Quality Assurance and Quality Improvement in Home and Community-Based Services
OHIO
Target Population
Persons with mental retardation and other developmental disabilities (MR/DD).
Geographic Focus
Statewide.
Primary Focus
- Align the State's current quality assurance and quality improvement (QA/QI) activities and promote greater participation by consumers and families in directing services. The State will assess the current QA/QI system across the seven focus areas within the Centers for Medicare & Medicaid Services (CMS) Home and Community-Based Services (HCBS) Quality Framework (hereafter, the Quality Framework), particularly the focus areas of participant outcomes and satisfaction, and system performance. The State will develop a new QA/QI system based on the four functions of the Quality Framework: design, discovery, remediation, and systems improvement.
- The grant is intended to develop a meaningful statewide QA/QI structure and develop and implement an analytical infrastructure using computerized tools that facilitates the collection, organization, and analysis of quality data and provides valuable information to all systems users about the needs of individuals and support agencies.
Goals, Objectives, and Activities
Goal: Promote increased efficiency and improved effectiveness of supports available to individuals with MR/DD.
Objectives/Activities
- Expand partnerships to form a grant advisory committee, demonstration sites, and internal quality assurance (QA) discussions.
- Contract with a consultant with expertise in the evaluation and development of state QA/QI systems.
- Evaluate the State's current QA/QI system using the Quality Framework as a benchmark.
- Determine the personal and systems outcome measures that must be reinforced to align with the Quality Framework.
- Research and develop a QA/QI framework using the four Quality Framework functions: design, discovery, remediation, and improvement.
- Design a training curriculum to initiate the new framework in five demonstration counties and test for replication.
- Pilot the new framework to individuals and families in five demonstration counties.
- Reevaluate the efficacy of the new quality systems design.
Goal: Develop and implement computerized tools to facilitate the collection, organization, and analysis of "quality" data, and to provide valuable information to all systems users about the needs of individuals and support agencies.
Objectives/Activities
- Identify and assess the available sources of information (e.g., databases, paper files, and existing Word documents).
- Assess and update current business processes relative to services provided by the Ohio Department of Mental Retardation and Developmental Disabilities (ODMR/DD) to individuals and support agencies.
- Organize information into logical, business-oriented views based on significant trends analysis in relation to the Quality Framework.
- Achieve a multi-dimensional system of reporting information and discoveries regarding individuals served that are ascertained through available data and compliance reviews to improve services from local service providers.
- Research computer hardware and software capable of assimilating, organizing, and analyzing available information.
- Conduct a cost analysis study to implement total system needs.
- Purchase, install, and test hardware, software, and new and updated processes.
- Implement and train staff for proper usage.
- Evaluate and update the effectiveness and relevancy of processes.
Key Activities and Products
- Evaluate Ohio's current QA/QI system and determine the personal and systems outcome measures that must be reinforced to align with the Quality Framework.
- Research and develop a new QA/QI framework and design a training curriculum to initiate the new framework in five demonstration counties, and test to determine whether it should be replicated.
- Pilot a new framework to individuals and families in five demonstration counties.
- Assess and update current business processes relative to services provided by ODMR/DD to individuals and support agencies.
- Achieve a multidimensional system of reporting information and discoveries regarding individuals served that are ascertained through available data and compliance reviews to improve services from local service providers.
- Research computer hardware and software capable of assimilating, organizing, and analyzing available information; conduct a cost analysis study to implement total system needs; and purchase, install, and test hardware, software, and new and updated processes.
- Train staff and evaluate and update the effectiveness and relevancy of reporting information and discovery processes.
Consumer Partners and their Involvement in Implementation Activities
- Consumers will participate in the pilot of the State's newly developed QA/QI framework.
- Consumers and their families will serve on the grant advisory committee.
Public and Private Partners and their Involvement in Implementation Activities
Public Partners
Agencies that will participate on the grant advisory committee include: Developmental Disabilities Planning Council (ODDPC), county boards of MR/DD (Allen, Clermont, Cuyahoga, Erie, Fairfield, Huron, Lucas, Mahoning, Richland, and Washington), and the Department of Jobs and Family Services (Single State Medicaid Agency).
Private Partners
- The State will secure a consultant(s) to facilitate the grant advisory discussions and to direct project staff in the redesign, development, and implementation of the QA/QI system. The consultant will assist project staff in the identification of other states involved in a similar stage of systems-change to maximize time efficiency during the grant's research phase.
- The State will utilize a consultant(s) to identify personal and systems measures and to assist in measuring the success of the new QA/QI system through an evaluation tool.
- Agencies that will participate on the grant advisory committee include: People First of Ohio, Arc of Ohio, Advocacy and Protective Services, Inc., Ohio Legal Rights Services (OLRS), Ohio Association of County Boards of MR/DD (OACBMR/DD), and the Ohio Provider Resource Association (OPRA).
Advisory Body, Committee, or Task Force
- The State will invite representatives to serve on an advisory committee from the local provider community (county boards of MR/DD and residential waiver provider), participants and family members of the service system, and advocacy groups.
- The advisory committee will ensure the development of an accurate quality framework by assuring that information of interest to a diverse audience is considered and that the Quality Framework developed is responsive to the needs of individuals and families. The committee will promote informed choice by providing pertinent information in user-friendly language and participate in tests of the system to ensure viability and efficacy.
Formative/Process Evaluation Activities
- Through the use of project management software and regular communication between ODMRDD and the advisory committee, ODMRDD will be able to monitor the project, learn from all valuable inputs, and make adjustments in virtually any aspect of the project where necessary.
- The State will engage an independent evaluator to provide objective, qualitative data regarding the project's progress. Staff will use reports and analyses to communicate during established agency meetings, as well as for updating the Director of ODMR/DD, key decision-makers, and CMS.
- There will be a pilot test for the training curriculum to initiate the new framework and the framework itself in five demonstration counties. For the test, a sample of 5 to 10 percent of consumers enrolled on waivers in each county will have an opportunity to participate.
Summative/Outcome Evaluation Activities
The consultant, in conjunction with the State, will construct an evaluation tool to measure indicators for the new quality system. The evaluation will determine whether the design is producing the desired results and whether the system can be replicated in additional counties.
Strategies to Ensure Sustainability
Ohio will support the changes proposed in this project past the proposed grant funding to ensure enduring systems change through five main avenues by doing the following:
- Ensuring a definition of "quality" is generated through the collaboration of a diverse and committed group of stakeholders.
- Utilizing the expertise of the contract consultant to perform facilitative functions and conduct an independent evaluation.
- Involving and rely on local systems to ensure enduring change.
- Developing a realistic business model.
- Linking with other systems change efforts in related areas.