Long-Term Care Quality Case Study Project

Long-Term Care: Managing Across the Continuum, Fourth Edition John R. Pratt

Chapter Twelve: Long-Term Care Quality

Chapter Highlights

Defining Quality

Means different things to different people and different things in different

situations.

Includes both technical care and the management of the interpersonal exchanges

between residents and providers.

Includes three generally accepted measurement types: structure, process, and

outcomes:

Structure – organizational makeup.

Process – how care is delivered.

Outcomes – results of care.

Quality of life refers to the total living experience, which results in overall

satisfaction with one’s life.

Total Quality Management/Continuous Quality Improvement

Has been used extensively in business and industry for years.

An organized quality program based on concept that those delivering the care

want to do a good job and know how.

Quality Initiatives – growing emphasis on measuring and improving quality in long-

term care.

System-Wide Quality Programs – include both government and private programs.

Chapter 11

© 2010 Jones and Bartlett Publishers, LLC

1

Long-Term Care: Managing Across the Continuum, Fourth Edition John R. Pratt

Government Programs – have historically consisted mostly of regulating quality,

but have recently included quality information initiatives.

History of Government Quality Regulations

Quality Assurance – an early method of quality management that identified

quality issues and set minimum standards to be met for the issues.

Quality Assurance and Performance Improvement (QAPI) program as proscribed

by Section 6102(c) of the Affordable Care Act

Minimum Data Set (MDS) for Long-Term Care – a means of structuring the

assessment of nursing facility residents.

OASIS – an assessment tool for home health care, called the Outcomes and

Assessment Information Set (OASIS).

Quality Improvement Organizations – CMS-contracted organizations that

review medical care and help beneficiaries with complaints about the quality of

care and to implement improvements in the quality of care available throughout

the spectrum of care.

Pay-for-Performance – involves identifying procedures for which providers will

not be reimbursed as CMS identifies them as not necessary or resulting from poor

quality.

Public Information Quality Initiatives

Chapter 11

© 2010 Jones and Bartlett Publishers, LLC

2

Long-Term Care: Managing Across the Continuum, Fourth Edition John R. Pratt

Nursing Home Compare – designed to identify certain quality measures and to

show how individual facilities compared to the preset standard and to each

other. The information is available on the CMS website.

“Five-Star” Ratings – a rating system based on the quality and safety

information on Nursing Home Compare to help beneficiaries, their families,

and caregivers compare nursing homes more easily.

Quality-Related Research – government agencies that fund and publish quality

research.

AHRQ – Agency for Healthcare Research and Quality funds quality-related

research.

National Library of Medicine – collects materials and provides information

and research services in all areas of biomedicine and health care

Private Quality Programs – nongovernment programs focusing on quality in health

care.

Quality First – a voluntary initiative created by several leading long-term care

professional organizations and designed to improve the quality of nursing home

care and other long-term care services.

AHCA/NCAL Quality Award: a criteria-based program that recognizes a

commitment to performance excellence by member facilities.

Chapter 11

© 2010 Jones and Bartlett Publishers, LLC

3

Long-Term Care: Managing Across the Continuum, Fourth Edition John R. Pratt

Advancing Excellence in America’s Nursing Homes – a coalition of 14 national

provider organizations that care for 650,000 elderly and disabled patients

annually.

Alliance for Quality Nursing Home Care – a coalition of 14 national provider

organizations that care for 650,000 elderly and disabled patients annually.

American Health Quality Association – a charitable, educational, not-for-profit

national membership association dedicated to health care quality through

community-based independent quality evaluation and improvement programs.

National Quality Forum – a private, not-for-profit membership organization

created to develop and implement a national strategy for health care quality

measurement and reporting.

Accreditation Organizations – organizations that require a strong emphasis on

quality improvement in the provider organizations they accredit.

Private Foundations – foundations (e.g., the Robert Wood Johnson Foundation

and the Henry. J Kaiser Family foundation) that provide funding for quality-

related research and project implementation.

College and University Research Institutes – many colleges and universities

maintain research institutes or other organizational divisions addressing quality of

care.

Other Organizations – There are many other organizations, associations, and

coalitions working to improve long-term care

Chapter 11

© 2010 Jones and Bartlett Publishers, LLC

4

Long-Term Care: Managing Across the Continuum, Fourth Edition John R. Pratt

Provider-Administered Quality Improvement Programs – programs used by long-

term and other health care providers to ensure quality of care within their organizations.

