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How Can QIS Boost Quality Assurance?

Dr. Andy Kramer
Provider Magazine – December 2010


How can QIS boost quality assurance?


One of the opportunities with the objectivity and replicable measures in QIS is that providers can use the QIS process and its results as a basis for quality assurance (QA) and performance improvement in survey results. State agencies have conducted approximately 5,000 QIS surveys during the past two or three years, and sufficient data exist to see some of the preliminary effects of the process.

One way to do this is to trend the average number of QIS deficiencies over time in comparison with the average number of traditional survey deficiencies over time. Average numbers of deficiencies over successive six-month periods, from October 2007 through March 2010, showed that deficiencies resulting from traditional surveys had no steady pattern of change, but did show an overall decrease from 7.3 to 6.3 deficiencies over this period.

Over the same 30 months, QIS deficiencies decreased steadily, starting out higher at 9.7, because it is a more rigorous and comprehensive process, but decreasing by almost 2.5 deficiencies to 7.3 deficiencies as providers addressed the quality issues raised in earlier QIS surveys.

Similar trends were revealed within states as QIS rolled out. A plausible reason for this decrease is that QIS survey metrics are explicit and can be addressed by staff as they learn from their experiences. This can lead to improved quality if providers address the concerns, as well as better survey results.

An analysis of changes in QIS survey deficiencies in matched pairs of two successive surveys in the same nursing facility revealed that individual nursing facilities typically improved by an average of about two deficiencies between two surveys. Some improved by more, some got worse, and others stayed the same, but on average they improved by two deficiencies. However, replicating a rigorous QA process based on QIS metrics prior to the survey was associated with greater survey improvement.

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