‘Pathways’ Standardize Stage 2 Assessments

Dr. Andy Kramer
Provider Magazine – April 2010

Q.

What is a Critical Element (CE) Pathway?

A.

A CE Pathway is a structured protocol to assist surveyors during Stage 2 in-depth investigations in a QIS. Stage 2 investigations assess compliance with regulation and utilize a structured protocol so they can be performed the same way every time.

This practice improves consistency of performance year to year and between survey teams, regions, and states. CE Pathways are derived directly from regulation and surveyor guidance and, like other Stage 2 investigative tools, lead to decisions about compliance.

In a QIS survey, a Care Area is a component of nursing facility care that is related to one or more quality-of-care and quality-of-life indicators (QCLIs), which are assessed in the Stage 1 preliminary investigation.

The objective of CE Pathways during Stage 2 is to determine if a facility has met the five Critical Elements of Care for a Care Area that has exceeded its threshold during Stage 1.

The five Critical Elements of Care that are assessed by a CE Pathway are:
Comprehensive assessments: Did the facility conduct an assessment regarding the risks and/or problems the resident has related to the diagnosis and/or condition(F-tag 272)

• Comprehensive care plan: Did the
  facility develop a care plan to address
  the care and treatment related to the
  clinical diagnosis and/or the identified
  condition? (F-tag 279)
• Care and services meet professional
  standards: Did the facility implement
  practices that meet professional standards
  of quality? (F-tag 281)
• Care plan revisions: Did the facility
  revise the plan of care as needed?
  (F-tag 280)
• Provision of care and services: Did
  the facility provide care and services
  in accordance with the comprehensive
  assessment and plan of care that meet
  Care Area regulation? (Various F-tags
  that are specific to a Care Area)

In addition to the Critical Elements of Care, CE Pathways include investigation into related compliance requirements that vary depending on which Care Area is being investigated. It is apparent from looking at the Critical Elements that the first four will be assessed consistently by the same regulations in every CE Pathway.

That is why the frequency of these four F-tags is likely to increase when QIS surveys are being implemented in a new state.

Facilities can assess their own five Critical Elements in a Care Area by using the CE Pathways and following the structured protocol. Because the regulations and surveyor guidance do not change between traditional and QIS surveys, the resulting indications of compliance will be valuable to a facility no matter which survey process is being used.