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QIS Use In Continuous Quality Improvement

Dr. Andy Kramer
Provider Magazine – February 2010


What are the differences between surveyors using the QIS for state surveys and facilities using it for continuous quality improvement (CQI)?


There are a few primary differences. To begin, the goals of state survey and facility CQI are different. Surveys are specifically focused on determining non-compliance with regulation. The survey is time- and resource-constrained, typically conducted by a team of four within a time allocation of about one week.

The QIS process is designed to provide a survey team with the ability to statistically infer quality of care and quality of life at a facility as it relates to regulatory compliance within those constraints.

On the other hand, facilities can utilize the QIS methodology on an ongoing basis to fulfill some core concepts of CQI, such as meeting the needs of those that the facility serves; focusing on processes and systems, rather than only individual circumstances; promoting the need for objective data to analyze and improve processes; applying the scientific method to everyday work; utilizing small, incremental changes to achieve CQI.

‘The QIS process is designed to statistically infer quality of care.’

Another key difference between QIS and CQI are sample sizes. In a state survey, samples of residents used for Stage 1 assessments are the minimum required to make valid statistical inferences for the purpose of determining if in-depth compliance investigations are warranted.

The survey sample size would not usually provide a large enough resident cross-section to analyze results by clinical or physical areas of a facility, such as floors, units, or wings.

Stage 2 samples are the minimum required to determine compliance, which are generally not large enough to properly conduct CQI.

Facilities may increase their sample size to provide a much broader cross-section of the resident pool so that root-cause analysis, which improves as the sample size grows, is improved and actionable results are more readily produced. Many facilities seek to perform Stage 1 assessments on all residents in a facility. A facility can increase its Stage 2 samples to provide better in-depth analysis so that improvement efforts are comprehensive.

However, Stage 1 assessments can be conducted on 10 percent of the resident census each week for 10 weeks, resulting in an assessment of the entire census over that period. Continuing this rate of assessment would capture new residents and allow repeat assessments to monitor the effectiveness of quality improvement efforts.

The metrics utilized in the QIS methodology allow facilities to apply the core steps in CQI, as follows:

  • Define clear goals—improvement of quality of care and quality of life for residents.
  • Understand the needs of the people who are served by the system.
  • Identify and define measures of success.
  • Determine change strategies for producing improvement.

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