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‘Pathways’ Standardize Stage 2 Assessments

Dr. Andy Kramer
Provider Magazine – April 2010


What is a Critical Element (CE) Pathway?


A CE Pathway is a structured protocol to assist surveyors during Stage 2 in-depth investigations in a QIS. Stage 2 investigations assess compliance with regulation and utilize a structured protocol so they can be performed the same way every time.

This practice improves consistency of performance year to year and between survey teams, regions, and states. CE Pathways are derived directly from regulation and surveyor guidance and, like other Stage 2 investigative tools, lead to decisions about compliance.

In a QIS survey, a Care Area is a component of nursing facility care that is related to one or more quality-of-care and quality-of-life indicators (QCLIs), which are assessed in the Stage 1 preliminary investigation.

The objective of CE Pathways during Stage 2 is to determine if a facility has met the five Critical Elements of Care for a Care Area that has exceeded its threshold during Stage 1.

The five Critical Elements of Care that are assessed by a CE Pathway are:
Comprehensive assessments: Did the facility conduct an assessment regarding the risks and/or problems the resident has related to the diagnosis and/or condition(F-tag 272)

  • Comprehensive care plan: Did the
    facility develop a care plan to address
    the care and treatment related to the
    clinical diagnosis and/or the identified
    condition? (F-tag 279)
  • Care and services meet professional
    Did the facility implement
    practices that meet professional standards
    of quality? (F-tag 281)
  • Care plan revisions: Did the facility
    revise the plan of care as needed?
    (F-tag 280)
  • Provision of care and services: Did
    the facility provide care and services
    in accordance with the comprehensive
    assessment and plan of care that meet
    Care Area regulation? (Various F-tags
    that are specific to a Care Area)

In addition to the Critical Elements of Care, CE Pathways include investigation into related compliance requirements that vary depending on which Care Area is being investigated. It is apparent from looking at the Critical Elements that the first four will be assessed consistently by the same regulations in every CE Pathway.

That is why the frequency of these four F-tags is likely to increase when QIS surveys are being implemented in a new state.

Facilities can assess their own five Critical Elements in a Care Area by using the CE Pathways and following the structured protocol. Because the regulations and surveyor guidance do not change between traditional and QIS surveys, the resulting indications of compliance will be valuable to a facility no matter which survey process is being used.

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