1. 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

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

3. 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

4. Hospice Data Sources for QAPI • Patient charts • Incident reports • Infection reports • Satisfaction surveys • Billing Records • Human resources files • Financial Reports • Volunteer Records

5. 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

6. Using the Data - Actionable Reporting • Graphs or tables • Track and trend over time • Relative to a benchmark or target

7. Identify Opportunities for ImprovementWhen to take action • Quality assessment indicates a “gap” between actual and desired performance • Survey deficiencies • Management want to improve • Staff suggestions

8. 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

9. 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

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

12. Pt.-level example: Symptom Management 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

13. Hospice-level example: Aggregated clinical data National Average 82%

14. Hospice-level example: Non-clinical operations