Like the proposed Quality Measures (QMs), the MDS 3.0-based QCLIs include prevalence and incidence measures. A prevalence measure is simply reporting the number of residents that have the condition on their most recent OBRA or PPS MDS. An important difference between prevalence measures in the Quality Measure (QM) data specifications and those in the QCLIs is that those in the QCLIs do not exclude Admission assessments. One example is Prevalence of Indwelling Catheter which is simply a measure of how many residents had an indwelling catheter recorded on their most recent MDS. If greater than 14.8 percent of residents have an indwelling catheter, this area would be flagged for investigation in Stage II. Other QCLIs measure incidence (or change between two points in time); one example is Incidence of Decline of Range of Motion. This QCLI is comparing range of motion (ROM) on the most recent assessment to the ROM on the prior assessment. If there is a decline noted between the two assessments, the resident will be counted into the numerator for this QCLI. If greater than 18.1 percent of the residents meet the definition, there will be an investigation of the care and services related to Range of Motion in the Stage II. There are several pairs of assessments that will be used to calculate the incidence QCLIs. For instance (like the ROM measure discussed above) some will use the previous and most recent assessments; some (like Increase in Rejection of Care) will compare the resident's status between admission and approximately one quarter later and another (Lack of Transferring Rehabilitation Status) will compare PPS 5-day and 30-day assessments for a given resident.
It is important to note that exceeding the threshold for a QCLI does not mean there is a deficient practice; compliance is not determined until Stage II investigation occurs. When a QCLI is exceeded, the particular area will be investigated fully in Stage II. When using the QCLI information in continuous quality improvement (CQI) activities in the facility, it is critical that facilities investigate residents who potentially meet the definition whether or not the facility exceeds the threshold for the QCLI. Certainly those areas where a threshold is at or near zero should take precedence for being aggressively addressed but all of the QCLIs represent an opportunity to examine care practices and outcomes. The QCLI Dictionary is available at www.QTSO.com along with the all of the QIS tools. It is imperative that providers familiarize themselves with the tools. All staff (including direct-care staff) must be aware of the survey process changes that will accompany QIS. Facility staff should be aware that frontline nursing management (e.g., unit charge nurses) will have a tremendous amount of interaction with the surveyors during a QIS. Their preparedness through education and training is critical to your QIS success!