Q. Does using the QIS process for quality improvement lead to better survey performance?

A.We now have data on the pattern of use by nursing facility providers so that we can determine the use characteristics that resulted in improved survey results.

The study looked at the following three groups of facilities over three annual survey cycles: facilities with substandard quality before using the system (n=117); facilities with good quality that used the system continuously and at a high level (n=168); and facilities with good quality that used the system at sporadic and low levels (n=166).

Facilities ranged from single facility organizations to members of large multifacility organizations and represented multiple states.

Facilities with prior substandard survey results had an average reduction of 3.4 survey deficiencies after using all of the QIS assessments continuously at a moderately high level for at least one year. Facilities with prior good survey results had an average reduction of 1.5 survey deficiencies with continuous high level of use for at least one year. Facilities with prior good survey results had no change in average survey deficiencies with sporadic and low-level use.

Results of this study strongly suggest that both facilities that are struggling with quality of care and high-performing facilities can improve using a Quality Assurance and Performance Improvement (QAPI) system based on QIS methods.

The study also showed that improvement takes a commitment to continuous use by facility staff involved in patient care, rather than the “mock survey” approaches during a survey window, such as the sporadic users.

Not surprisingly, it took more comprehensive QAPI to achieve additional quality improvements in already high-performing facilities; however, this group with high use on average achieved a 22 percent improvement in one year.

It should also be recognized that it took more than simply conducting the Stage 1 assessments to have an impact. Successful organizations used the root-cause analysis and investigation methods included in the system to conduct their QAPI process. Thus, it appears that nursing facilities have the tools available to them to improve survey results; the challenge is to engender staff commitment to consistent adherence with a QAPI program.

Andy Kramer, MD, is a long term care researcher and professor of medicine who was instrumental in the design and development of the Quality Indicator Survey (QIS).