Stratis Health Leads National Demonstration Project to Improve Care in Nursing Homes

The University of Minnesota and Stratis Health are leading 17 nursing homes in California, Florida, Massachusetts, and Minnesota in a Centers for Medicare & Medicaid Services (CMS) demonstration project to develop and test prototypes of a national Quality Assurance Performance Improvement (QAPI) program for nursing homes.

A QAPI program is a comprehensive, structured program used by health care organizations to assess the quality of care provided to their patients/residents and to improve the care they provide.

The Affordable Care Act requires that all nursing homes develop QAPI programs to meet national quality standards currently being developed by CMS. From this demonstration and its evaluation, CMS expects to refine tools and resources and assemble best-practice examples to assist in the national QAPI rollout. This initiative will align nursing homes with other health care programs­—such as dialysis units, hospice, and hospitals—which have a QAPI requirement.

The QAPI initiative in nursing homes represents a step in moving the quality process from one based on assessment of inadequacies to one focused on improvement. Under the new QAPI approach, quality assurance will continue to play an important role, while nursing homes simultaneously are engaged in more intensive activity rooted in performance improvement.

"QAPI ushers in new possibilities for nursing homes to develop comprehensive, proactive performance improvement programs tailored to their own programs and needs," said Jennifer Lundblad, PhD, president and CEO, Stratis Health. "This work will take nursing homes beyond compliance with rules. It will engage whole organizations in programs that aspire to ever-improving quality."

The nursing homes participating in the demonstration project will receive individualized technical assistance and form a learning collaborative for collective sharing of challenges and strategies to launch QAPI programs. The demonstration will run from September 2011 through August 2013.

CMS has developed a common framework for a QAPI program. The framework is made up of five elements:

1. Design and Scope
2. Governance and Leadership
3. Feedback, Data Systems, and Monitoring
4. Performance Improvement Projects
5. Systematic Analysis and Systemic Action

CMS is sensitive to the differences in nursing homes where residents live for long periods of time and have unique challenges related to quality of life, environmental quality, and individual choice. The five elements have been customized for nursing home QAPI. The program integrates safety and high quality clinical interventions with autonomy and choice in daily life for residents.

Both the University of Minnesota and Stratis Health are steeped in quality assurance and quality improvement, with long histories of research and direct assistance to improve care in nursing homes. Stratis Health offers nursing homes expertise on quality improvement, culture change, and organizational change, as well as facilitates improvement in clinical areas.