CHSRA researchers have developed PIP (Provider Initiative Project) to provide long-term care facilities in-depth Quality Indicator/Quality Measure (QI/QM) information using MDS assessment data. The heart of quality improvement is reliable information. CHSRA's state-of-the-art data submission and reporting system allows you to quickly and concisely analyze QI/QM status and trends for your facility. The data you receive will help your facility ensure quality care for all residents, improve your quality improvement process and survey performance. By submitting your MDS data electronically to CHSRA, you have access to a variety of important reports and resources for your facility at any time.

As a PIP member, your facility joins an elite group of facilities nationwide on the cutting edge of quality improvement.

PIP participants...

Securely submit MDS data electronically to CHSRA for analysis.
Access the ePIP Report Center to create and run a variety of specialized reports.
Access unique QI/QM reports only available through CHSRA, including:
Receive quality information based on 26 chronic QI/QMs and 3 post-acute QI/QMs.
Additionally, PIP members have access to quality improvement resources and tools, including
- Specific QI Guides and data collection tools
- "The Peer Facts" newsletters
- QI/QM training materials
Other valuable features, including Frequently Asked Questions, a Glossary, and a staffed Help Desk with a toll-free number to assist you in everything from installing ePIP software to understanding the QI/QM reports.

Why should your facility participate in PIP?

PIP helps staff improve MDS accuracy which is crucial to care planning, reimbursement, survey results, and the impending CMS public quality reporting initiative.
PIP examines the data behind the numbers and assists in identifying the underlying causes and interrelationships among quality problems.
PIP establishes benchmarks for quality comparisons and quality improvement trends over time.
PIP identifies care areas and individual residents to be targeted for specific quality improvement activities.
PIP incorporates risk factors and identifies residents at risk for specific adverse outcomes, enabling facilities to be proactive rather than reactive in care planning.
PIP helps determine real quality problems.
PIP integrates all staff and shifts in ongoing quality improvement activities.

MEMBERSHIP

If you value the features that PIP offers, you can be a part of this exciting project! For additional information about PIP services, please contact us by phone or email to discuss PIP membership.

Contact us at:
CHSRA
University of Wisconsin-Madison
ATTN: PIP
11th Floor WARF Building
610 Walnut Street
Madison, WI 53726-2397

Toll-free: 888-300-8098
Fax: 608-263-4523

ePIP

ePIP (CHSRA's electronic submission and report generation system) allows you to easily submit MDS data via a secure internet website. Submitting data to CHSRA does not, however, eliminate the requirement to submit MDS data to your state. You still must submit your data separately to your individual state for MDS reporting purposes.

QUALITY INDICATOR/QUALITY MEASURE HISTORY

This report is a list of your facility's QI/QM percentage for the current quarter and your facility's QI/QM percentages for the previous four quarters. This report can be used to view your population's QI/QM percentages over time and to see trends or changes and compare these results to the comparison group percentages.

Click here to view a sample report.

NEWSLETTERS

The Peer Facts newsletter offers a quick look at the quality indicators and some basic investigation tools and ideas.

View a sample of the Peer Facts Newsletter in PDF format.

QUALITY INDICATOR/QUALITY MEASURE GRAPHS

The Quality Indicato/Quality Measurer Graph report is a visual representation of your QI/QM percentages over time. The comparison group's averages, as well as the 25th and 75th percentile results are displayed on the same graph. The graphs can be run either by month or quarter; and you can choose to graph some or all of the QI/QMs. These graphs are a great way to view your QI/QM percentages over time, see trends or changes and evaluate your results against the comparison group percentages.

Click here to view an example of the QI/QM Graph.

INDIVIDUAL QUALITY INDICATOR/QUALITY MEASURE SERIES

The Individual Quality Indicator/Quality Measure Series report helps to make it easier to view all residents who flagged on a particular QI/QM. This is a new ePIP report which is not available from any state MDS system. It contains information similar to the Resident Quality Indicator/Quality Measure Summary Report; however, this report presents a separate QI/QM on each page. It can be used to look more closely at an individual QI/QM and see all the residents who flagged on that particular QI/QM. This series of reports could also be used to further investigate clinically linked QI/QMs.

Click here to view a sample of this new Individual QI/QM Series report. You can run this new report and all the reports from the Report Center page.

CHRONIC QUALITY INDICATORS/QUALITY MEASURES

Incidence of new fractures
Prevalence of falls
Residents who have become more depressed
  or anxious
Prevalence of behavior symptoms
  affecting others
Prevalence of symptoms of depression without
  antidepressant therapy
Use of 9 or more different medications
Incidence of cognitive impairment
Low-risk residents who lost control of their
  bowels or bladder
Residents who have/had a catheter inserted
  and left in their bladder
Prevalence of bladder or bowel incontinence
  without a toileting plan
Prevalence of fecal impaction
Residents with a urinary tract infection

Residents who lose too much weight
Prevalence of tube feeding
Prevalence of dehydration
Residents who have moderate to severe pain
Residents whose need for help with daily
  activities has increased
Residents who spend most of their time in a
  bed or chair
Residents whose ability to move in and around
  their room got worse
Incidence of decline in ROM
Prevalence of antipsychotic use in the absence
  of psychotic conditions
Prevalence of antianxiety/hypnotic use
Prevalence of hypnotic use more than two
  times in last week
Residents who were physically restrained
Prevalence of little or no activity
Residents with pressure ulcers

POST-ACUTE QUALITY INDICATORS/QUALITY MEASURES

Short-stay residents with delirium
Short-stay residents who had moderate to severe pain
Short-stay residents with pressure ulcers

REPORT CENTER

The report center is the place to start for all report related features of ePIP. There is a great deal of flexibility to the report selections, parameters and comparison groups that the user may choose. Here the user can:

Run the predefined CHSRA Standard Report Set with the simple click of a button.
Set up new Report Sets with any collection of reports and parameters and save these Report Sets to run whenever they choose.
Run individual report(s).
And an exciting new feature of ePIP is the ability to subdivide a facility into classifications for reporting purposes. The user can create classifications based on the MDS room number or resident name fields and then generate reports for specific groups or subgroups of the facility.

ePIP provides all the standard reports available from your state agencies as well as many new and exciting graphs and reports. Click here to view samples of many of the reports available to members of ePIP.

SPECIFIC QI GUIDES

The Specific QI Guides present a step-by-step process for the Assessment of MDS Information, Decision Making, Care Planning, Implementation and Monitoring/Evaluation phases of QI investigation. They include a thorough list of references, recommended reading, websites for further review, and appendices.

DATA COLLECTION TOOL

The Data Collection Tool helps you select a sample of residents and to systematically examine whether your facility has a problem in a particular care area.