Quality Assurance and Quality Improvement in Home and Community-Based Services

WEST VIRGINIA

Target Population

Persons with mental retardation and other developmental disabilities (MR/DD), and persons with disabilities of all ages.

Geographic Focus

Statewide.

Primary Focus

• The purpose of the quality assurance and quality improvement (QA/QI) grant is to strengthen West Virginia's ability to assure the health, welfare, and dignity of individuals participating in the home and community-based services (HCBS) waiver by developing an effective and systematic QA/QI system that enlists people with disabilities, their family members, advocates, and allies as active participants in the process.



• The grant will address and enhance the four basic components of an effective and ongoing quality initiative: design, discovery, remediation, and system improvement and will apply the principles and utilize many of the strategies outlined in the Centers for Medicare & Medicaid Services (CMS) workbook "Improving the Quality of Home and Community-Based Services and Supports."



• While the grant's objectives will address the focus area of participant access to services, the State will develop and later expand the core measurement sets that define what is important for HCBS waivers to monitor to address each of the seven focus areas of the CMS HCBS Quality Framework (hereafter, the Quality Framework).

Goals, Objectives, and Activities

Goal: Develop, implement, and support a quality assurance process and improvement infrastructure in the design of home and community-based waiver services.

Objectives/Activities

• Establish and maintain a Quality Improvement Team.



• Establish and maintain a statewide Aged and Disabled (A/D) Waiver QA/QI Council.



• Promote QA/QI sustainability by incorporating the QA/QI Councils into the existing Bureau for Medical Services (BMS) structure.

Goal: Define and expand core measurement sets for the HCBS waiver programs.

Objectives/Activities

• Develop a core measurement set for the A/D Waiver within the focus areas of the Quality Framework.



• Expand the core measurement sets for the MR/DD waiver program to incorporate all seven Quality Framework focus areas.

Goal: Develop and implement a data collection strategy of "real-time" and retrospective information for assessing the performance of HCBS waivers.

Objectives/Activities

• Compile and organize existing data and information on the performance of A/D Waiver services within the core measurement sets of the Quality Framework.



• Gather input from the QA/QI Council for each waiver regarding quality issues not identified by existing data.



• Collect additional information on the MR/DD Waiver through Participant Experience Survey (PES) questions.



• Compile lists of issues concerns for each waiver.



• Design a template for A/D Waiver management reports using descriptive program data and data collected for core measurement.



• Design and implement an approach for assessing HCBS waiver provider experience.



• Administer the PES to participants of the A/D Waiver and compile results.

Goal: Select, design, and implement QA/QI strategies for the State's HCBS waiver programs.

Objectives/Activities

• Prioritize identified areas of quality concerns for each waiver program.



• Select a priority issue within the each waiver and initiate quality improvement projects.



• Disseminate the QA/QI project results to program participants, community members, providers, direct care workers, advocates, and other partners.

Goal: Develop and implement a QA/QI system that involves HCBS waiver participants, their families, advocates, and allies in active roles.

Objectives/Activities

• Involve participants in conducting the face-to-face PES with A/D Waiver participants.



• Develop and implement a schedule to conduct at least two focus groups per year with A/D participants.



• Conduct presentation and solicit feedback from the CMS funded Real Choice Partnership.



• Conduct presentation and solicit feedback from the Consumer Oversight Commission (COC) of the CMS-funded Nursing Home Transitions Grant.



• Identify opportunities for participants and community members to play active roles in all quality assurance aspects of program review.



• Promote the sustainability of participant involvement through ongoing commitments from councils and BMS.

Goal: Evaluate and upgrade the State's technology-based direct care service management and data collection system.

Objectives/Activities

• Assess the required information technology functions of the A/D Waiver.



• Determine the technology needed to support the identified functional requirements of the A/D Waiver.

Key Activities and Products

• Develop a core measurement set for the A/D Waiver and expand the core measurement sets for the MR/DD Waiver.



• Compile and organize existing data and information on the performance of A/D Waiver services within the core measurement sets.



• Administer select questions from the PES to MR/DD and A/D Waiver participants to gather additional information on the waivers, and analyze the results.



• Design a template for A/D Waiver management reports using descriptive program data and data collected for core measurement.



• Prioritize identified areas of quality concerns, select a priority issue, initiate QA/QI projects, and disseminate the results.



• Train consumers as interviewers for the PES, conduct focus groups with consumers, and engage consumers who are members of statewide long term care task forces to inform development of a QA/QI system.



• Assess the required information technology functions of the A/D Waiver and determine the technology needed to support the identified functional requirements of the A/D Waiver.

Consumer Partners and their Involvement in Implementation Activities

• People with disabilities and long term illnesses and their representatives will play a key role in the implementation and monitoring of this project as active members of each waiver's QA/QI Council. A participant representative from each council will serve on the Quality Improvement Team, which is responsible for guiding the implementation of this grant and providing oversight and coordination for the two councils.



