Revision 16-1; Effective February 3, 2016

 

Evidence-based best practices are based on the best available studies, clinical trials and research that show which practices produce the best results. This is the standard of the Quality Monitoring Program (QMP). The goal is to help facilities to use evidence-based best practices to improve care systems and resident outcomes. The information that quality monitors (QMs) provide on evidence-based best practices is based on clinical science.

Through the provision of technical assistance during the visits, QMP staff focuses on specific, statewide quality improvement priorities for which evidence-based best practices can be identified from published clinical research. DADS encourages the use of evidence-based best practices to promote the highest-quality care to Texas nursing facility residents.

 

Focus Areas

 

The term “focus area” is used to refer to the specific clinical areas in which QMs provide technical assistance. These include:

  • Advance care planning;
  • Appropriate use of antipsychotic, antidepressant, anxiolytic, and hypnotic drugs;
  • Dehydration;
  • Dementia care;
  • Documentation;
  • Enteral nutrition;
  • Fall risk management;
  • Immunizations;
  • Infection control;
  • Medication regimen simplification;
  • Pain assessment and management;
  • Preadmission Screening and Resident Review (PASRR);
  • Pressure ulcers;
  • Restraint reduction; and
  • Weight management.

Focus areas are identified for the development of evidence-based best practice frameworks in a variety of ways, including:

  • Information from the Centers for Medicare and Medicaid Services (CMS) quality measure reports that indicate Texas lags behind other states;
  • Stakeholder input; and
  • DADS initiatives.

 

Focus Area Selection during QM Visits

 

Currently, all QM visits include a review of the use of antipsychotic medications in individuals with dementia, as well as the PASRR process. The selection of additional focus areas during a QM visit will be data driven, and will be prioritized based on the impact to residents' health and safety, and on quality of care. Data resources used to determine the selection of focus area include:

  • Certification and Survey Provider Enhanced Reports (CASPER);
  • Long-Term Care (LTC) Provider Search;
  • CMS Nursing Home Compare; and
  • Reports from previous QM visits.

 

Technical Assistance

 

The QM reviews resident care in each selected focus area, looking at the appropriateness of assessments, care planning and outcomes. The technical assistance that QMs provide during monitoring and rapid response team visits is intended to help providers improve these three aspects of the care process. QMP staff use structured evaluation tools to help determine whether improvements in a nursing facility's clinical systems are needed. These tools incorporate the key elements of best practice for each focus area.

An assessment gives providers important information about the specific needs of the resident and identifies not only potential problems, but also the resident's strength, abilities and preferences. Care planning incorporates the information identified during assessment, using that information to develop person-centered interventions to meet the resident's needs. Interventions are periodically evaluated to determine whether or not they are effective. Based on the evaluation, the plan of care may be updated.

After each visit, facilities receive a summary of the QM's findings. The report is organized according to the focus areas addressed during the visit. Each focus area includes the QM's findings on resident assessment, care planning and care. These reports give providers a written record of the visit, and serve as a reference for providers as they undertake changes in care practices to address the improvement opportunities identified during a visit.

Note: These reports are not shared with DADS Regulatory Services Division.