QI, PI, QA – Making Sense of Alphabet Soup (Part 2)

Welcome to Part II of our series entitled QI, PI, QA – Making Sense of Alphabet Soup.  In the last installment, we discussed the basics of the QI mindset and the elements of a solid QI program.  In this blog, we will review the guidelines of a typical QI study.

Once you’ve identified areas where your agency’s performance varies from the requirements, you need a plan.  The field of quality improvement is big on measurement, objectivity and study.   Don’t just assume something’s a problem.  Study it.  Let’s say you discover a problem with supervisory visits not being performed in a timely manner.  It’s a good idea to document what you are going to study so that everyone understands the parameters and you can assure consistency of measurement and reporting.  Here is an example:

On 1/1/12, Best Home Health created a quality study of supervisory visits.  The QI Manager will review charts of all patients on service during every quarter of 2012, and document the presence of HHA supervisory visits performed every 14 days, and LPN and PTA supervisory visits conducted every 30 days. The audit goal is 100% compliance with the supervisory visit schedule. This will be done by reviewing the notes filed in the patient charts and filling out the Supervisory Visit Audit Tool.  A report will be given to the QI Committee every quarter.

This little blurb tells you a few important things:  The period of time being studied (every quarter of 2012), the person responsible for the study (QI Manager), the nature of the study (supervisory visits), the parameters (HHA every 14 days, LPN & PTA every 30 days), the goal (100% compliance), the method of study (reviewing visit notes), the data collection process (using the Supervisory Visit Audit Tool), and the reporting schedule (to the QI Committee every quarter).

The next step is to gather your data.  Do a review of a sufficient time period; in this case, the audit is quarterly and involves reviewing the notes for the entire quarter.  Based on the outline of the quality study discussed above, your Supervisory Visit Audit Tool could look something like this: (click here for an example)

Note the section for scoring and recall that we explained that the field of QI requires objective measurement.  A score tells you quickly and without bias whether your agency is meeting the requirement or not.  There’s no leeway; either the supv visit was done or it wasn’t.  In this case, you would score the audit as follows:

[# Yes divided by the (# Yes + # No)] x 100%

Here is an example: (click here)

For Patient #23:  [# Yes (2) divided by the # Yes + # No (2+0)] x 100% = (2 )2) x 100% = 1 x 100% = 100%

For Patient #28:  [# Yes (1) divided by the # Yes + # No (1+2)] x 100% = (1 )3) x 100% = .33 x 100% = 33%

For Patient #19:  [# Yes (1) divided by the # Yes + # No (1+1)] x 100% = (1 )2) x 100% = .5 x 100% = 50%

Here is an example: (click here)

In the next part of our four-part series on Quality Improvement, we’ll discuss what to do with your audit results which, in our example, indicate a serious compliance problem.

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