Abuse is 0—only 1 resident is needed to exceed the threshold Not percentiles or benchmarks Reviewed and reset if appropriate Based on QIS data Separate threshold values for smaller census/admission samples University of Colorado Anschutz Medical Campus

10 Simplified QCLI Threshold Analysis
Survey QCLI Rate Cited? 19% 1 20% N 2 3 22% 4 35% 5 40% Y  6 41% 7 50% Y  8 70% If current threshold is 19% 8 – TRIGGERED and – CITED 3/8 or % citation rate University of Colorado Anschutz Medical Campus

11 Simplified QCLI Threshold Analysis
Survey QCLI Rate Cited? 19% 1 20% N 2 3 22% 4 35% 5 40% Y  6 41% 7 50% Y  8 70% If current threshold is 37% 4 – TRIGGERED and – CITED 3/4 or % citation rate University of Colorado Anschutz Medical Campus

12 Simplified QCLI Threshold Analysis
Survey QCLI Rate Cited? 19% 1 20% N 2 3 22% 4 35% 5 40% Y  6 41% 7 50% Y  8 70% If current threshold is 45% 2 – TRIGGERED and – CITED 2/2 or % citation rate University of Colorado Anschutz Medical Campus

13 Small/Not Small Sample Thresholds
Census Sample Small: 35 or fewer residents Not Small: 36 – 40 residents Admission Sample Small: 9 or fewer residents Not Small: 10 – 30 residents University of Colorado Anschutz Medical Campus

14 Stage 2 In-depth investigations of triggered care areas and non-mandatory facility tasks Critical Element Pathways guide investigation Additional interviews, observations, and record reviews Compliance decision Is facility in compliance with regulations? Individual and then as team University of Colorado Anschutz Medical Campus

15 QIS Surveyor Training After SMQT
Extensive Classroom training (computer basics, QIS process and software) Mock survey—putting training into practice Compliance surveys—performance is evaluated by QIS Trainers Additional classroom and onsite education to become a QIS Trainer University of Colorado Anschutz Medical Campus

16 QIS Implementation University of Colorado Anschutz Medical Campus

17 QIS in Indiana First surveys conducted in January, 2011
As of 7/17/2012—212 QIS ( 500 NH) 15 of 21 teams trained Full implementation can take up to 3 yrs. Following slides/results are based upon QIS from 1/28/2011 – 7/17/2012; National and Indiana QIS results from same time period University of Colorado Anschutz Medical Campus

18 Triggered Care Areas National and Indiana rates are similar for the following: Frequently Triggered (> 60% of surveys) Abuse/Abuse Prohibition, Accidents, ADLs, Community Discharge, Dental Status, Nutrition, Personal Property, Pressure Ulcers, Psychoactive Meds Less Frequently Triggered (< 20% of surveys) Food Quality, Notification of Change, Privacy, Sufficient Nursing Staff, Social Services University of Colorado Anschutz Medical Campus

19 Triggered Care Areas cont’d
Indiana is a low outlier (compared to National QIS rates) for: Physical Restraints and Positioning No high outliers for Indiana for triggered care areas University of Colorado Anschutz Medical Campus

20 Source of “Negative” Responses
Indiana QIS rates for: Resident Observation 5% Resident Interview 7% Family Interview 3% Staff Interview 10% Census Clinical Record 5% Admission Clinical Record 5% These rates are similar to Nat’l QIS rates. University of Colorado Anschutz Medical Campus

21 Citation Rates for Mandatory Facility Tasks
Liability Notices 25% (↑than Nat’l QIS) Dining 23% Infection Control 46% (↑than Nat’l QIS) Kitchen 27% QA & A 13% (↑than Nat’l QIS) Resident Council 13% (↑than Nat’l QIS) Med. Admin 13% Med Storage 22% Unnecessary Med Use 39% University of Colorado Anschutz Medical Campus

22 Citation Rates for Non-Mandatory Facility Tasks
Abuse Prohibition 23% Adm, Tfr, DC 22% Environment 74% Personal Funds 26% Sufficient Nursing Staff 13% Extended Survey 60% Rates = # cited divided by # investigated (not total # of surveys) University of Colorado Anschutz Medical Campus

23 Citation Rates for Triggered CA/Tasks
Indiana QIS similar to Nat’l QIS for most Indiana QIS low outlier for: Behavioral and Emotional Status, Rehabilitation, UTIs Indiana QIS high outlier for: Physical Restraints and Positioning University of Colorado Anschutz Medical Campus

24 Scope and Severity A 3.6% 1.2% B 4.8% 2.7% C 3.9% 3.0% D 64.3% 65.3%
Percentage of F-tags at each S/S level for Indiana QIS very similar to Nat’l QIS, slightly higher percentages at A & B IN QIS Nat’l QIS A 3.6% 1.2% B 4.8% 2.7% C 3.9% 3.0% D 64.3% 65.3% E 17.6% 19.9% F 3.2% 4.8% G 2.5% 2.4% H – L 0.2% 0.55% University of Colorado Anschutz Medical Campus

25 Most Frequently Cited F-tags
Nationally in QIS states F441 Infection Control % F329 Drug Regimen free from Unecc. Drugs % F323 Free of Accident Hazards % Indiana QIS F282 Srvcs by Qualified Persons per Care Plan % F323 Free of Accident Hazards % F279 Develop Comp. Care Plans % University of Colorado Anschutz Medical Campus

26 Citation Rates for Selected F-tags
Nat’l QIS IN QIS diff F % 44.7% -23.6% (Svcs by Qual. Pers per CP) F % 28.9% -16.9% (Notice of Rights) F % 32.0% -12.5% (Housekeeping) University of Colorado Anschutz Medical Campus

27 Citation Rates for Selected F-tags
Nat’l QIS IN QIS diff F % 22.3% 5.5% (Right to particp. In CP) F % 4.1% 5.8% (Srvcs. meet Professional Stds.) F % 17.8% 6.5% (Comprehensive Assessments) University of Colorado Anschutz Medical Campus

28 Citation Rates for Selected F-tags
Nat’l QIS IN QIS F % 0% (Comply w/Fed/St/Local Laws/Prof. Stds.) F % 0% (Comp. Assess. After Sig Change) F % 0% (Nurse Aide Perform Rev-12 hr/yr in-service) University of Colorado Anschutz Medical Campus

29 Citations and Survey Time
Nat’l QIS IN QIS Average Number of Citations per Survey Percentage of Citation- Free Surveys 6.9% 9.6% Survey Time (Prep, Onsite, Offsite) University of Colorado Anschutz Medical Campus

30 Contact Information University of Colorado QIS website CMS Project Officers Susan Joslin and Tom Kress University of Colorado Anschutz Medical Campus

31 Questions? Martha Powell (303) Sayuri Kelly (303) For CMS QIS forms and Information: https://www.qtso.com/qisdownload.html University of Colorado Anschutz Medical Campus


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