Ask Dr. Kramer

Isn't the QIS the same as the MDS?

The QIS is not the same as the Minimum Data Set (MDS). The name Quality Indicator Survey does not mean that the QIS is based on the MDS quality indicators. It is based on a much larger set of quality indicators from multiple other sources including interviews of residents, family, and staff; observations of residents and facility practices; and record reviews. In fact, the vast majority of the deficiencies cited in QIS surveys (over 80%) do not originate from MDS data. MDS is an assessment instrument for residents, not a Nursing Home Quality management system. While clinical assessment of residents is a critical aspect of quality, we all know that much of nursing home care has to do with issues such as residents' freedom to make choices about their daily routine; respecting residents' privacy and dignity; providing necessary assistance with eating, dressing and ambulation; and the availability of activities. Even in the quality of care domains such as nutrition and incontinence, the QIS expands greatly on the MDS data. Therefore, even extensive experience in the MDS is not sufficient to utilize or train others in the QIS.

How much does the QIS rely on QI/QM results?

One of the principles behind the development of the QIS was that providing high quality nursing home care goes far beyond managing the selected clinical problems included in the MDS QIs and QMs. Resident-centered information on quality of life and quality of care obtained directly from residents and their families is necessary to assess the delivery of long term care. The QIS contains 136 new quality indicators covering quality of care and quality of life that are not included in the MDS QI/QM calculations. As a result, less than one quarter of the QIS indicators are based on MDS data. At Nursing Home Quality, we believe that a comprehensive quality system for nursing homes goes well beyond the MDS QIs/QMs.

How can a nursing home use the QIS for improving quality?

At Nursing Home Quality, our view is that QIS stands for the "Quality Improvement System." Although the QIS was designed for surveyors to conduct the Federal survey, the two-stage quality assessment tools that are used in the QIS provide the basis for a comprehensive quality assurance system for nursing homes. The QIS system will be most beneficial if used throughout the year, not just at survey time. If used correctly, these tools can help a nursing home assess their residents' quality of care and quality of life using structured information reported by residents, residents' families, and staff members; combined with information obtained through observation and record review. Significant training is required to use these QIS tools and is being provided by Nursing Home Quality. The forms used as the basis of the assessment by surveyors are posted on our CMS Forms page. To conduct a quality review and provide guidance on how to improve care, Nursing Home Quality is also developing an automated quality improvement system for nursing homes to submit their findings and receive statistical analysis based on the QIS standards. Sign up on our Contact Us page to receive QIS news, alerts about abaqis module releases and QIS training updates.

How do I get training in the QIS?

One of the difficulties in getting training in the QIS is that only a small group of individuals who have recently been working with the QIS have sufficient current knowledge to provide adequate training. Most of these individuals worked as part of the original University of Colorado training staff that contracted with CMS to train the surveyors in the demonstration states and that developed the content for the QIS surveyor training. That is why we started Nursing Home Quality — to bring the approved training and tools to you so that you can get the greatest benefit from the QIS process. Our trainers are experienced surveyors who trained the QIS demonstration surveyors and supervisors, and who developed the training curriculum under my direction. We are currently accepting pre-registration for our introductory QIS Training Webcast and we will soon be offering more advanced training and an automated quality improvement system. We are also available to conduct classroom training sessions at conferences or meetings and customized Web or audio presentations for smaller audiences. CMS is only allowing certified QIS trainers to train surveyors because the process is complex and must be conducted correctly. I strongly recommend that you review the credentials of those offering QIS training to make sure that they have the necessary knowledge and experience to help you.

If you have questions for Nursing Home Quality regarding the QIS please send them to info@nursinghomequality.com.