ltss consumer quality – technical workgroup

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LTSS Consumer Quality – Technical Workgroup May 22, 2014 (Updated) Gary Montrose & Jose Torres-Vega and Spark Policy Institute

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LTSS Consumer Quality – Technical Workgroup. May 22, 2014 (Updated) Gary Montrose & Jose Torres-Vega a nd Spark Policy Institute . Agenda. Review of LTSS tools used by state partners (from May 2, 2014 state presentations) - PowerPoint PPT Presentation

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Page 1: LTSS Consumer Quality – Technical Workgroup

LTSS Consumer Quality – Technical Workgroup

May 22, 2014 (Updated)

Gary Montrose & Jose Torres-Vegaand

Spark Policy Institute

Page 2: LTSS Consumer Quality – Technical Workgroup

Agenda• Review of LTSS tools used by state partners

(from May 2, 2014 state presentations) • Debrief: Dr. Kaye’s presentation for

Colorado relevance, opportunities • Review: Cross walk update, utility for future

consumer survey work • Explore: Next steps and Scope of

Recommendations

Page 3: LTSS Consumer Quality – Technical Workgroup

STATE AGENCY LTSS TOOLS

Review & Debrief

Page 4: LTSS Consumer Quality – Technical Workgroup

CURRENTLY USEDState Agency Instruments

Page 5: LTSS Consumer Quality – Technical Workgroup

Office of Behavioral Health: Data & Evaluation Unit

• MHSIP/YSS-F/YSS (Mental Health Statistics Improvement Program/Youth Services Survey for Families/Youth Services Survey)– Currently piloted: ECHO+– Two qualitative questions:

• +/- aspects of behavioral health services received– 45+ quantitative questions

1. Access to services & general satisfaction2. Participation in treatment planning3. Quality of treatment (cultural sensitivity for youth

clients)4. Perceived outcomes 5. Social connectedness & functioning

Page 6: LTSS Consumer Quality – Technical Workgroup

HCPF/Div. for Intellectual & Developmental Disabilities (DIDD)

• NCI–DD Adult Consumer Survey– Currently implemented: First year for

Colorado (40 states implement)– Qualitative face-to-face interview

1. Individual outcomes2. Health, welfare and rights3. System performance4. Staff stability5. Family outcomes

– Quantitative• Demographic and basic medical data

Page 7: LTSS Consumer Quality – Technical Workgroup

• NCI framework comprised of four types of surveys– NCI-DD face to face – Three mail surveys• Adult Family Survey• Family Guardian Survey• Child Family Survey

Page 8: LTSS Consumer Quality – Technical Workgroup

HCPF• MFP Quality of Life Survey

– Qualitative method only (primarily phone interview)1. Living Situation2. Choice & Control3. Access to Personal Care4. Respect & Dignity5. Community Integration & Inclusion6. Satisfaction7. Health Status

– Case managers collect prior to transition from facility-based care & 11 and 24 months post-transition

– Mathematica evaluator

Page 9: LTSS Consumer Quality – Technical Workgroup

HCPF• CSS Waiver: client satisfaction survey

– Qualitative: only in “additional comments”– Quantitative:

• Yes/No questions, Likert Scale for overall satisfaction questions & demographics

– Domains1. Their Case Manager2. Level of involvement and choice in services & providers3. Availability of information and resources4. Knowledge of how to file complaints5. Quality of care received from caregivers

– Online survey sent to SEP agencies that mail paper copy to clients

Page 10: LTSS Consumer Quality – Technical Workgroup

HCPF• CAHPS (Consumer Assessment of Healthcare

Providers and Systems) surveys for Adult and Child Medicaid (FFS and Managed Care) and CHP+– Qualitative: member, self-reported (mail & phone)

• Rating of all Health Care• Rating of Personal Doctor• Rating of Specialist Seen Most Often• Coordination of Care

– Conducted by HSAG (EQRO)• Random sample

– Annual consumer satisfaction survey

Page 11: LTSS Consumer Quality – Technical Workgroup

FUTURE PLANSState Agency Instruments

Page 12: LTSS Consumer Quality – Technical Workgroup

HCPF• TEFT (Testing Experience and

Functional Tools in Community-Based Long Term Services and Supports– Planning & Demonstration grant funded• Test with Home & Community-Based

Services for the Elderly, Blind & Disabled (HCBS-EBD)• HCBS for Supported Living Services

– Random sample for each, large enough for statistical analysis

– Truven contractor

Page 13: LTSS Consumer Quality – Technical Workgroup

TEFT (continued)• Domains

1. Services and Supports from personal assistant and behavioral staff

2. Services and Supports from homemakers3. Case Management4. Choice5. Transportation6. Personal Safety7. Community Inclusion and empowerment8. Employment

Page 14: LTSS Consumer Quality – Technical Workgroup

HCPF• NCI-AD (National Core Indicators – Aging and Disability)

– Qualitative: face-to-face interviews1. Service Satisfaction2. Living Space3. Safety/Security/Privacy4. Community5. Everyday living6. Relationships7. Healthcare8. Planning for Future9. Independence/Functional Competence 10. Direct Care Workers11. Health Care Workers

– Quantitative• Demographic & medical

Page 15: LTSS Consumer Quality – Technical Workgroup

DR. KAYE’S PRESENTATION

Overview and Debrief

Page 16: LTSS Consumer Quality – Technical Workgroup

Why Measure LTSS QOL?• States transitioning to managed care• Quality measures help states’ commitment

to providing quality services • Quality measures can focus on meeting

people’s needs • Quality measures allow advocates to track

outcomes• People’s lives are better if they can stay in

the community rather than in the institutions

Page 17: LTSS Consumer Quality – Technical Workgroup

Types of Measures• Structure: The system • Process: Provision of services by the

system• Outcomes: Effect of services on

consumer*

Page 18: LTSS Consumer Quality – Technical Workgroup

LTSS Quality & Outcomes:CLPC Conceptual Framework

QOL Domains

1. Paid/unpaid LTSS providers

2. Supportive Environment

3. Services & Supports Received

4. Consumer Outcomes

Page 19: LTSS Consumer Quality – Technical Workgroup

Potential data sources• Program documents & administrators– scope, organization, accountability, etc.

