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How to Build an Effective QAPI Program

    QAPI: What is it and why is it important?

    As the pressure to transition towards value-based care increases, home health agencies must implement an effective Quality Assurance and Performance Improvement (QAPI) program to improve patient care and documentation, and maintain compliance with the Conditions of Participation (CoP).

    QAPI is one of the new and modernized initiatives that the Centers for Medicare & Medicaid (CMS) introduced in 2017 under the CoPs. It requires home health agencies to develop, implement, evaluate, and maintain an effective, ongoing, agency-wide, data-driven QAPI program. QAPI merges two (2) complementary approaches to quality management: quality assurance (QA) and performance improvement (PI). QA is reactive and retrospective while PI is proactive and continuous. 

    The Foundation of an Effective QAPI Program

    To create a performance improvement plan that works well, it is essential to have a holistic approach. For one, having a system that identifies and addresses problem areas is the foundation for an effective QAPI program. This is majorly influenced by incident reporting and OASIS data analysis.

    Problems in patient care are reported as “incidences.” When all incidences are reported and documented, training needs for employees and/or policy and procedure changes can take place. Your QA team or provider should have an Incident Reporting System that enables the ability to run reports that show trends in problems with patient care.

    Effective Incident Identification and Reporting

    It is key to establish the practice of documenting all incidences, making the effort to mitigate the incident (change in policy, employee training, etc.), and evaluating the effectiveness of the effort (as evidenced by statistics after policy change, training, etc.). Some ways to do this are:

    1. Orient and train both clinical and administrative staff on identifying and reporting incidences.
    2. Analyze reports every three (3) months, summarize all incidences, and determine the cause of such incidences. Insights from this should then be used in making changes in policies and procedures.
    3. Implement process improvements based on gathered data.

    It is important to repeat this process at intervals of three (3) months and review if additional improvements need to be made.

    OASIS Data Analysis

    To establish an effective QAPI program, agencies need to use OASIS-driven data in a way that allows for actionable insights. Incorrect understanding and a knowledge gap on OASIS questions can certainly impact patient safety and outcomes. Your OASIS data analytics system should be able to track the improvement, or lack thereof, in both patient care and documentation. Sample key data your agency can identify are:

    • Top OASIS documentation errors (based on frequency)
    • OASIS error rate per clinician
    • Overall OASIS QA return rate

    Agencies can definitely leverage this data to identify and track progress as they are relevant to the agency’s QAPI objectives. OASIS data should now allow you to identify knowledge gaps and use them to conduct training for all staff with monthly follow-ups, establish benchmarks, and track progress every quarter.

    Your OASIS reviewers play a vital part in implementing actual OASIS data capture and interpretation. While OASIS data can drive improvement initiatives, it can be a complex system that requires the use of data capturing tools and data interpretation knowledge. If your agency does not have robust systems in place to realize this, it would be helpful to explore working with providers who specialize in providing tech-enabled home health documentation and back-office solutions.

    Rolling Out an Effective QAPI Program

    In line with the five elements to a successful QAPI program, here are some tips and best practices to help you implement one in your agency:

    1. Establish progress indicators

    Have indicators that can measure progress. Track certain quality indicators, including adverse patient events, that reflect improvement in outcomes, patient safety, and quality of care.

    1. Utilize OASIS review

    Use OASIS-driven data, along with other relevant data, to track and monitor the effectiveness of the QAPI program thus far and identify areas that need improvement. Having an OASIS QA partner can be beneficial in making this process successful to help your agency capture and translate data into actionable insights.

    1. Identify and address the root cause

    Focus on more challenging areas that are high-risk and have high volume. Track adverse patient events, find out how those events happened, and then establish corrective action plans to eliminate or avoid them in the future. 

    1. Make measuring progress and tracking areas for improvement a habit

    Document what projects and efforts have been put in place to address problem areas, why they were undertaken, and the quantifiable positive results achieved by them.

    1. Let your leaders get involved

    Management must make sure that the QAPI program is defined, implemented, and maintained, and then set priorities for the QAPI program to improve operations and patient outcomes.

    QAPI: A Habit for Efficiency

    Performance improvement is an ongoing and constant pursuit of enhancements. Management plays a vital role in ensuring the success of the QAPI program. They can use data to make sure their staff understands the importance of the project, and then provide support for them so they can enforce best practices to remain compliant with the CoPs.

    At the same time, a vital aspect of quality assurance is the systematic measurement, which includes monitoring processes with a feedback loop to prevent errors. A key player in the feedback loop could be an outsourcing partner that can provide valuable insights that contribute to process improvement. Your agency should always be collecting data and refining policies and procedures. This means asking the right questions, tracking knowledge gaps, and distinguishing challenging areas to create steps towards positive outcomes on all fronts.