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QIS. Data to Bolster States Get ready for QIS Preparing and Execution . Plan. Welcome and Presentations Foundation and Review of QIS

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QIS Information to Support States Preparing for QIS Training and Implementation

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Agenda Welcome and Introductions Background and Overview of QIS – Continuous Quality Improvement State Roles and Responsibilities in Training Process Description and Timing of QIS Training Questions

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What is the QIS? Affirmed Federal nursing home overview procedure to expand consistency, dependability and exactness Uses modified programming on tablet PCs to guide surveyors through a two-arranged efficient audit of the administrative prerequisites 3

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QIS Development Produce model (1998 – 2005) Demonstration and Evaluation (2005 – 2007) Two groups each in: KS, OH, CA, CT, LA Develop and refine national preparing model (2006 2007) Three States: FL, CT, KS National execution State-by-State to supplant Traditional study (2007 – show) 4

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What Does the QIS Provide? Organized way to deal with accomplish more exact and steady outcomes Larger and more differing arbitrarily chose tests to get a more precise photo of the occupants Automation to deliberately audit administrative territories, orchestrate surveyor discoveries, upgrade investigative conventions, and sort out surveyor documentation

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What QIS Is Not QIS Does Not Represent: Change in Social Security Act Change in the Regulations Change in Interpretive Guidance Change in requirement handle

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Comparison of QIS and Traditional Survey Process

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Automation Traditional Information recorded on paper all through procedure; PCs are utilized for Statement of Deficiencies (CMS-2567) QIS Each colleague utilizes a tablet PC to archive discoveries all through the procedure; discoveries are combined, composed, and stacked to the CMS-2567 by the product

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Traditional Review: OSCAR 3 and 4 Reports QM/QI Reports Results of grievance examinations Pre-select a specimen in view of above QIS Review: OSCAR 3 Report Uninvestigated protests Random choice of Stage 1 tests from MDS information stacked onto tablet PCs Offsite Preparation

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Onsite Preparation Traditional Roster/Sample Matrix – Form CMS-802 QIS Alphabetical inhabitant statistics with room numbers/units List of new confirmations over most recent 30 days

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Initial Tour Traditional Gather data about pre-chosen occupants and distinguish new concerns Determine whether pre-chosen occupants are as yet proper QIS Brief general impression of the office, the occupants, and the staff Not proposed for test determination or supplementation

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Sample Selection Traditional Sample estimate controlled by office registration Residents chose in view of QM/QI percentiles and issues recognized offsite and on the underlying visit QIS Stage 1 test measure: Admission (30) Census (40) Stage 2 test estimate in light of number of activated care zones Residents chose by programming Surveyor-started test

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Survey Structure Traditional Phase I: centered & exhaustive audits Phase II: centered surveys QIS Stage 1: preparatory examination Stage 2: inside and out examination of activated worries from Stage 1

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Two Stages of QIS Stage 1 : Preliminary examination of administrative ranges to decide inhabitant mind zones and office hones for Stage 2 examination Stage 2 : top to bottom examination to figure out if lacking practice exists, record inadequacies, and decide seriousness and scope

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Three Steps in Each Stage Sampling (PC created) Investigation Synthesis

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QIS Stage 1 Sampling – Random evaluation (40) and affirmation (30) tests Investigation – Structured inhabitant, family, and staff interviews; occupant perceptions; outline surveys Synthesis – 128 occupant focused and 34 office level Quality of Care and Quality of Life Indicators (QCLIs) to recognize mind zones that surpass national edges

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Stage 1 Triggers for Stage 2 Investigations

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Surveyor-Initiated Sample Surveyors can start an examination of look after any occupant or of office errands. In view of the extensive QIS tests, surveyor-started examinations are a little piece of the procedure.

