Quality Assurance Performance Improvement

QA is the specification of standards for quality of service and outcomes, and a process throughout the organization for assuring that care is maintained at acceptable levels in relation to those standards.

PI (also called Quality Improvement - QI) is the continuous study and improvement of processes with the intent to better services or outcomes, and prevent or decrease the likelihood of problems, by identifying areas of opportunity and testing new approaches to fix underlying causes of persistent/systemic problems or barriers to improvement.

Five Elements

CMS has developed a general framework for implementing a QAPI program in nursing homes, based on five key elements of effective quality management. Click here for detailed information on the Five Elements.

QAPI Regulatory Background:

The existing Quality Assessment and Assurance (QAA) provision at 42 CFR, Part 483.75(o) specifies the QAA committee composition and frequency of meetings in nursing facilities and requires facilities to develop and implement appropriate plans of action to correct identified quality deficiencies. This provision provides a rule but not the details as to the means and methods taken to implement the QAA regulations. CMS is now reinforcing the critical importance of how nursing facilities establish and maintain accountability for QAPI processes in order to sustain quality of care and quality of life for nursing home residents.

QAPI Tools and Resources:

Process Tool Framework
Implementing Change in LTC
National Nursing Home Quality Care Collaborative Change Package
QAPI At A Glance
QAPI Written Plan: How To
AHRQ TeamSTEPPS
New England QIN-QIO
Topic-Specific Resources


Staff Contact: 
Danielle Watford
Director of Quality Improvement & Regulatory Affairs