• The councils will conduct focus groups each year to provide participants with the opportunity to comment on the implementation of this grant and specific HCBS waiver performance or design concerns.



• Approximately 300 A/D Waiver participants randomly sampled will respond to the PES.



• Consumers on the CMS funded Real Choice Partnership and the COC of the Nursing Home Transition Grant will have the opportunity to comment on the overview of the grant's activities.

Public and Private Partners and their Involvement in Implementation Activities

Public Partners

• Public organizations called upon to provide training, information, and other technical assistance as necessary include: Bureau of Senior Services (BoSS), Bureau for Behavioral Health and Health Facilities (BHHF), Bureau for Medical Services, the Medley Management Team (Special Education; Developmental Disabilities Council; West Virginia Protection and Advocacy; Division of Rehabilitation Services; Centers for Independent Living); and the Ombudsman and Olmstead Office.



• The Bureau for Medical Services will contract with the Center for Excellence in Disabilities (CED) at West Virginia University (WVU) to implement the grant. The Center will play an integral role on the Quality Improvement Team during the implementation of this initiative.

Private Partners

• For the surveys, grant staff will seek the assistance of the Medstat Group in determining a survey methodology (including sampling) and in the training of potential interviewers, many of whom will be current and former participants in HCBS programs.



• HCBS providers, direct-care workers, advocates, and allies of people with disabilities will play significant roles on both QA/QI Councils, including the opportunity to participate on QA/QI project work groups.



• Grant staff will also consult with consumer organizations such as Senior Centers, Independent Living Centers, ADAPT, West Virginia Mental Health Consumer's Association, West Virginia Leadership Academy, and local People First Chapters to identify former and current HCBS recipients interested in conducting surveys for the A/D Waiver program.

Advisory Body, Committee, or Task Force

• The Quality Improvement Team will provide guidance and feedback to grant staff regarding the implementation of this 3–year grant and provide oversight and coordination of both waiver quality assurance and improvement initiatives. The team comprises: (1) directors of both waiver programs; (2) staff from each waiver program responsible for quality functions; (3) BMS representatives; and (4) a current or former recipient from each waiver's QA/QI Council. These individuals will come from the Bureau of Senior Services, Bureau for Behavioral Health and Health Facilities, or BMS.



• The team will ensure that the members of each waiver's council receive the information and training they need to play an active and viable role, and provide a means of ensuring that relevant information on the quality of home and community-based services is shared and discussed with both waivers. The team will identify and address common issues of concern and evaluate proposed systems change in the context of its affect on both waivers.



• The QA/QI Councils (one for each waiver) will comprise current or former recipients (one third representation), and other HCBS stakeholders, including family members, direct care workers, providers, and advocates. The Quality Improvement Team will select the members of the A/D Waiver Council (MR/DD Waiver already has a council). A current or former recipient of each waiver that is on this council will also serve on the Quality Improvement Team.



• Each council will compile a list of performance issues based on available data and input. The councils will then define criteria for prioritizing these issues, select priorities to address, and design and implement QA/QI projects to attain and evaluate desired outcomes.

Formative/Process Evaluation Activities

• Through a Quality Work Group and the Quality Improvement Team, the QA/QI projects will continually monitor the effectiveness of their efforts and adjust their strategies as needed to ensure desired outcomes. Staff will disseminate information regarding the success of projects through reports and a video.



• Staff will seek technical assistance and support from the developers of the workbook "Improving the Quality of Home and Community-Based Services and Supports" as necessary to ensure successful implementation of grant activities.



• Staff will provide updates will be provided to the Real Choice Partnership that includes six State agencies and eight public and private partners who can provide feedback.

Summative/Outcome Evaluation Activities

The Quality Improvement Team and QA/QI Councils will conduct evaluations of QI projects.

Strategies to Ensure Sustainability

• This grant assures enduring change by establishing an ongoing and effective QA/QI infrastructure that relies first on protecting the health, welfare, and dignity of HCBS waiver participants by building quality into the design of the programs.



• Once established, trained, and involved with the development process, the ongoing QA/QI Councils will provide the infrastructure to maintain the framework.



• The Quality Improvement Team, consisting of agency and council representatives, will also be maintained by BMS to provide the support to ensure the continuing effectiveness of this established framework and process.



• The creation of the template will provide HCBS waivers with their first, stakeholder-driven reporting tool for monitoring ongoing progress toward meeting program goals and quality issues. It will create a feedback loop for councils, stakeholders, and participants that builds accountability.



• The evaluation of current technology and the development of a technology-based direct care services management and data collection system will provide a sustainable database that will be utilized by State agencies and the Olmstead Office to provide continual improvements to the State's home and community-based waiver services.