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CT DDS CT DDS Quality Service ReviewQuality Service Review

Connecticut Community Connecticut Community Providers Association Providers Association

Presented by Fred Balicki,Presented by Fred Balicki,DDS Quality Management DDS Quality Management

ServicesServicesMay 27, 2008May 27, 2008

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Quality System and Service Review – All in One

ProvidersCase Managers

And Brokers

System Operations

Individuals

State

Case ManagersRegional

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

- and from different reviewer perspectives -

-and MAXIMIZES use of personnel to meet multiple obligations-LPRIC, plan oversight, QA and waiver compliance

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On-Going Interactions with

Case Management and Regional Quality

Activities

Regional Meetings

with VendorsModify Vendor QI

Plan as Needed

State QSR Certification

Review

Modify Vendor QI Plan as

Needed

Quality Review & Improvement Cycle

Quality Review & Improvement

Cycle

Vendor Self Assessment

Vendor QI Plan

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Quality Service Review Overview

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

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

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

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Why QSR?

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

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

What Personal Outcomes Provider Performance

by service type Case Management Regional Office

Performance State System of

Safeguards, Oversight and Improvement

Who 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

Physical Plant and Safety indicators Evaluated for 100% of service locations

25% of Individual Plans and associated indicators are evaluated by CM Supervisors

20 Indicators Evaluated for 100% of Individuals by Case Managers

Another set of Personal Outcome and Support Indicators assessed for 30% of the people by Regional Reviewers

System Review,

Analysis & Improveme

ntState Level Certification

Review of Public and Private Provider Organizations

Sample of Individuals Across All Settings Using All Indicators

•Revise Policy and Procedure•Provider Profile•Quality Improvement Councils•Plans of Correction or Improvement•Target Organization Development & Educational Support

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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 QualityReview Visit

Consumer Interview

Observation

Documentation

Safety Checklist

Support Person Interview

Case Management ReviewConsumer Interview

Observation

Documentation

Any Observed Non-CompliantSafety Indicators

Case Management Supervisor Review

Documentation Indicators

MY QSR: Web-based Data Management System

Interim Tracking System

Central OfficeQSR

Certification Review

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QSR Components

There are 23 Personal Outcomes and 29 Support Expectations 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

Seven Focus Areas organize the major sections of the QSR Tool.

Planning & Personal Achievement SafetyRelationships & Community inclusion Health & WellnessChoice & Control SatisfactionRights, Respect & Dignity

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QSR Components Continued

Quality Indicators are assessed through:Consumer Interview – 73, Support Person Interview

- 50Observation – 21, Documentation Review- 57Safety Checklist – 52, Application Packet – 8

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

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

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

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

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

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

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

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

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

Tracks and closes corrections and actions

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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

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

Integrating QSR Certification Process with Existing Activities

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QSR and Vendor Certification

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

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

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

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

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 QSR Tools are Tailored to Each ServiceService

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Vendor Certification Reporting

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 State Level Certification 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:

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

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

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

For More Information On...For More Information On...

Please see the DMR web site: http.www.ct.gov/dds

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Questions & Answers

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THANK YOU!