• Administrative records– expenditures, participation, settings, services

received, complaints, workforce• Medical or claims records (encounter data)

– health & functional status, utilization, prevention• National or state survey data

– unmet LTSS need, workforce, caregiver support• Surveys of LTSS recipients

– adequacy, appropriateness, consumer outcomes

Page 20: LTSS Consumer Quality – Technical Workgroup

Paid & unpaid

providers

Supportive

environment

LTSSResource

s

LTSS receivedConsum

erOutcome

s

TheLTSS

Consumer

LTSS program characteristics

LTSS system responsiveness

Available LTSS quality tools• Survey instruments, e.g.,

– National Core Indicators– Developmental Disabilities– Aging & Physical Disabilities

– HCBS Experience Survey– Participant Experience Survey– MFP Quality of Life Survey

• Consumer outcome/QOL domains– PEONIES– Kane Quality of Life domains– CQL Personal Outcome Measures

– Process & structure measures– Indicators

Page 21: LTSS Consumer Quality – Technical Workgroup

Selecting quality & outcome measures

• Clarify your purpose and keep it in mind• Stakeholder & consumer input is critical• Consider using existing measures, either as

is or as a starting point for further development

• Selecting or developing measures is generally a trade-off:– How relevant are the measures?– Can the results be used for comparison?– Are findings likely to influence policy?– How difficult is it to obtain the needed data?– Have the measures been tested for validity/reliability?

Page 22: LTSS Consumer Quality – Technical Workgroup

Steps for Developing Questions• Creating a new instrument– Qualitative interviews to find out what’s

important– Develop questions based on understanding

which issues are important to the consumer

• Cognitive testing of instrument– Pilot the survey/interview– Ask testers to comment on each response

Page 23: LTSS Consumer Quality – Technical Workgroup

Steps for Selecting Existing Questions

• Use the LTSS Question Library to identify potential questions within domains/sub-domains– Selection based on what is NOT

currently captured through existing state data collection but is important to understand LTSS quality of life

Page 24: LTSS Consumer Quality – Technical Workgroup

CROSSWALK UPDATE & POTENTIAL FUTURE SURVEY WORK

Review

Page 25: LTSS Consumer Quality – Technical Workgroup

Kaye’s FrameworkQOL Domains

1. Paid/unpaid LTSS providers

2. Supportive Environment

3. Services & Supports Received

4. Consumer Outcomes

Page 26: LTSS Consumer Quality – Technical Workgroup

Kaye’s Domains & Subdomains Related to QOL

1. Paid & Unpaid LTSS Providers

a. Caregiver/family supportb. Workforce developmentc. Worker availability and

quality

2. Supportive Environment

a. Accessibility and accommodations

b. Technologyc. Resourcesd. Settings

Page 27: LTSS Consumer Quality – Technical Workgroup

3. Services and Supports Received 4. Consumer Outcomes

a. Adequacyb. Appropriatenessc. Coordinationd. Utilization

a. Health and Functionb. Well-beingc. Participationd. Safety

Kayes’ Domains and Subdomains Related to QOL

Page 28: LTSS Consumer Quality – Technical Workgroup

Instruments Cross-walked by Kaye’s Domains/Subdomains

State of Colorado Uses

1. National Core Indicators Adult Consumer (NCI- DD): Colorado implement for first time in 2014

2. NCI Aging and Disability (NCI-AD): Colorado will pilot in 2015

Nationally recognized instruments

3. NCI Family Adult Intellectual and Developmental Disabilities (NCI-I/DD)

4. CQL – Personal Outcomes Measures (POMS)

5. CQL Basic Assurances6. Personal Experience

Outcomes iNtegrated Interview and Evaluation (PEONIES)

Page 29: LTSS Consumer Quality – Technical Workgroup

Kaye “Supportive Environment/ Resources” & POMS “My

Self/Security and Continuity”

Page 30: LTSS Consumer Quality – Technical Workgroup

POMS Detail

Page 31: LTSS Consumer Quality – Technical Workgroup

Kaye “Supportive Environment/ Resources” & CQL Basic Assurances”

Page 32: LTSS Consumer Quality – Technical Workgroup

CQL Detail

Page 33: LTSS Consumer Quality – Technical Workgroup

DRAFT REPORTOverview of the Crosswalk Results

Page 34: LTSS Consumer Quality – Technical Workgroup

Structure• Assesses NCI-DD and AD by Kaye

domains/subdomains• Provides table in each section with– Advisory Committee input on Kaye

subdomains– Potential questions derived from other

instruments in the crosswalk• Serves as the technical report and basis

for a library of questions by domains

Page 35: LTSS Consumer Quality – Technical Workgroup

NEXT STEPS AND SCOPE OF RECOMMENDATIONS

Explore

Page 36: LTSS Consumer Quality – Technical Workgroup

Proposed Consensus Recommendations

1. Update the 2007 HCPF Quality Strategy from a Consumer Perspective

2. Consumer-Agency Alignment3. Pursue R&D opportunities regarding

“Add-on” questions to standardized surveys

4. Maintain/grow an LTSS Question/Methods Library

5. Pursue funding opportunities