LTSS Consumer Quality – Technical Workgroup
May 22, 2014 (Updated)
Gary Montrose & Jose Torres-Vegaand
Spark Policy Institute
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
STATE AGENCY LTSS TOOLS
Review & Debrief
CURRENTLY USEDState Agency Instruments
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
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
• 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
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
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
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
FUTURE PLANSState Agency Instruments
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
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
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
DR. KAYE’S PRESENTATION
Overview and Debrief
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
Types of Measures• Structure: The system • Process: Provision of services by the
system• Outcomes: Effect of services on
consumer*
LTSS Quality & Outcomes:CLPC Conceptual Framework
QOL Domains
1. Paid/unpaid LTSS providers
2. Supportive Environment
3. Services & Supports Received
4. Consumer Outcomes
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
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
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?
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
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
CROSSWALK UPDATE & POTENTIAL FUTURE SURVEY WORK
Review
Kaye’s FrameworkQOL Domains
1. Paid/unpaid LTSS providers
2. Supportive Environment
3. Services & Supports Received
4. Consumer Outcomes
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
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
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)
Kaye “Supportive Environment/ Resources” & POMS “My
Self/Security and Continuity”
POMS Detail
Kaye “Supportive Environment/ Resources” & CQL Basic Assurances”
CQL Detail
DRAFT REPORTOverview of the Crosswalk Results
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
NEXT STEPS AND SCOPE OF RECOMMENDATIONS
Explore
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
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