Performance Improvement Project Implementation: Ensuring Home Health QAPI Compliance

Having a Quality Assurance and Performance Improvement (QAPI) program is mandated by the new Home Health Conditions of Participation (CoPs). While home health agencies should already have their QAPI programs up and running, you have until July 13, 2018 to implement and document at least one performance improvement project (PIP) to ensure compliance with the CoPs.

The performance improvement project process includes identifying opportunities and implementing measures designed to improve the quality of patient care as well as organizational performance.

While the current draft of the Conditions of Participation for Home Health Agencies Interpretive Guidelines does not provide any guidance regarding what surveyors should look for when it comes to performance improvement projects, there are steps that your agency should follow to ensure compliance.

How to Identify a Performance Improvement Project

The first step in developing a performance improvement project is identifying and prioritizing area(s) for improvement. You should review all aspects of your agency, including clinical care processes, non-clinical processes, and regulatory requirements. While reviewing these areas, pay close attention to topics that are meaningful and address the needs of both patients and staff.

Use analytics from a number of data sources such as Home Health Compare, HHQI reports, CASPER reports, Home Health CAHPS survey results, on-site survey deficiencies, EHR software, and other analytic tools to uncover where performance improvement projects are needed most. You should also consider feedback from patients, families, and staff members as well as “near misses,” incidents, and high-risk situations.

Once you have identified areas that require improvement, use this performance improvement project prioritization worksheet to identify potential areas for PIPs. The worksheet considers factors such as high-risk, high-volume, or problem-prone areas that affect health outcomes and quality of care.

Some examples of areas that home health agencies could focus on include: reducing the number of patients who are discharged with uncontrolled blood pressure, improving patient understanding of medication usage and dosage, reducing the prevalence of pressure ulcers among high-risk patients, reducing rehospitalizations, etc.

How to Develop a Performance Improvement Project

Once you have identified and prioritized the area(s) that need improvement, you can then move on to developing your performance improvement project. Use this performance improvement project charter worksheet to clearly outline the key components of your PIP, provide team members with a clear understanding of the components, and help your team stay focused on the project. Key elements of a solid charter include:

Problem to be solved
Be brief and specific, describing when and how often the problem occurs, and what the impact is on your patients and your agency when it occurs.

Background leading up to the need for the performance improvement project
This is where you can provide supporting evidence and specific background documents to support the need for the PIP.

Goal(s) for the performance improvement project
Your goals should be clearly stated, describing what your agency or QAPI team intends to accomplish.

Project scope
Define what is involved in the project and what is not. It is important to identify the tools, services, processes, departments, and locations during the project definition phase.

Recommended time table
Identify when you expect each phase of the project to begin and end. This should include initiation of the PIP, planning, implementation, monitoring, and closing.

Project team & responsibilities
Identify who will provide overall direction and oversee financing for the project, who will coordinate the activities of the project team, and who will manage the day-to-day project operations.

Resources required
Indicate any equipment, software, supplies, etc. needed to manage the performance improvement project.

Barriers
Analyze what could get in the way of your success. What can you do about these barriers?

Project approval
Have each member of the team sign off on the project charter, indicating their understanding of the purpose and approach to the project.

How to Launch a Performance Improvement Project

Following the development of your PIP, the next step is to implement the project. Refer to this checklist to successfully launch your PIP, ensuring that all important steps have been taken, saving time and confusion among project team members.

Project stakeholders & team members

Ensure that the project charter is understood and accepted by all project team members. Roles should be assigned and each member should understand how the project fits with the overall goals of the agency.

Project resources

Make sure that you have secured and allocated the resources necessary to launch the project. Ensure that budget has been established and approved, and staff time has been designated for project work.

Project process

Prior to launching your PIP, you will want to be sure that a schedule has been set, goals have been established, and methods for monitoring progress are in place.

How to Monitor a Performance Improvement Project

Now that you have launched your performance improvement project, your job is done, right? Definitely not! Following project launch, you will need to monitor and document your progress so you can make changes and take action. How you do so will have already been laid out in your project charter.

In order to monitor your progress with the PIP, you will want to make sure that you have clearly identified what measure(s) or indicator(s) should be used. You will also need to know how that data is to be collected. Can the information be found and reported from within your EHR software? Is it data that can be retrieved from your CASPER reports?

Once you have completed the performance improvement project, you will want to report and review the results with your QAPI team. Consider utilizing a storyboard guide for PIPs that can be used to simply and clearly communicate the story of your PIP by providing only the most essential information and including easy to understand graphs and/or charts that clearly demonstrate the impact of your efforts.

Your storyboard should include:

Problem
Describe the issue that is being addressed by the PIP.

Goal
Explain the goal of the PIP.

Intervention(s)
Describe what change and/or changes were introduced to address the issue.

Measures & Indicators
Identify what measures or indicators were used to monitor the effectiveness of the intervention(s).

Results
Discuss the impact of the interventions over time, utilizing charts and graphs for easy understanding.

Lessons Learned
Indicate a couple of key lessons that were learned through the PIP.

Next Steps
Identify what steps should be taken next to improve upon the PIP. Do you need to refine the intervention? Do you need to standardize the intervention? Did you achieve success with this PIP? Are you ready to establish new PIPs?

Performance improvement projects are important not only for regulatory compliance, but when the processes of performance improvement work effectively, home health agencies can see a positive difference in their care quality, outcomes, patient satisfaction, and publicly reported performance scores.

Want to learn more about the CoPs? HEALTHCAREfirst has created a thorough Home Health Conditions of Participation Resource Hub to give you the latest information through FAQs, guides, expert blog posts, and recorded webinars.