November 2022
July 18, 2023

TMF Doubles Nursing Home Attendance at Education Events with Five-Part QAPI Series

TMF Health Quality Institute, a Centers for Medicare & Medicaid Services (CMS) Quality Innovation Network-Quality Improvement Organization (QIN-QIO), works with nursing homes and skilled nursing facilities in Arkansas, Mississippi, Nebraska, Puerto Rico and Texas to improve staff and resident COVID-19 vaccination and booster rates. To accomplish this, TMF provides technical assistance and education to facilities through weekly webinars and online office hour events. In July 2022, the COVID-19 resident booster rate among nursing homes referred by CMS to TMF for assistance was 43 percent. Understanding these facilities needed more knowledge and tools to improve this rate, the QIN-QIO created a five-part webinar series in August 2022 focused on Quality Assurance Performance Improvement (QAPI) to increase registration, attendance and engagement at weekly webinars. QAPI is a program CMS requires all nursing homes to have in place.

The series was designed to follow a fictitious long-term care facility as it used the QAPI process to increase COVID-19 booster vaccination rates. The series explained how to use QAPI templates and tools, such as the Fishbone Diagram Root Cause Analysis Tool, a Quality Improvement (QI) Plan and a QI Outcomes Tracker. During each session, participants were encouraged to ask questions and provide feedback about the scenarios facing the fictitious facility, how these scenarios related to their facilities, and share the ideas they have used to solve problems. This resulted in increased peer-to-peer sharing and engagement compared to previous weekly webinar sessions. Participants shared stories and the creative solutions they have used to increase their COVID-19 vaccination and booster rates. These included:

  • “We made it known to our referral sources that the first vaccine was needed for admission.”
  • “We did use Medical Directors and even our Corporate Medical Director to host team calls. This helped dispel some myths and untruths.”
  • “We offered a $60 bonus if staff received vaccine. It is more effective to use bonuses than to have the time lost.”
  • “We teamed up with our local pharmacy [for vaccines]. We make it an outing for our residents. We take them and I get them slushies.”

In addition to regular promotions on TMF’s website and outreach to facilities, the QIN-QIO began a new email campaign. This included sending a reminder email to all facilities on the morning of the event. TMF’s QI specialists also began sending a personal follow-up email to attendees who registered for the session with resources, a recording of the event, and a brief teaser of the next session at the conclusion of each session.

As a result of these efforts, TMF saw a significant increase in registration and attendance at its weekly education sessions. Overall, when comparing the number of registrants and attendees from the five weeks prior to the QAPI series, registration increased approximately 100 percent and attendance increased 200 percent.

Following the QAPI webinar series, the resident COVID-19 booster rate for the facilities referred to TMF for assistance increased to 73 percent in September 2022.

The success of TMF’s QAPI webinar series can be attributed to the QIN-QIO identifying a topic that appealed to nursing home staff, increasing promotional efforts in advance of the series, and providing a forum that fostered peer-to-peer engagement. All of TMF’s QAPI webinar series videos and handouts are available on


This material was prepared by The Bizzell Group (Bizzell), the Data Validation and Administrative (DVA) contractor, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. 12SOW/Bizzell/DVA-1147-07/18/2023

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