CT DDS Quality Service Review

Connecticut Community Providers Association

Presented by Fred Balicki, DDS Quality Management Services May 27, 2008

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Quality System and Service Review – All in One

One set of measures – organized in different ways – to evaluate different components

System Operations

- and from different reviewer perspectives -

State Providers Individuals Case Managers And Brokers Regional Case Managers -and MAXIMIZES use of personnel to meet multiple obligations-LPRIC, plan oversight, QA and waiver compliance 2

Quality Review & Improvement Cycle

Vendor Self Assessment Vendor QI Plan Modify Vendor QI Plan as Needed On-Going Interactions with Case Management and Regional Quality Activities Quality Review & Improvement Cycle State QSR Certification Review Modify Vendor QI Plan as Needed Regional Meetings with Vendors

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Quality Service Review Overview

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The Quality Service Review (QSR) is a service review and certification process to determine the quality of service delivered by qualified vendors, and a personal outcome review to assess individual consumers’ experience and satisfaction with services and supports

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The QSR will certify private and public service vendors using the new set of quality measures in addition to reviewing regulatory and policy standards

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The QSR also serves as a foundation for gathering system wide information for quality review and improvement

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Why QSR?

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Long time goal of the department to enhance quality measures to include personal outcomes and measures related to choice, inclusion and satisfaction

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Need a method to certify non-licensed vendors to meet waiver program compliance and build an effective QMS/QI system for: individual supports, all day service types, and new family support services

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What is Evaluated and By Whom

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What

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Personal Outcomes Provider Performance by service type Case Management Regional Office Performance State System of Safeguards, Oversight and Improvement

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Who

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Case Managers Regional Based Quality Review Staff Regional Based QI Divisions State Certification Review Teams State Planners and Evaluators Quality Improvement Councils

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QSR Constructed from the Bottom Up

System Review, Analysis & Improvement State Level Certification Review of Public and Private Provider Organizations Sample of Individuals Across All Settings Using All Indicators 25% of Individual Plans and associated indicators are evaluated by CM Supervisors •Revise Policy and Procedure •Provider Profile •Quality Improvement Councils •Plans of Correction or Improvement •Target Organization Development & Educational Support Another set of Personal Outcome and Support Indicators assessed for 30% of the people by Regional Reviewers Physical Plant and Safety indicators Evaluated for 100% of service locations 20 Indicators Evaluated for 100% of Individuals by Case Managers

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Integrating Regional & State Quality Systems

Performance measures and expectations are drawn from one pool of quality indicator data Quality Service Review Indicators: Consumer Interview - Observation - Support Person Interview Documentation - Safety Checklist - Application Packet Regional Quality Review Visit Consumer Interview Observation Documentation Safety Checklist Support Person Interview

Interim Tracking System

Case Management Review Consumer Interview Observation Documentation Any Observed Non-Compliant Safety Indicators Case Management Supervisor Review Documentation Indicators MY QSR: Web-based Data Management System Central Office QSR Certification Review

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QSR Components

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Seven Focus Areas the QSR Tool.

organize the major sections of Planning & Personal Achievement Relationships & Community inclusion Choice & Control Rights, Respect & Dignity Safety Health & Wellness Satisfaction

 There are

23 Personal Outcomes

and

Expectations 29 Support

found in the QSR tool under the Focus Areas 

Personal Outcomes

identify desired results regarding individuals’ experiences 

Support Expectations

identify ways that vendors may assist individuals to achieve those personal outcomes 9

QSR Components Continued

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Quality Indicators are assessed through:

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Consumer Interview – 73, Support Person Interview 50

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Observation – 21, Documentation Review- 57 Safety Checklist – 52, Application Packet – 8

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Indicators are aligned according service type. Not all indicators apply to each service type

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Interpretive Guidelines provide information from policy and procedure, regulation, best practice and reference specific definitions and sources. They provide examples and discussion for Reviewers and Vendors

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QSR Content

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Regulation Policy Best Practice Quality Measures in planning, choice, inclusion, health, behavioral health, rights, safety, and satisfaction

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Data System Makes It Happen

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Dynamic and real time – reports are communicated via web system, reviewed and responded to. Action plans negotiated and tracked on line.

