QAPI? Prepare But Don't Panic

Abstract

The Quality Assurance and Performance Improvement initiative in the health reform act may seem like something new and different for nursing facilities, but if you're a medical director, don't panic, said AMDA Past President Dr. Cheryl Phillips, CMD. Some of you – especially those in Program of All-Inclusive Care for the Elderly (PACE) programs – are probably doing QAPI already, she told an audience at the AMDA annual meeting. “It is not onerous and pedantic,” said Dr. Phillips, senior vice president for advocacy of LeadingAge and cochair of Advancing Excellence in America's Nursing Homes. Many of the quality measures urged by QAPI aren't new, said Dr. Robert L. Kane, director of the Center for Aging at the University of Minnesota School of Public Health, Minneapolis. “You're already doing this stuff …. What's different about this is that it is, indeed, data driven.” The focus on data will require a new way of thinking, particularly for those who are used to dealing with anecdotes, he said, adding that it will also require new ways of communicating, such as learning how to talk to people who have different intellectual roots. “Your job is to bridge that gap,” he said. Other new ideas for nursing homes and medical directors may include systems approaches, the use of data to prioritize projects, formal “project implementation plans,” and the use of root cause analyses, said Dr. Kane. QAPI may also demand higher levels of staff and leadership participation and resident and family involvement than some medical directors are used to. “What we're talking about is integrating clinical leadership in a process that includes the entire team,” Dr. Phillips said, noting that attending physicians must also be engaged in QAPI implementation.