QUALITY ASSURANCE PERFORMANCE IMPROVEMENT COLLABORATIVES: A NOVEL APPROACH TO NURSING HOME QUALITY

The Centers for Medicare and Medicaid introduced the Quality Assurance Performance Improvement (QAPI) program to improve quality of care and resident outcomes in nursing facilities, but is not currently used broadly or consistently. QAPI integrates tenets of the Quality Assurance, Performance Improvement, and Lean Six Sigma approaches to quality to create a data-based process for systems change. Under the direction of the Indiana State Department of Health, seven regional collaboratives were formed across Indiana as a pilot to implement the QAPI approach in their regions. Collaboratives included a leadership team and membership of at least 20 skilled nursing facilities and community and regional partners. The University of Indianapolis Center for Aging & Community provided training, technical assistance, guidance, and overall program management. Goals included building the collaborative, educating members on the QAPI process, and completing two Process Improvement Projects (PIPs) in each region. Project topics included reducing rates of UTIs, hospitalizations, pneumonia, falls, staffing retention, and inappropriate antipsychotic use. Improving staff retention, particularly for certified nursing assistants was also targeted. Collaborative leadership and members were surveyed about their experiences and attitudes about the collaborative process. Initial results show overall positive impact of the pilot program. Project one outcomes included reductions by 16% for pneumonia incidence, 29% for falls, 38% for hospitalizations, 40% (average) for UTIs. Savings of more than $289,343 were identified in six months. Collaborative members reported improved utilization of the QAPI model and positive attitudes toward the collaborative approach. Discussion will include additional outcomes and implications for expansion of the pilot.