Comparing Apples to Apples: Use of Common Tools to Rebalance Systems
22
Comparing Apples to Apples: Use of Common Tools to Rebalance Systems National HCBS Waiver Conference October 28, 2003 Val Bradley & Sarah Taub Human Services Research Institute
description
Comparing Apples to Apples: Use of Common Tools to Rebalance Systems. National HCBS Waiver Conference October 28, 2003 Val Bradley & Sarah Taub Human Services Research Institute. Changing Quality Landscape. Exposure of fault-lines in the system (e.g., CMS and the press) - PowerPoint PPT Presentation
Transcript of Comparing Apples to Apples: Use of Common Tools to Rebalance Systems
Comparing Apples to Apples: Use of Common Tools to Rebalance Systems
National HCBS Waiver ConferenceOctober 28, 2003
Val Bradley & Sarah TaubHuman Services Research
Institute
Changing Quality Landscape
Exposure of fault-lines in the system (e.g., CMS and the press)Emergence of self-determinationOlmstead decision and proposed closuresStruggles with MIS applicationsDirect support staff shortagesExpansion of supports to individuals on the waiting list
Signs of Change in Performance ManagementNo longer just better than the institutionRooted in outcomesEmphasis on enhancement and CQIChanging role of the stateChanges in experiences of families and people with mental retardation Changes in accreditation approaches
More Signs of Change
Movement away from prescriptive standards to individualized risk managementCollaborative development of standardsInclusion of consumer and family participation in oversight
Satisfaction
CQI
Consensus
Emergence of Performance IndicatorsFirst appeared in behavioral and acute careProvide some “cues” for managing these complex systemsHighlight impact of cost containmentIlluminate what’s workingProvide early warning signs
Characteristics of Performance Indicators
Reflect major organizational or system goals.Address issues that can be influenced by the organization or systemHave face validity
Point a direction Reflect rates or major events Related to associated standards
NCI Beginnings
NASDDDS and HSRI collaborationLaunched in 1997Seven field test states (plus steering committee)~60 candidate performance indicatorsDevelopment of data collection protocols
What has NCI Accomplished?
Nationally recognized set of performance and outcome indicators for developmental disabilities service systemsReliable data collection methods & tools (consumer & family surveys, provider survey, system data)Baseline and trend data at the state & national level
Participating NCI States
NDAK
HI
WA
OR
ID
MT
WY
ND
SD
NE
CAUT
NV
AZ
CO
NM
KS
OK
TX
MN
IA
WI
IL IN
MO
AR
MI
OH
KY
TN
MS
LA
AL GA
FL
SC
NC
VAWV
PA
NY
MEVTNH
MD
DC
DE
NJCT
MA
RI
PR
Orange County
NCI Structure
Currently 20 states plus Orange County in Phase VI (FY2004)HSRI provides technical assistance under subcontract to NASDDDSSubcommittees address specific issuesMeet with full steering committee annually
Where does NCI fit in?One component of state Quality Management systemsIn many participating states, main process for measuring consumer and family satisfactionIntegration of information is the key (many QA systems are fragmented)Increasing interest in using NCI to measure provider performance
What are the data sources?Consumer Survey
Face-to-face interviewMinimum n=400Standardized training providedHigh inter-rater reliabilityFirst section (subjective) allows consumer responses ONLY
Provider SurveyStaff StabilityBoard Representation
Family SurveysMail surveys (goal=40% return)Adult Family Survey (at home, 18+)Family Guardian Survey (out-of-home)Children Family Survey (at home, <18)
System DataIncidentsMortality
How is NCI data used?Setting goals and strategic planningSetting priorities for quality improvement, Quality Management plansBudget requests to Governor and legislatorsHelps shape data reporting systems (e.g., incidents, mortality)Stakeholder advisory committees(Quality Councils)
More specific uses…Pennsylvania – part of Independent Monitoring and quality improvementSouth Carolina – Core component of external monitoringWyoming – Annual reports, CMS review*Massachusetts – Strategic planningNorth Carolina – Health status indicators
*See Wyoming presentation: “Using CORE INDICATORS in Federal HCBS Reviews”
How are resultsdisseminated?Reports of state results vs. national results posted on websitesPresentations to staff, providers, communitySummaries shared with families who filled out surveys (AZ)Simplified version of Consumer Survey report for self-advocates (VT)
Trend AnalysisBeginning to look at trends over past three yearsFive states collected Consumer Survey data annually for three years
ConnecticutKentuckyNorth CarolinaPennsylvaniaRhode Island
CM helps get what person needs…
90% 88%83% 83%
78% 78%
0%10%20%30%40%50%60%70%80%90%
100%
5 state average All state average
FY00 FY01 FY02
92.8%
93.6%
94.4%
92%
93%
94%
95%
FY00 FY01 FY02
Person is satisfied with home…
0%
20%
40%
60%FY00 FY01 FY02
HousemateHome staffCase manager
Person had input in choosing…
Staff Stability
35.2%41.7%
52.9%
35.8%
45.1%
31.2%
0%
10%
20%
30%
40%
50%
60%
1999 2000 2001
residential day
Next steps…Expanding indicators on self-directed services and supportsAdapting survey for people with different communication stylesAdding health status indicators based on NC supplementCreating templates for displaying informationContinuing trend analysis
For More InformationReports are available on HSRI’s website: www.hsri.org/nciContact: [email protected]
