Quality Assurance and Process Improvement

Healthcare quality improvement has evolved significantly in recent years.  The approach to healthcare quality began to change rapidly with publication of the Institute of Medicine’s To Err is Human in 1999 and continues through the 2015 release of Dying in America: Improving quality and honoring individual preferences near the end of life.  The focus of healthcare quality improvement has shifted to promoting evidence-based practices, utilizing process improvement, and assessing quality through outcome measures.

CMS is leading an initiative to improve the approach to healthcare quality.  The Quality Assurance and Performance Improvement (QAPI) initiative is a comprehensive, structured quality improvement program to assess the quality of care provided to patients/ residents and improve the quality of care. The QAPI initiative is a step in moving the quality process from one based on assessment of inadequacies to one that focuses on improvement.  While quality assurance continues to play a role, facilities are expected to engage in continuous performance improvement.

The OSDH is following this QAPI approach to the development of CMP funded projects. The Program is monitoring quality of care and services through performance indicators drawing data from multiple sources.  Sources of performance indicators include but are not limited to:

• CMS Nursing Home Compare,
• CMS National Partnership to Improve Dementia Care in Nursing Homes,
• Quality indicator data from CMS designated quality improvement organization,
• OSDH review of survey data to identify deficiency rates and trends,
• Long Term Care Minimum Data Set (MDS),
• Outcome and Assessment Information Set (OASIS),
• Quality improvement project data and reports,
• CDC healthcare associated infection reports, and
• AHRQ research reports.