Qualilty
Focused on improving participant outcomes and experience
What is Quality?
Required proof that care or action was completed
What is documentation?
Required action when a grievance is received
What is follow-up, investigation, and resolution?
A key measure used to evaluate how well a process is working
What is a performance metric?
This team develops the participant’s care plan
What is the IDT (Interdisciplinary Team)?
This identifies patterns like falls, hospitalizations, or repeated concerns
What is quality trend?
These are set federal standards for PACE Programs
What is PART 460 (PACE) Regs?
A participant expression of dissatisfaction
What is a grievance?
Example: IDT care plan signatures are not completed same day
What is compliance program gap?
This should guide all IDT decisions
What are participant needs and safety?
This is used to improve processes and systems of care
What is quality improvement activities?
Focused on meeting regulations, policies, and requirements
What is Compliance?
This type of grievance relates to delays or service issues
What is a service-related grievance?
This happens when multiple transportation complaints occur in one month
What is a performance trend of system issue?
This can occur when the IDT does not approve a requested service
An appeal
This tool is used to find the cause of a probelm
What is a Root Cause Analysis (RCA)?
Missing these creates regulatory risks even if care was provided
What are required timeframes/signatures?
This is required to track grievance patterns over time
What is a grievance log?
This is used to determine if an issue is isolated or widespread
What is data review or analysis?
This must be documented when a request is denied
What is clinical rationale (medical, physical, emotional and social needs).
This type of focus looks at "How well are we doing?"
What is quality performance?
This occurs when processes do not meet regulatory requirements
What is compliance deficiency, violation, or condition?
This ensures grievances are handled within required standards
What are grievance timelines?
This helps decide if an issue is Quality, Compliance, or Grievance
What is classification of issues?
This ensures decisions align with regulations and care goals
What is regulatory and clinical compliance?