Overview

The Quality Indicator Survey (QIS) is a revised long-term care survey process that involves two stages of review. In the first stage, preliminary investigations are conducted through structured resident, family, and staff interviews, resident observations, record reviews, and analysis of Minimum Data Set (MDS) data. These tasks, in combination with structured facility reviews, yield 162 Quality of Care and Quality of Life Indicators (QCIs) that are compared with national norms to identify Care Areas for further investigation in the second stage of the QIS survey. The second stage involves in-depth quality investigations using Critical Element Pathways that address assessment, care planning, care provision, and reassessment. The Care Areas are mapped to specific F tags.

History of QIS

The original two-stage quality assessment approach on which the QIS is based was developed under Dr. Kramer's leadership at the University of Colorado in 1993. The first test of the two-stage approach as a survey process involved concurrent surveys conducted by Colorado and Massachusetts surveyors in 1994 (See Kramer et al., Pilot Test of a Staged Quality of Care Survey Using Quality Indicator Profiles, University of Colorado, September 1995). The University of Colorado team continued to use and refine the two-stage quality assessment for research, including a study conducted for the General Accounting Office that led to Senate testimony by Dr. Kramer about the nursing home survey process. Subsequent to the Senate hearings, the Centers for Medicare and Medicaid Services (CMS) let a contract under the leadership of the University of Colorado and University of Wisconsin to expand the two-stage quality assessment process to more regulatory areas. This contract was completed in 2003 and resulted in the QIS, which was automated for state surveyor use by CMS.

The QIS Demonstration

A demonstration of the QIS in six states was begun in September 2005, led by Dr. Kramer's University of Colorado research team. Two survey teams in three states, Connecticut, Kansas, and Ohio, were initially trained in the QIS process. The training consisted of one week of classroom training, followed by a complete training survey. Subsequently, two surveys of record were conducted by each survey team during which University of Colorado trainers assessed surveyor compliance with QIS protocols. Beginning in February 2006, two additional survey teams were trained in California and Louisiana. Florida was added to the demonstration in October 2006 to test a statewide implementation approach to prepare for a national QIS rollout. Go to our QIS News page to learn about the status of the demonstration and the national rollout of QIS.

QIS Objectives

The QIS has four objectives:

1. Improve consistency and accuracy of the survey
2. Comprehensively review more regulatory areas within current survey resources
3. Enhance documentation through automation
4. Focus survey resources on facilities with the greatest quality concerns

QIS Strengths

• Larger Samples - The QIS includes review of up to 40 residents residing in the facility at the time of the survey and up to 30 residents that were admitted in the prior six months.
• Comprehensive - Upon completion of Stage I and the required facility level tasks, surveyors have directly reviewed more quality of care and quality of life regulations than in the current process.
• Objective - Structured interviews, observations, and record reviews combined with use of the Critical Element Pathways result in a more objective, consistent, and accurate process.
• Focused - Although Stage I takes approximately two days in all facilities, the duration of stage II is directly related to the number of Care Areas identified in Stage I as requiring more in-depth review.

If you have any questions about the QIS structure or process, please e-mail Dr. Kramer at dr.kramer@nursinghomequality.com. The answers to your questions may be posted in our next Ask Dr. Kramer segment.