Building a Foundation for Quality Improvement in Post-Acute Care

This blog post excerpts an article by Linda Hollinger-Smith PhD, RN, FAAN, Vice President, Mather LifeWays Institute On Aging, in the Fall 2014 issue of HealthStream's PX Advisor, our quarterly magazine focused on improving the patient experience.

Faced by an aging population and significant growth in the population of those 85 years of age and older, the need for quality, cost-effective, post-acute care is anticipated to rise significantly. During the past decade, post-acute care has evolved, providing more complex, specialized care in skilled nursing, rehabilitation facilities, assisted living and home settings, and reaching growing numbers of short-stay residents post-hospital stay. Reforms in reimbursement and regulatory initiatives require greater focus on quality improvement efforts targeting the resident at the center of care delivery and health outcomes.

Growth of Post-Acute Care

The growth of post-acute care is tied to the beginning of Medicare’s prospective payment system for acutecare hospitals in the mid-1980s, which incentivized hospital providers to reduce length of stay by moving patients to post-acute care settings at earlier points in their recovery. These settings can be aligned on a continuum of acuity as noted in the figure above.

The primary growth in post-acute care has been at the low end of the continuum in the home health services/care and skilled nursing settings. Combined, these two settings account for about 80% of all post-acute care Medicare expenditures.

In 2010, the Affordable Care Act (ACA) was signed into law. In terms of key objectives, the ACA focuses on reducing the growth of healthcare costs while promoting high-value, efficient, and high-quality care (U.S. Department of Health & Human Services, 2014). Much of the progress thus far in terms of implementing components of the ACA has focused on the reporting and transparency requirements that form the basis for evaluating the quality of care provided by post-acute organizations (Kaiser Commission, 2013).

This article includes:

  • Quality Improvement in Post-Acute Care
  • Strategies to Improve Quality in Post-Acute Care
  • A New Post-Acute Care Framework, Quality Assurance and Performance Improvement (QAPI)
  • Putting QAPI to Work: Caring for a Resident with Late-Stage Alzheimer’s Disease
  • QAPI Activities to Evaluate Physical Aspects of Care
  • Additional Resources Focused on Building a Foundation of Quality in Post-Acute Care 


April 1, 2021