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

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
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 whats working
• Provide early warning signs

6
Characteristics of Performance Indicators

• 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

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
WA
ME
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
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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 full steering committee annually

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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

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What are the data sources?

• Consumer Survey
• Face-to-face interview
• Minimum n400
• Standardized training provided
• High inter-rater reliability
• First section (subjective) allows consumer
  responses ONLY
• Provider Survey
• Staff Stability
• Board Representation

• Family Surveys
• Mail surveys (goal40 return)
• Adult Family Survey (at home, 18)
• Family Guardian Survey (out-of-home)
• Children Family Survey (at home, lt18)
• System Data
• Incidents
• Mortality

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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

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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)

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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

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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
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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
Staff Stability
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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

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For More Information

• Reports are available on HSRIs website
  www.hsri.org/nci
• Contact staub_at_hsri.org