Using QIS for Quality Improvement Sayuri Kelly, MS, OTR

1. University of Colorado Anschutz Medical Campus It's not so much that we're afraid of change or so in love with the old ways, but it's that place in between that we fear . . . . It's like being between trapezes. It's Linus when his blanket is in the dryer. There's nothing to hold on to. Marilyn Ferguson

2. University of Colorado Anschutz Medical Campus Using QIS for Quality Improvement Sayuri Kelly, MS, OTR University of Colorado Anschutz Medical Campus Division of Health Care Policy and Research September 13, 2012

3. Overview University of Colorado Anschutz Medical Campus Federal Oversight for QIS QIS stand-alone complaints Using QIS for Quality Improvement

4. Federal Oversight University of Colorado Anschutz Medical Campus • FOSS (Traditional) • Regional Office (RO) Surveyor joins the State Agency team • Comparative (Traditional) • Team of RO Surveyors complete a separate survey and compare results with the State Agency

5. Federal Oversight of the QIS University of Colorado Anschutz Medical Campus • FOQIS • More structured, objective process • Targeted, data driven approach using the DAR • Parallel investigations in Stage 1 and 2 • On-going dialogue and RO education and guidance • Implemented in October 2011

6. QIS Comparative University of Colorado Anschutz Medical Campus • QIS Comparative • Matched Stage 1 and Stage 2 samples • Implementing in October 2012

7. Implementation of the Stand-alone Complaints University of Colorado Anschutz Medical Campus • Stand-alone Complaint • Completed preliminary work – fact finding and research phase • Development work and software requirements begin September 2013

8. Using QIS for Quality Improvement University of Colorado Anschutz Medical Campus • Two options • Option 1: Use Stage 1 forms and investigate all concerns • Option 2: Follow the same process as the State Agency (using all QIS forms)

9. Option 1 – Review Every Resident University of Colorado Anschutz Medical Campus • Complete the following for every resident in the facility (or a subset of residents): • Resident Observation • Staff Interview • Record Review • Resident Interview, if appropriate • Family Interview, if appropriate

10. Option 2 Follow the QIS Process University of Colorado Anschutz Medical Campus

11. Follow the QIS Process University of Colorado Anschutz Medical Campus • Modify to account for resources and time • Use the same QIS principles • 10 residents for each staff member • Complete in 10 - 12 hours • Conduct multiple observations of the resident • At various times of the day

12. Follow the QIS Process (cont.) University of Colorado Anschutz Medical Campus • Interview techniques and protocol • Complete the interview at one sitting • Ask the question exactly as written • Ask lengthy questions in parts • Ask the questions in sequence for skip patterns • Ask probing open-ended questions for any identified concerns • Staff interview – licensed staff with frequent or direct resident contact • Staff interview – required documentation

13. QIS Stage 1 Sample University of Colorado Anschutz Medical Campus • Stage 1 sample = 40 residents • Resident Interview - all interviewable residents • Observation = all 40 residents • Staff Interview = all 40 residents • Record Review = all 40 residents • Family Interview = 3 family interviews (non-interviewable residents) • Automate the process

14. Stage 1 Example – DAR Data IN QIS DAR Data: 1/28/2011 – 7/17/2012 University of Colorado Anschutz Medical Campus

15. Peyton Manning H: Leaning to the side without support to maintain an upright position Relevant finding: 8/22/11, 8/23/11 observed resident leaning in wheelchair to the right side. University of Colorado Anschutz Medical Campus

16. Andrew Luck I: Lack of needed head or torso support Relevant finding: Resident observed sitting in high-back w/c in activity room, asleep, since 1:30 P.M. Head/neck leaning over toward chest. 10/18/11 at 10:10 A.M. Asleep in activity room in high back wheelchair. Head and neck down towards chest. University of Colorado Anschutz Medical Campus

17. Tim Tebow H: Leaning to the side without support to maintain an upright position Relevant finding: Yesterday during activities, the resident was sleeping and leaning to the left. Observed today also leaning to the left. Propelling self back from the dining room. University of Colorado Anschutz Medical Campus

18. John Elway F: Uncomfortable Geri-chair positioning, hyper-flexion of the neck, sliding down in the chair, no-support for the legs Relevant finding: sliding down in chair. Redirected to sit up, scoot self up times two in a ten minute period 1:20 to 1:30 p.m. on 09/19/11. University of Colorado Anschutz Medical Campus

19. Investigate All Triggered Areas University of Colorado Anschutz Medical Campus • Complete an in-depth investigation for every triggered care area (e.g., positioning) • Exception: Harm, SQC or IJ • In-depth investigation = root cause determination • Sample size = 3 residents/care area

20. Care Area Investigation Key University of Colorado Anschutz Medical Campus

21. Use University of Colorado Anschutz Medical Campus

22. Procedure University of Colorado Anschutz Medical Campus

23. Unable to Position Independently University of Colorado Anschutz Medical Campus

24. Resident/Representative Interview University of Colorado Anschutz Medical Campus

25. Staff Interviews University of Colorado Anschutz Medical Campus

26. Assessment University of Colorado Anschutz Medical Campus

27. Care Planning University of Colorado Anschutz Medical Campus

28. Care Planning (cont’d) University of Colorado Anschutz Medical Campus

29. Care Planning (cont’d) University of Colorado Anschutz Medical Campus

30. Care Plan Implementation University of Colorado Anschutz Medical Campus

31. Care Plan Revision University of Colorado Anschutz Medical Campus

32. Care Plan Revision (cont’d) University of Colorado Anschutz Medical Campus

33. Provision of Care and Services University of Colorado Anschutz Medical Campus

34. Independent but Associated Concerns University of Colorado Anschutz Medical Campus

35. Conclusions University of Colorado Anschutz Medical Campus Modify Option 2 as necessary One tool for providers for on-going quality improvement

36. Questions? University of Colorado Anschutz Medical Campus Martha Powell Martha.Powell@ucdenver.edu (303) 724-2434 Sayuri Kelly Sayuri.Kelly@ucdenver.edu (303) 724-2490 For CMS QIS forms and Information: https://www.qtso.com/qisdownload.html