NCI: A Growing Commitment

Five Years of Performance Measurement

127th Annual AAMR Meeting, Chicago, ILVal Bradley Human Services Research Institute

Project Beginnings

NASDDDS and HSRI collaboration Launched in 1997 Seven field test states (plus steering

committee) ~60 candidate performance indicators Development of data collection

instruments

What has NCI Accomplished?

Nationally recognized set of performance and outcome indicators for developmental disabilities service systems

Reliable data collection methods & tools Baseline and trend data at the state &

national level Benchmarks of performance

NCI Structure

Currently 21 states plus Orange County in Phase V (FY2003)

HSRI provides technical assistance under subcontract to NASDDDS

Subcommittees address specific issues

Meet with full steering committee annually

Participating States Phase V

WA

IN

AZ

UT

NC

IL

IA

OK

VT

WV

KY

PA

MA

DE

RI

CT

MT

WY

NE

HI

Orange County

WA

IN

AZ

NC

IA

OK

VT

WV

KY

PA

MA

DE

RI

CT

WY

NE

HI

Orange County

AL

SD

SC

ME

What are the data sources?

Consumer Survey Family Survey

Adult Family Survey (at home, 18+) Family Guardian Survey (out-of-home) Children Family Survey (at home, <18)

Provider Survey Staff Stability Board Representation

System Data Incidents Mortality

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

CM helps get what person needs…

90% 88%83% 83%

78% 78%

0%10%20%30%40%50%60%70%80%90%

100%

5 state average All state average

FY00 FY01 FY02

92.8%

93.6%

94.4%

92%

93%

94%

95%

FY00 FY01 FY02

Person is satisfied with home…

95.6 95.6

82.5

94.8

82.8

93.4

75%

80%

85%

90%

95%

100%

FY00 FY01 FY02

% feel safe at home % feel safe in neighborhood

People report feeling safe…

40%

60%

80%

100%

FY00 FY01 FY02

Physical exam within the last yearGYN exam within the last yearDental check-up within the last six months

Frequency of health visits (5 state average)

0%

20%

40%

60%FY00 FY01 FY02

Roommate Home staff Case manager

Person had input in choosing…

65%

75%

85%

95%

FY00 FY01 FY02

CT KY NC PA RI

CM helps get what person needs… (by state)

Staff Stability

Rising trend in staff turnover over past three years

Turnover is higher in residential settings vs. day settings

In FY2002, turnover rates ranged from 33% (Hawaii) to 54% (Indiana)

Direct Contact Staff Turnover

35.2%

41.7%

52.9%

35.8%

45.1%

31.2%

0%

10%

20%

30%

40%

50%

60%

1999 2000 2001

residential day

Consumer Survey

7917 surveys completed 67% of people interviewed were able to

respond to Section I

Consumer Survey Phase IVLevel of MR

Severe14.5%

Moderate 26.3%

Unknown

2.5%

No Label3.7%

Profound 14.9%

Mild38.2%

Consumer Survey Phase IVPlace of Residence

0.0 20.0 40.0

0.9Nursing Facility

3.7Other

4.3Apartment Program

8.5Specialized Facility

9.9Foster Care or Host Home

18.6Independent Home or Apt

24.7Group Home

29.1Parent or Relative Home

Areas of Strength

92% report they have enough privacy over 90% report support staff treat them with

respect 94% satisfied with home 96% satisfied with work/day program High community participation (69% to 96%)

Areas for Improvement

77% report service coordinators get them what they need, compared with 90% in FY2001

48% reported “sometimes” or “always” lonely

only 52% of women had a GYN exam in the past year and 7% have never had one

How Are NCI States Using Their Data?

Pennsylvania – Independent monitoring and quality improvement

South Carolina – Core component of external monitoring

Wyoming – Annual reports, CMS review Massachusetts – Strategic planning South Dakota – Provider profiles North Carolina – Health indicators

Rhode Island has formed a Quality Management Group

Arizona advertises reports in their newsletter; sends reports to all families who participated; and shares their information with the Legislature and Governor.

Alabama will use the consumer survey as part of Wyatt settlement

Kentucky included NCI in its ten-year plan. They are expanding their focus on team interviewing techniques to enhance consumer and family participation.

Washington used the NCI data collection protocols to revise their incident reporting and mortality data system

In Indiana, the information from the surveys has been posted on the web site of the Bureau of Quality Improvement Services and notice has gone out to all providers

For More Information

Final Reports for Phase IV (FY2002) are available on HSRI’s website: www.hsri.org

Contact: staub@hsri.org cmoseley@nasddds.org