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Quality Indicator Survey (QIS)

Quality Indicator Survey (QIS) . Elizabeth Honiotes Centers for Medicare & Medicaid Services. QIS - Overview. Revised Long Term Care survey process Two survey stages of review Tablet PC and database design. QIS - Objectives. Improve consistency and accuracy of the survey

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Quality Indicator Survey (QIS)

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  1. Quality Indicator Survey (QIS) Elizabeth Honiotes Centers for Medicare & Medicaid Services

  2. QIS - Overview Revised Long Term Care survey process Two survey stages of review Tablet PC and database design

  3. QIS - Objectives Improve consistency and accuracy of the survey Comprehensively review more regulatory areas within current survey resources Enhance documentation through automation Focus survey resources on facilities with the greatest quality concerns

  4. QIS – First Stage Preliminary investigations conducted Structured resident, family & staff interviews Resident observations Record reviews Analysis of Minimum Data Set (MDS) data

  5. QIS – First Stage Preliminary investigations Quality of Care & Quality of Life Indicators (CQIs) CQIs are compared to national norms Identify Care Areas for Second Stage

  6. QIS – Second Stage In-depth quality investigations Critical Element Pathways for investigations Assessment Care planning Reassessment Care areas are mapped to specific F tags (regulations)

  7. QIS Software • Previously using Research Grade Software • Can be cumbersome for surveyors • Currently using Production Software • More stable than research grade • More convenient for surveyors • Automatically encrypts data • Easier to navigate • Easier data sharing among the survey team

  8. QIS – Time spent on survey Based on Ohio Experience (2009) Average time on survey – 192.61 hours Greater than traditional survey – 118.29 hours May decrease as teams become more experienced

  9. QIS – surveyors Average number of surveyors/survey (Ohio-2009) QIS – 4.7 surveyors Traditional – 3.4 surveyors

  10. QIS - Citations Average number of citations/survey Based on Ohio Experience (2009) QIS – 7.74 tags Traditional – 5.7 tags

  11. QIS – Scope/Severity Ohio Experience (2009) Most citations represent D level deficiencies for the QIS and traditional surveys (62%) Second highest citation rates are at E level deficiencies for both types of survey (19%)

  12. QIS – Demonstration Phase Phase 1 –9/05 Connecticut, Kansas, Ohio Phase 2 – 2/06 – California, Louisiana Phase 3 – 10/06 – Florida tested a statewide implementation to prep for national rollout National implementation progressing state by state.

  13. RO V QIS Implementation Full implementation of QIS throughout the State 310 surveys in 64 counties conducted 60 facilities/27 counties repeat QIS Full implementation by December 2011

  14. QIS – National Implementation • Indiana -Band Two of state groupings • implementation to be initiated January 2011 • Wisconsin -Band Four • Illinois - Band Five • Michigan-Band Six • Implementation in all 50 states depends on the annual budget allocations for survey and certification.

  15. Federal Monitoring Surveys for QIS • Federal Oversight Quality Indicator Survey (FOQIS) • FOSS-light process • More focused than traditional Federal Oversight and Support Survey (FOSS) • Data sharing between state team and federal team

  16. Federal Monitoring Surveys for QIS RO V FOQIS Experience • Encryption software incompatibility • Research-grade software version of FOQIS used in 2009 • Revised FOQIS process is under development • Current approach to meeting our 5% oversight obligation for observational surveys (FOSS) • RO embed with State teams (RO part of the survey team) • Observe non-QIS surveys (when available) • Observe complaints and revisits

  17. Federal Monitoring Surveys for QIS • Comparative FMS • QIS comparative protocol under development • Modified comparative for look-behind of QIS • Hybrid Traditional/QIS survey • Use QIS information from State survey • Compare outcome similar to traditional look-behind • Consider the focus of the State team when comparing survey findings (i.e., would not hold State accountable for tags that involved care areas they did not investigate).

  18. Federal Oversight • Revisits and Complaint Investigations • Currently no QIS process • Continue with current traditional process for oversight (FOSS)

  19. QIS-Tools for CQI & Oversight Tools for State supervisors & managers (currently under development) Reports on survey data among specific survey teams and surveyors States can explore and address variations among surveys and teams (not available in traditional surveys)

  20. QIS-Tools for CQI & Oversight Tools for CMS (currently under development) Output reports and feedback systems Review each state to determine statewide variations Address and reduce variations between states

  21. QIS – Future Research To examine key aspects of QIS Focus on the extent to which QIS will provide better tools for continuous quality improvement

  22. QIS – Private Sector Quality Assurance Tool for Providers (to be developed) Nursing homes may use QIS for self-analysis CMS plans to make info publicly available for broad use in nursing homes Private sector use of the QIS methodologies will need to be privately funded by nursing homes No date set, yet – far into the future

  23. QIS Elizabeth.Honiotes@cms.hhs.gov

  24. Questions?

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