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

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Presentation on theme: "Quality Indicator Survey (QIS) Design and Development Martha Powell, PhD Assistant Research Professor Division of Health Care Policy and Research September."— 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  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 2 Presentation Overview

3  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 3 CU’s Role

4  Traditional  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 Campus4 Survey Process

5  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 5 History of QIS

6  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 6 QIS Basics

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

8  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 8 QCLIs

9  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 Campus9 Thresholds

10 SurveyQCLI RateCited? 19% 120%N 2 N 322%N 435%N 540%Y 641%N 750%Y 870%Y University of Colorado Anschutz Medical Campus10 Simplified QCLI Threshold Analysis If current threshold is 19% 8 – TRIGGERED and 3 – CITED 3/8 or 37.5% citation rate

11 SurveyQCLI RateCited? 19% 120%N 2 N 322%N 435%N 540%Y 641%N 750%Y 870%Y University of Colorado Anschutz Medical Campus11 Simplified QCLI Threshold Analysis If current threshold is 37% 4 – TRIGGERED and 3 – CITED 3/4 or 75.0% citation rate

12 SurveyQCLI RateCited? 19% 120%N 2 N 322%N 435%N 540%Y 641%N 750%Y 870%Y University of Colorado Anschutz Medical Campus12 Simplified QCLI Threshold Analysis If current threshold is 45% 2 – TRIGGERED and 2 – CITED 2/2 or 100.0% citation rate

13  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 Campus13 Small/Not Small Sample Thresholds

14  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 14 Stage 2

15  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 Campus15 QIS Surveyor Training

16 University of Colorado Anschutz Medical Campus 16 QIS Implementation

17  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 Campus17 QIS in Indiana

18 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 Campus18 Triggered Care Areas

19  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 Campus19 Triggered Care Areas cont’d

20 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 Campus20 Source of “Negative” Responses

21  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 Campus21 Citation Rates for Mandatory Facility Tasks

22  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 Campus22 Citation Rates for Non-Mandatory Facility Tasks

23  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 Campus23 Citation Rates for Triggered CA/Tasks

24 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 QISNat’l QIS A3.6%1.2% B4.8%2.7% C3.9%3.0% D64.3%65.3% E17.6%19.9% F3.2%4.8% G2.5%2.4% H – L 0.2%0.55% University of Colorado Anschutz Medical Campus24 Scope and Severity

25  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 Campus25 Most Frequently Cited F-tags

26 Nat’l QISIN 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 Campus26 Citation Rates for Selected F-tags

27 Nat’l QISIN QISdiff F %22.3%5.5% (Right to particp. In CP) F2819.9%4.1%5.8% (Srvcs. meet Professional Stds.) F %17.8%6.5% (Comprehensive Assessments) University of Colorado Anschutz Medical Campus27 Citation Rates for Selected F-tags

28 Nat’l QISIN QIS F4923.2%0% (Comply w/Fed/St/Local Laws/Prof. Stds.) F2741.6%0% (Comp. Assess. After Sig Change) F4971.2%0% (Nurse Aide Perform Rev-12 hr/yr in-service) University of Colorado Anschutz Medical Campus28 Citation Rates for Selected F-tags

29 Nat’l QISIN QIS Average Number of Citations per Survey Percentage of Citation- Free Surveys6.9%9.6% Survey Time (Prep, Onsite, Offsite) University of Colorado Anschutz Medical Campus29 Citations and Survey Time

30 University of Colorado QIS website ool/departments/medicine/hcpr/qis/Pages/default.aspx CMS Project Officers Susan Joslin and Tom Kress University of Colorado Anschutz Medical Campus30 Contact Information

31 University of Colorado Anschutz Medical Campus31 Questions? Martha Powell (303) Sayuri Kelly (303) For CMS QIS forms and Information: https://www.qtso.com/qisdownload.html


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