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QIS Facility Tasks Completed on each overview Liability Notices & Beneficiary Appeal Rights Review Dining Observations Infection Control and Immunizations Kitchen/Food Services Medication Administration and Drug Storage QAA Resident Council President Interview Completed if activated Abuse Prohibition Review Admission, Transfer, and Discharge Review Environmental Observations Personal Funds Review Sufficient Nursing Staff Review

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QIS Stage 2 Sampling – Three inhabitants for every activated Care Area in addition to surveyor-started occupants (e.g., protests) Investigation – Specific or general Critical Element pathway or office assignment pathway and interpretive rules Synthesis – Determine consistence with each Critical Element, record resistance at the relevant F labels, decide seriousness and extension

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QIS Satellite Broadcast: QIS Resource Manual: QIS Electronic Forms and Worksheets: QIS Brochure: Additional Information 21

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QIS – Quality Improvement CMS-Federal Monitoring of the QIS RO surveyors prepared in QIS handle Desk Audit Reports DAR-SA for State DAR-RO for CMS Regional Office Federal Oversight of the QIS (FOQIS) QIS Comparative Survey

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QIS - Quality Improvement Desk Audit Report (DAR) an administration apparatus which can be utilized by: The CMS CO for continuous checking of QIS consistency crosswise over Regions Offices (RO) and States (SA); The RO's for Federal Oversight of the QIS procedure (FOQIS); and The SA's for checking regions, groups and individual surveyors

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RO & SA utilization of the DAR Reviews comes about; Raises questions; Investigates results; Assists the RO & SA with oversight/preparing; and Can coordinate SA observing

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Timeline CU sends 6 DAR-SAs with clinical examination and a call to talk about every CU sends 3 DAR-SAs with clinical investigation and no call SA gets clinical examination preparing CU and SA correlation for one DAR SA accepts accountability of dissecting DAR-SAs

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Goal of QIS Data Identify and address wellsprings of irregularity: Implementing the QIS procedure precisely Conducting satisfactory and exhaustive examinations and settling on exact consistence choices

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DAR-SA Review Throughout each quarter, SA surveys various DAR-SAs Identify and break down exceptions/patterns Determine underlying driver Implement preparing, observing or restorative activity as proper Monitor viability

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DAR-RO Review 2. Toward the finish of the quarter, RO and SA gets State-Specific DAR-RO 3. RO conducts QI call inside 4 weeks (not completely actualized) 4. On location FOQIS is led utilizing a focused on, information driven approach (not completely actualized)

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Preparing for Successful QIS Training and Implementation Review CMS Issued Documents Fiscal Year State Survey & Certification Budget Letter (Mandatory Requirements - gear and encryption) State Operations Manual, Appendix P QIS Training Process - State Operations Manual, Chapter 4 National Implementation Priority Order (S&C 09-50) QIS Satellite Broadcast: QIS Brochure:

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Preparing for Successful QIS Training and Implementation Informing State administration about QIS Identifying QIS administration and groups Educating partners in the State Begin coordinations readiness for beginning QIS classroom preparing

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Preparing State Management Team for QIS Kick off call with State, CMS, and NHQ Orient and instruct chiefs/administrators about QIS, the preparation procedure and State creates QIS preparing arrangement Identify a QIS State Lead Identify a QIS IT Lead Identify 8 surveyors to take an interest in introductory/center QIS Classroom Training Identify extra care staff to help with preliminary coordinations for QIS preparing

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Role of QIS State Lead Able to settle on supervisory choices and give oversight Support the QIS procedure Participate in QIS preparing, classroom and field Achieve dominance of the QIS Manage potential difficulties from nursing homes Serve as the purpose of contact for the State Agency for talk with CMS as well as its contractual workers Educate supplier and purchaser associations Collaborate in the arranging and preliminary exercises with the preparation temporary worker

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Role of QIS State IT Lead First line of contact for surveyors to address and resolve programming issues utilizing the QIS procedure and QIS programming Successfully finishes ASPEN Technical Training Experienced and capable with all ASPEN suite of items Creating study shells in ACO Assisting staff with transferring studies from ASE to ACO Participates in both classroom and on location QIS preparing Able to prepare extra staff on the specialized parts of the QIS procedure

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QIS Core Group of Surveyors State recognizes eight surveyors (2 groups of 4) to partake in starting round (center) of QIS preparing Minimum of two years of late LTC study encounter SMQT qualified Possess middle of the road PC aptitudes Prior instructing or preparing background, if conceivable State chooses four QIS mentor applicants from starting center gathering of surveyors prepared in QIS

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Educating Stakeholders on QIS & State's Implementation Plan Dedicate a segment of State Web website for QIS data and assets for partners Schedule, declare and take an interest in "Diagram of QIS for Stakeholders" with CMS and NHQ Communicat


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