101 Guide: Quality Assessment and Performance Improvement (QAPI)

In today’s rapidly evolving healthcare landscape, quality assessment and performance improvement (QAPI) are crucial. These practices are essential for healthcare organizations that aim to enhance patient care while meeting regulatory and payer expectations.  

That’s why we sat down with Mandi Diamond, senior practice transformation advisor at DataGen, to discuss the nuances. Read on for essential information on QAPI and how to measure your quality data. 

What is quality assessment and performance improvement? 

Defining quality assessment 

The National Institutes of Health (NIH) defines quality assessment (QA) as "the measurement of the technical and interpersonal aspects of health care and the outcomes of that care."  

Diamond expands upon that definition, describing QA as the systematic evaluation of outcomes within an organization to measure the success of essential workflows. 

Both definitions touch on the use of repeatable and systematic evaluations to measure the success of certain workflows, focusing on the practice’s growth and maturity. This process involves collecting numerical data with clearly defined parameters to ensure ongoing consistency.  

Defining performance improvement 

Diamond noted that performance improvement (PI), on the other hand, refers to assessing these outcomes to set achievable goals and interventions, assigning ownership and establishing timeframes for advancement. Examples include: 

1. Reducing medication errors: documenting medication reconciliation consistently upon receiving patients from transitions of care is imperative to maintain prescription and dosing accuracy. 

2. Increasing access: feedback from patients regarding practice-patient connection should be collected and assessed. Increasing hours, offering telemedicine or calling patients back timely leads to reduced use of EDs and urgent care centers.  

3. Decreasing gaps in care: implementing patient communications on various platforms to remind them of necessary care, visits or services that are overdue drives improved outcomes and healthier patients.  

4. Improving chronic disease management: by leveraging data from electronic health records (EHRs) and adhering to evidence-based medicine, healthcare organizations can track and monitor patients with chronic diseases like diabetes or hypertension, leading to quick interventions and reduced hospitalizations. 

5. Increasing patient satisfaction: introducing patient-centered care models where care teams actively involve patients in decision-making has boosted patient satisfaction scores, as seen in institutions that have improved communication and support services. 

6. Optimize screening opportunities: understanding the whole person from a medical and behavioral health perspective, and their social determinants, guides treatment plans that meet patients where they are. Screening tool use uncovers patients' needs in various areas of their wellbeing.  

7. Reducing disparities of care: approaching patients with vulnerabilities such as using materials in diverse languages, sliding payment scales and culturally competent clinical teams impacts patients' comfort with a practice. This is a good foundation for advancing equitable care under NCQA’s Health Equity Accreditation. 

The role of quality performance assessments 

Quality performance assessments measure crucial aspects of a practice, including: 

• clinical outcomes; 

• cost and utilization; 

• care coordination across departments; 

• patient and staff experiences; 

• access to care; and 

• health equity. 
  
  

These assessments hold practices accountable to internal and external goals, payer benchmarks and other contractual obligations. Importantly, they provide a framework for aligning efforts and reducing reporting fatigue — a common challenge in healthcare settings. 

Conducting effective data quality assessments 

Diamond outlines a clear strategy for performing data quality assessments: 

1. Determine data collection frequency: define when data will be collected and reports generated. 

2. Assign accountability: identify team members responsible for data collection. 

3. Identify data sources: understand where electronic reports come from and what they measure. For example, ask questions like, "Are we documenting in the right places for the reports to best reflect our daily interventions?" and "Which of our systems is responsible for which report?"  

4. Streamline manual reports: develop efficient methods for gathering data to complete deliverables on time. However, this only applies if you do manual reporting. 

5. Establish a tracking system: document statistics over time, i.e., measurement periods, to identify trends and improvements. 

Assessing quality performance 

Assessing quality performance effectively requires a team-based approach. Diamond emphasizes the importance of open conversations about quality improvement (QI) measures, setting reasonable goals and implementing feasible interventions.  

Regular re-evaluation and communication are key to achieving meaningful results. This approach ensures buy-in from all team members, fostering motivation and a sense of ownership in driving organizational success. Here's an outline:  

1. Create ownership: Quality performance must be done as a team, not in a silo. PI only works if the whole team is involved, as everyone interacts with patients in one form or another.   

2. Foster open conversations: QI measures should be discussed outwardly, and current statistics should be reviewed at a desired frequency. 

3. Set achievable goals: For example, if you’re currently at 49% adherence with flu vaccines, your goal should not be drastic, like 90% adherence. This creates unreasonable expectations and sets the team up for failure. Instead, setting a 52% adherence goal would be within reason.   

4. Review possible interventions: This is the time to get feedback from employees who interact daily with patients and the measures in question. The care team members are subject matter experts. These ideas and interventions help leadership identify the best places to move the needle, determine the feasibility of certain implementations and assign responsibility. 

5. Set reasonable and realistic timelines: You need to determine how long it will take to implement the interventions you identified. Then, after implementation, you’ll have to give a reasonable amount of time for your interventions to “simmer.” In other words, you'll want to check back in on progress in certain intervals before changing what you just implemented. This will allow your efforts to be most effective. So, re-measure when appropriate and set a frequency for that.   

6. Revaluate each measurement: You can take this time to celebrate your accomplishments with your team. It may also be useful to talk with staff about interventions that aren't working so well and reflect on why. This will provide you with brainstorming opportunities to be agile and improve. 

The power of quality data 

Quality data is a powerful tool that can transform perceptions into reality. It provides: 

• clarity through goal alignment and data interpretation; 

• incentives in the form of ROI and payments for meeting benchmarks; 

• a pathway to advancing value-based purchasing (VBP); 

• enhanced reputation by sharing successes internally and externally; 

• motivation for teams to actively contribute to organizational achievements; and 

• healthy competition that drives continuous improvement. 

DataGen: Your strategic partner in QAPI 

Quality assessment and performance improvement (QAPI) are foundational pillars for driving excellence in healthcare. By implementing robust QAPI programs, practices can enhance outcomes, increase efficiency and maintain compliance with regulatory standards, such as the Affordable Care Act and CMS guidelines. 

With thorough quality assurance assessment and the implementation of data-driven solutions, healthcare practices can consistently evaluate and enhance their performance. 

For healthcare professionals, practice managers and quality improvement teams, DataGen’s value-based care consulting solution offers a pathway to achieving sustainable results. By leveraging quality data and performance assessment tools, organizations can transform challenges into opportunities for growth and success. We can provide you with:  

• Quality improvement (QI) templates used for data collection and reporting, e.g., QI meeting minutes, agendas, slides, etc.; 

• expert guidance on how to interpret, apply and assess QI data; and 

• education on the measures practices are accountable for and how to work with electronic vendors to maximize reporting. 

Contact DataGen today to transform challenges into growth opportunities. To learn more about how DataGen can support your practice in achieving its quality improvement goals, from short- to long-term care, visit our website and explore our range of solutions. You can also explore our blog on how to unlock the potential of value-based payments. 

This content is for informational purposes only. It has been partially generated from an AI language model, which may not always be exhaustive or tailored to individual circumstances. We encourage you to contact one of our experts for more information. We assume no liability arising from any use of this content.