Transcript Document

Trends in Quality Assurance
Achieving Safety, Health
and Valued Outcomes
Signs of Change in
Performance Management
No longer just better than the institution
Rooted in outcomes
Emphasis on enhancement
Changing role of the state
Changes in experiences of families
and people with mental retardation
Changes in accreditation
approaches
More Signs of Change
Movement away from prescriptive
standards
Emphasis on CQI
Exploration of self-assessment
Collaborative development of
standards
Inclusion of customer satisfaction
Consensus
CQI
Person-Centered
Systems:
Facilitate individual choice
Support relationships and community
membership
Encourage natural supports
Encourage health, well-being and safety
Foster productivity and participation in
meaningful work
Maximize self-determination
Support families
Build staff and provider capacity
Public Quality Assurance
Responsibilities
Assuring that individuals are free from abuse,
neglect, and exploitation;
Protecting the rights of individuals and families;
Assuring accountability in the use of public
dollars;
Assuring that individuals have access to
necessary professional services;
Evaluating the effectiveness if service and
supports;
Assessing the performance of service providers
Changing Quality Landscape
Exposure of fault-lines in the
system (e.g., HCFA and the press)
Expansion of supports to
individuals on the waiting list
Emergence of self-determination
Olmstead decision
Struggles with MIS applications
Direct support staff shortages
Critical Constraints
Consolidation of providers
Management of multiple systems
“Generic” approaches to quality
Increasing gray areas in public
jurisdiction
Pressure from HCFA
Lack of collaboration with sister
agencies
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
For more information: www.hsri.org
(Core Indicators Project)
Project Beginnings
NASDDDS and HSRI collaboration
Launched in 1997
Seven field test states + steering
committee
~60 candidate performance indicators
Development of data collection
instruments
Current Participating States
Arizona
Connecticut
Delaware
Hawaii
Illinois
Iowa
Indiana
Kentucky
Massachusetts
Montana
Nebraska
North Carolina
Oklahoma
Pennsylvania
Rhode Island
Utah
Vermont
Washington
West Virginia
Wyoming
What will CIP accomplish?
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•
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Nationally recognized set of performance
and outcome indicators for
developmental disabilities service
systems
Benchmarks of performance
Trend data at the state level
Broad dissemination to all stakeholders
What are the Core Indicators?
 Consumer
Outcomes:
 Satisfaction,
choice, employment,
community inclusion, natural supports,
family supports…
 System Performance:
 Service expenditures and utilization,
access…
 Protection
 Injuries,
data…
 Provider
 Staff
of Health and Safety:
crime victimization, mortality
Agency / Workforce Stability:
turnover…
Data Sources
Consumer Survey
Family Support Survey (plus new
version for families with kids)
Family/Guardian Survey
Provider Survey (limited)
DD System MIS
Consumer employment data
Where people work:
Duplicated counts
Aggregate N = 3900 (11 states)
 27.7% -- supported employment
 21.7% -- group employment (enclave/crew)
 40.4% -- facility-based employment
 36.8% -- non-vocational day supports
Types of Employment Supports
by State
80%
70%
60%
SEP
GRP
FAC
50%
40%
30%
20%
10%
0%
1
2
3
4
5
6
7
8
9
10
11
Community Inclusion
attend religious
events
55.93%
exercise/sports
72.47%
go out for
entertainment
84.15%
eat at restaurants
90.15%
91.50%
shopping
errands
93.71%
0%
20%
40%
60%
80%
100%
Choice and Decision-Making
11.29%
chose service coordinator
29.49%
chose job staff
30.77%
chose home staff
32.17%
chose people to live with
chose day program
50.23%
chose home
51.13%
70.53%
chose job
75.30%
choose schedule
89.46%
choose freetime activities
0%
10%
20%
30%
40%
50%
60%
70%
80%
90% 100%
Consumer Outcomes
Access

81% of respondents reported that they almost
always have a way to get where they want to go
Safety

93% of respondents report feeling safe in their
neighborhoods

96% report feeling safe at home
Health Outcomes
Last OB/GYN Exam
Don't Know
23%
Never Had an
Exam
9%
Over a Year Ago
14%
Within Past Year
54%
Health Outcomes
Last Physical Exam
Within Past Year
86%
Don't Know
8%
Over a Year Ago
6%
Health Outcomes
Last Routine Dental Exam
Don't Know
19%
Over 6 Months
Ago
26%
In Last 6 Months
55%
Family Survey Comparisons
More positive responses on Family/Guardian
Survey (this group was generally older and
received more supports)
Out-of-home families more satisfied with
individual supports than those with family
members living at home (84% vs. 64%)
Much greater variation on satisfaction ratings
for the in-home group (50% to 70%)
Staff Stability
Day support providers report:



Lower turnover
Current staff have been employed longer
Half as many vacant positions (both FT and PT)
Both types of agencies report:


Staff who left within the last year were employed on
average about 19 months
Part-time position vacancies are much higher than
full-time position vacancies
For more information…
Visit HSRI’s website:
www.hsri.org/cip/core.html
Important Next Steps
Place individual
outcomes at the center of
the system
Enlist assistance of
consumers and families
Identify key areas of
performance
Link technology with need
for information
Look at the costs and
benefits of existing
approaches
Make results available
and accessible
Get serious about
uniform reporting of
critical health and safety
events
Develop staff
credentialing and
expand training options
Reassess roles of case
managers
Refine performance
contracting
Expand understanding
of person-centered
planning
Final Words
“Beware the
Continuous
Improvement of
Things Not Worth
Improving”
W. Edward Deming