Organized – all findings can be sorted by person, place, provider, service type, assessment methodology, region, state.

Integrated – Findings from other systems entered (Behavior Review, Unusual Incidents, Abuse and Neglect Findings, Mortality Review) Closes the Loop- manages follow-up without duplicating data entry

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Reporting, Informing, Monitoring, Closing

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Informs Certification Review decisions with longitudinal data instead of one-time snapshot

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Informs and permits on going performance evaluation of providers through trend monitoring by the regions and central office, on-demand

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Informs choice of consumers and families by providing easy to read report cards

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Informs Quality Improvement Councils with comparative findings from across providers and the state

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Regional and State level monitoring activities can target QI needs if trends are noted or trigger enhanced contract oversight activities

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Tracks and closes corrections and actions

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Integrating QSR Certification Process with Existing Activities

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The QSR will include the vendor’s self assessment and quality improvement planning activities to evaluate the effectiveness of their own service and quality management systems

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Findings from all levels of interaction with the department will continually inform on-going quality improvement efforts by vendors and DDS

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QSR and Vendor Certification

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The QSR for Vendor Certification combines regional review information along with a Vendor’s performance data from incident reporting, abuse/neglect, PRC and HRC, mortality review, financial audits etc. for a biennial retrospective review

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A sample of individuals from each service is selected to conduct the consumer and service State Level reviews

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Information for consumers and services may validate other findings, reinforce evidence that the Vendor has systematically improved, or suggest that performance may not be consistent with other findings

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Certification is Service Specific

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Individual Support Habilitation- Person’s Own Home Supports in a Family Home Self-Directed Supports Day Service Option Sheltered Work Supported Employment – Individual and Group Individualized Day Support

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Family Respite Center Case Management Community Living Arrangement, 4 or more Consumers Community Living Arrangement, 3 or Fewer Consumers Public Residential Center QSR Tools are Tailored to Each Service

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Vendor Certification Reporting

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Findings are reported for all individuals who have been evaluated by Case Managers and Regional Quality Monitors. The findings are included with the results from a specific sample of individuals for the S tate Level C ertification Review Service findings are discussed with Vendors in the context of their Quality Improvement Planning Performance expectations will continue in Consumer Rights, Individual Plan Implementation, Consumer Health and Welfare, and Environmental Safety Vendor performance benchmarks will be defined and adjusted over time as reviews are completed Findings will be posted on the DDS web site for Families and Consumers using easy to understand aggregate reports by the QSR Personal Outcomes, Support Expectations, and Focus Area summaries for Vendor services reviewed

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Additional Components Contributing to Vendor Certification Review

The following DDS Quality System components will contribute to Certification Review Findings:

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PRC and HRC Committees Medication Administration Regulations Incident and Abuse / Neglect Reporting and Follow-up Mortality Reviews Resource Administration and Monitoring Complaints Financial Audits

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Licensure Transition to the QSR

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CLAs will still need a “license” to operate and maintain DSS funding requirements This “licensing” will occur at the time of the Vendor Certification QSR for each home Regional staff complete Environmental Safety Reviews of each home each year. The Quality Indicators address all Physical Environment elements found in regulation Regional staff also complete a broader review of at least one consumer per home each year Central Office staff conduct consumer reviews at a sample of locations operated by the Vendor at the time of the Certification Review Corrective Action Plans will continue to be required for select Quality Indicators that affect Consumers’ Health and Welfare during Regional and State Level Reviews

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Reference

Please see the DMR web site: http.www.ct.gov/dds For More Information On...

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Quality Service Review DDS HCBS Waivers Supports and Services Provider Forms DDS Manual – Service Delivery Fire Safety and Emergency Guidelines

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Questions & Answers

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THANK YOU!

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