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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 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)

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Comparing Apples to Apples: Use of Common Tools to Rebalance Systems

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  1. 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

  2. Changing Quality Landscape • Exposure of fault-lines in the system (e.g., CMS and the press) • Emergence of self-determination • Olmstead decision and proposed closures • Struggles with MIS applications • Direct support staff shortages • Expansion of supports to individuals on the waiting list

  3. Signs of Change in Performance Management • No longer just better than the institution • Rooted in outcomes • Emphasis on enhancement and CQI • Changing role of the state • Changes in experiences of families and people with mental retardation • Changes in accreditation approaches

  4. Satisfaction Consensus CQI More Signs of Change • Movement away from prescriptive standards to individualized risk management • Collaborative development of standards • Inclusion of consumer and family participation in oversight

  5. Emergence of Performance Indicators • First appeared in behavioral and acute care • Provide some “cues” for managing these complex systems • Highlight impact of cost containment • Illuminate what’s working • Provide early warning signs

  6. Reflect major organizational or system goals. Address issues that can be influenced by the organization or system Have face validity Point a direction Reflect rates or major events Related to associated standards Characteristics of Performance Indicators

  7. NCI Beginnings • NASDDDS and HSRI collaboration • Launched in 1997 • Seven field test states (plus steering committee) • ~60 candidate performance indicators • Development of data collection protocols

  8. What has NCI Accomplished? • Nationally recognized set of performance and outcome indicators for developmental disabilities service systems • Reliable data collection methods & tools (consumer & family surveys, provider survey, system data) • Baseline and trend data at the state & national level

  9. Participating NCI States NH ME WA VT ND AK ND MT MA MN OR NY WI SD RI ID MI CT WY PA NJ IA OH DE NE NV IN IL DC WV UT VA MD CO CA MO KS KY NC HI TN SC OK AR AZ NM Orange County MS GA AL LA TX FL PR

  10. NCI Structure • Currently 20 states plus Orange County in Phase VI (FY2004) • HSRI provides technical assistance under subcontract to NASDDDS • Subcommittees address specific issues • Meet with fullsteering committee annually

  11. Where does NCI fit in? • One component of state Quality Management systems • In many participating states, main process for measuring consumer and family satisfaction • Integration of information is the key (many QA systems are fragmented) • Increasing interest in using NCI to measure provider performance

  12. What are the data sources? • Family Surveys • Mail surveys (goal=40% return) • Adult Family Survey (at home, 18+) • Family Guardian Survey (out-of-home) • Children Family Survey (at home, <18) • System Data • Incidents • Mortality • Consumer Survey • Face-to-face interview • Minimum n=400 • Standardized training provided • High inter-rater reliability • First section (subjective) allows consumer responses ONLY • Provider Survey • Staff Stability • Board Representation

  13. How is NCI data used? • Setting goals and strategic planning • Setting priorities for quality improvement, Quality Management plans • Budget requests to Governor and legislators • Helps shape data reporting systems (e.g., incidents, mortality) • Stakeholder advisory committees (Quality Councils)

  14. More specific uses… • Pennsylvania – part of Independent Monitoring and quality improvement • South Carolina – Core component of external monitoring • Wyoming – Annual reports, CMS review* • Massachusetts – Strategic planning • North Carolina – Health status indicators *See Wyoming presentation: “Using CORE INDICATORS in Federal HCBS Reviews”

  15. How are resultsdisseminated? • Reports of state results vs. national results posted on websites • Presentations to staff, providers, community • Summaries shared with families who filled out surveys (AZ) • Simplified version of Consumer Survey report for self-advocates (VT)

  16. Trend Analysis • Beginning to look at trends over past three years • Five states collected Consumer Survey data annually for three years • Connecticut • Kentucky • North Carolina • Pennsylvania • Rhode Island

  17. CM helps get what person needs… 100% 90% 88% 83% 83% 90% 78% 78% 80% 70% 60% 50% 40% 30% 20% 10% 0% 5 state average All state average FY00 FY01 FY02

  18. Person is satisfied with home… 95% 94.4% 94% 93.6% 92.8% 93% 92% FY00 FY01 FY02

  19. Person had input in choosing… FY00 FY01 FY02 60% 40% 20% 0% Housemate Home staff Case manager

  20. 52.9% 60% 50% 41.7% 35.2% 40% 45.1% 30% 35.8% 31.2% 20% 10% 0% 1999 2000 2001 day residential Staff Stability

  21. Next steps… • Expanding indicators on self-directed services and supports • Adapting survey for people with different communication styles • Adding health status indicators based on NC supplement • Creating templates for displaying information • Continuing trend analysis

  22. For More Information • Reports are available on HSRI’s website: www.hsri.org/nci • Contact: staub@hsri.org

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