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Long-Term Care: Managing Across the Continuum, Fourth Edition John R. Pratt


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Defining Quality

 Means different things to different people and different things in different


 Includes both technical care and the management of the interpersonal exchanges

between residents and providers.

 Includes three generally accepted measurement types: structure, process, and


 Structure – organizational makeup.

 Process – how care is delivered.

 Outcomes – results of care.

 Quality of life refers to the total living experience, which results in overall

satisfaction with one’s life.

Total Quality Management/Continuous Quality Improvement

 Has been used extensively in business and industry for years.

 An organized quality program based on concept that those delivering the care

want to do a good job and know how.

Quality Initiatives – growing emphasis on measuring and improving quality in long-

term care.

 System-Wide Quality Programs – include both government and private programs.

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© 2010 Jones and Bartlett Publishers, LLC




Long-Term Care: Managing Across the Continuum, Fourth Edition John R. Pratt

 Government Programs – have historically consisted mostly of regulating quality,

but have recently included quality information initiatives.

History of Government Quality Regulations

 Quality Assurance – an early method of quality management that identified

quality issues and set minimum standards to be met for the issues.

 Quality Assurance and Performance Improvement (QAPI) program as proscribed

by Section 6102(c) of the Affordable Care Act

 Minimum Data Set (MDS) for Long-Term Care – a means of structuring the

assessment of nursing facility residents.

 OASIS – an assessment tool for home health care, called the Outcomes and

Assessment Information Set (OASIS).

 Quality Improvement Organizations – CMS-contracted organizations that

review medical care and help beneficiaries with complaints about the quality of

care and to implement improvements in the quality of care available throughout

the spectrum of care.

 Pay-for-Performance – involves identifying procedures for which providers will

not be reimbursed as CMS identifies them as not necessary or resulting from poor


Public Information Quality Initiatives

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© 2010 Jones and Bartlett Publishers, LLC




Long-Term Care: Managing Across the Continuum, Fourth Edition John R. Pratt

Nursing Home Compare – designed to identify certain quality measures and to

show how individual facilities compared to the preset standard and to each

other. The information is available on the CMS website.

 “Five-Star” Ratings – a rating system based on the quality and safety

information on Nursing Home Compare to help beneficiaries, their families,

and caregivers compare nursing homes more easily.

Quality-Related Research – government agencies that fund and publish quality


 AHRQ – Agency for Healthcare Research and Quality funds quality-related


 National Library of Medicine – collects materials and provides information

and research services in all areas of biomedicine and health care

Private Quality Programs – nongovernment programs focusing on quality in health


 Quality First – a voluntary initiative created by several leading long-term care

professional organizations and designed to improve the quality of nursing home

care and other long term care services.

 AHCA/NCAL Quality Award: a criteria-based program that recognizes a

commitment to performance excellence by member facilities.

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© 2010 Jones and Bartlett Publishers, LLC


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