Developing a Quality Improvement Program – includes several important

elements, including:

Top-Level Support – must have support from the very top levels of

administration.

Mission Based – should be an integral part of the mission of the organization.

Defining the Customers – the organization will need to define who its

customers are, those residents or other individuals served by the organization.

Measurement – defining and monitoring certain key indicators (e.g., the

number of residents with physical restraints, number of medication errors, or

infection rates).

Evaluation – evaluating how well the organization is doing.

Improvement – making changes in procedures based on the information

gleaned.

Ongoing Measurement and Evaluation – a continuous process.

Quality Teams – quality improvement usually involves teams consisting of staff

closely involved with the area being evaluated.

Technology – an increasingly valuable resource in measuring and maintaining

quality.

Chapter 11

© 2010 Jones and Bartlett Publishers, LLC

5

Long-Term Care: Managing Across the Continuum, Fourth Edition John R. Pratt

Chapter 11

© 2010 Jones and Bartlett Publishers, LLC

6

CHAPTER TWELVE: LONG-TERM CARE QUALITY

CHAPTER HIGHLIGHTS

Defining Quality

Total Quality Management/Continuous Quality Improvement

Quality Initiatives – growing emphasis on measuring and improving quality in long-term care.

System-Wide Quality Programs – include both government and private programs.

Government Programs – have historically consisted mostly of regulating quality, but have recently included quality information initiatives.

History of Government Quality Regulations

Quality Assurance – an early method of quality management that identified quality issues and set minimum standards to be met for the issues.

Minimum Data Set (MDS) for Long-Term Care – a means of structuring the assessment of nursing facility residents.

OASIS – an assessment tool for home health care, called the Outcomes and Assessment Information Set (OASIS).

Quality Improvement Organizations – CMS-contracted organizations that review medical care and help beneficiaries with complaints about the quality of care and to implement improvements in the quality of care available throughout the spectrum of care.

Pay-for-Performance – involves identifying procedures for which providers will not be reimbursed as CMS identifies them as not necessary or resulting from poor quality.

Public Information Quality Initiatives

Nursing Home Compare – designed to identify certain quality measures and to show how individual facilities compared to the preset standard and to each other. The information is available on the CMS website.

“Five-Star” Ratings – a rating system based on the quality and safety information on Nursing Home Compare to help beneficiaries, their families, and caregivers compare nursing homes more easily.

Quality-Related Research – government agencies that fund and publish quality research.

AHRQ – Agency for Healthcare Research and Quality funds quality-related research.

National Library of Medicine – collects materials and provides information and research services in all areas of biomedicine and health care

Private Quality Programs – nongovernment programs focusing on quality in health care.

Quality First – a voluntary initiative created by several leading long-term care professional organizations and designed to improve the quality of nursing home care and other long term care services.

Advancing Excellence in America’s Nursing Homes – a coalition of 14 national provider organizations that care for 650,000 elderly and disabled patients annually.

Alliance for Quality Nursing Home Care – a coalition of 14 national provider organizations that care for 650,000 elderly and disabled patients annually.

American Health Quality Association – a charitable, educational, not-for-profit national membership association dedicated to health care quality through community-based independent quality evaluation and improvement programs.

National Quality Forum – a private, not-for-profit membership organization created to develop and implement a national strategy for health care quality measurement and reporting.

Accreditation Organizations – organizations that require a strong emphasis on quality improvement in the provider organizations they accredit.

Private Foundations – foundations (e.g., the Robert Wood Johnson Foundation and the Henry. J Kaiser Family foundation) that provide funding for quality-related research and project implementation.

College and University Research Institutes – many colleges and universities maintain research institutes or other organizational divisions addressing quality of care.

Provider-Administered Quality Improvement Programs – programs used by long-term and other health care providers to ensure quality of care within their organizations.

Developing a Quality Improvement Program – includes several important elements, including:

Top-Level Support – must have support from the very top levels of administration.

Mission Based – should be an integral part of the mission of the organization.

Defining the Customers – the organization will need to define who its customers are, those residents or other individuals served by the organization.

Measurement – defining and monitoring certain key indicators (e.g., the number of residents with physical restraints, number of medication errors, or infection rates).

Evaluation – evaluating how well the organization is doing.

Improvement – making changes in procedures based on the information gleaned.

Ongoing Measurement and Evaluation – a continuous process.

Quality Teams – quality improvement usually involves teams consisting of staff closely involved with the area being evaluated.

Technology – an increasingly valuable resource in measuring and maintaining quality.