QAPI Program Utilization_Manual

LEVELS OF PERFORMANCE, PATTERNS, TRENDS, AND VARIATIONS Quarter: _______________ Quality Assurance, Performance Improvement Program Page 2 PATTERNS : Total of patients with: Nursing services only: _______________ Therapy Only services: ___________ Personal Care only: _________ Multiple discipline: __________________ Skilled Services + MSW: _________ Frequency of visit compliance: _____ % Total long term cases (more than 2 episodes): ___________ Total of D/C goals met: _______ Total of Recerts: _________________ Total of re-admissions: _________________ Pattern on diagnoses (mark only the most cases admitted or re-certified) : 9 Diabetes 9 Wound Care 9 Therapy 9 BP monitoring 9 Respiratory Problems 9 Infections 9 Pain management 9 Other: ____________________________________ Most Prognosis: 9 Fair 9 Guarded Referral sources: Doctor Office ____ % Hospital: ____ % Place of services: Patients home ____ % ALF/Nursing Home: _____ % Hospice: ____ % Other: ______ % Average visits/episode: ___________ Cost/episode: 9 fair 9 above average 9 bellow average TRENDS : 9 Reimburse, billing problems ____ % 9 N/A 9 Disposition of capital for increase service, marketing 9 Big volume of ADR (chart review requested by CMS or subcontractors) 9 Shortage of staff: 9 nurses 9 therapists 9 aides 9 MSW 9 Face to Face documentation problems 9 Difficult to Orders, POC signed on time 9 Increase in operational costs (supplies, salary, utilities, etc) 9 Increase in regulations, laws, surveys 9 High competitive area, great volume of home health agency 9 Documentation problems, QA/PI problems 9 Problems following POC, Medication Management 9 Problems with communication with patient’s physician New technologies implementation, EHR, etc Increase in accreditation fees, license fees 9 Other: _____________________________________________________________________________________________________________________ Action Plan to solve problems: ___________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ VARIATIONS : 9 Increase in Adverse Events 9 Patient satisfaction survey un-satisfactory ____ % 9 Incidents, risk factors 9 Un-met goals discharge _____ % 9 Patients complaints _______ % Medication Plan 9 Hospitalizations __________ % Compliance ____ % 9 Other: ____________________________________________________________________________________________________________________ Report completed by (Name/Title): _______________________________________________ Date: _____________ 9 Discussed by BD Signature 153