HU245 Ethics Unit Three Seminar Ethics of Universal Healthcare John Balicki.
1 CT DDS Quality Service Review Connecticut Community Providers Association Presented by Fred...
-
Upload
marion-horton -
Category
Documents
-
view
218 -
download
1
Transcript of 1 CT DDS Quality Service Review Connecticut Community Providers Association Presented by Fred...
1
CT DDS CT DDS Quality Service ReviewQuality Service Review
Connecticut Community Connecticut Community Providers Association Providers Association
Presented by Fred Balicki,Presented by Fred Balicki,DDS Quality Management DDS Quality Management
ServicesServicesMay 27, 2008May 27, 2008
2
Quality System and Service Review – All in One
ProvidersCase Managers
And Brokers
System Operations
Individuals
State
Case ManagersRegional
One set of measures – organized in different ways – to evaluate different components
- and from different reviewer perspectives -
-and MAXIMIZES use of personnel to meet multiple obligations-LPRIC, plan oversight, QA and waiver compliance
3
On-Going Interactions with
Case Management and Regional Quality
Activities
Regional Meetings
with VendorsModify Vendor QI
Plan as Needed
State QSR Certification
Review
Modify Vendor QI Plan as
Needed
Quality Review & Improvement Cycle
Quality Review & Improvement
Cycle
Vendor Self Assessment
Vendor QI Plan
4
Quality Service Review Overview
The Quality Service Review (QSR) is a service review and certification process to determine the quality of service delivered by qualified vendors, and a personal outcome review to assess individual consumers’ experience and satisfaction with services and supports
The QSR will certify private and public service vendors using the new set of quality measures in addition to reviewing regulatory and policy standards
The QSR also serves as a foundation for gathering system wide information for quality review and improvement
5
Why QSR?
Long time goal of the department to enhance quality measures to include personal outcomes and measures related to choice, inclusion and satisfaction
Need a method to certify non-licensed vendors to meet waiver program compliance and build an effective QMS/QI system for: individual supports, all day service types, and new family support services
6
What is Evaluated and By Whom
What Personal Outcomes Provider Performance
by service type Case Management Regional Office
Performance State System of
Safeguards, Oversight and Improvement
Who Case Managers Regional Based
Quality Review Staff Regional Based QI
Divisions State Certification
Review Teams State Planners and
Evaluators Quality Improvement
Councils
7
QSR Constructed from the Bottom Up
Physical Plant and Safety indicators Evaluated for 100% of service locations
25% of Individual Plans and associated indicators are evaluated by CM Supervisors
20 Indicators Evaluated for 100% of Individuals by Case Managers
Another set of Personal Outcome and Support Indicators assessed for 30% of the people by Regional Reviewers
System Review,
Analysis & Improveme
ntState Level Certification
Review of Public and Private Provider Organizations
Sample of Individuals Across All Settings Using All Indicators
•Revise Policy and Procedure•Provider Profile•Quality Improvement Councils•Plans of Correction or Improvement•Target Organization Development & Educational Support
8
Integrating Regional & State Quality Systems
Performance measures and expectations are drawn from one pool of quality indicator data
Quality Service Review Indicators:
Consumer Interview - Observation - Support Person Interview Documentation - Safety Checklist - Application Packet
Regional QualityReview Visit
Consumer Interview
Observation
Documentation
Safety Checklist
Support Person Interview
Case Management ReviewConsumer Interview
Observation
Documentation
Any Observed Non-CompliantSafety Indicators
Case Management Supervisor Review
Documentation Indicators
MY QSR: Web-based Data Management System
Interim Tracking System
Central OfficeQSR
Certification Review
9
QSR Components
There are 23 Personal Outcomes and 29 Support Expectations found in the QSR tool under the Focus Areas
Personal Outcomes identify desired results regarding individuals’ experiences
Support Expectations identify ways that vendors may assist individuals to achieve those personal outcomes
Seven Focus Areas organize the major sections of the QSR Tool.
Planning & Personal Achievement SafetyRelationships & Community inclusion Health & WellnessChoice & Control SatisfactionRights, Respect & Dignity
10
QSR Components Continued
Quality Indicators are assessed through:Consumer Interview – 73, Support Person Interview
- 50Observation – 21, Documentation Review- 57Safety Checklist – 52, Application Packet – 8
Indicators are aligned according service type. Not all indicators apply to each service type
Interpretive Guidelines provide information from policy and procedure, regulation, best practice and reference specific definitions and sources. They provide examples and discussion for Reviewers and Vendors
11
QSR Content
Regulation Policy Best Practice Quality Measures in
planning, choice, inclusion, health, behavioral health, rights, safety, and satisfaction
12
Data System Makes It Happen
Dynamic and real time – reports are communicated via web system, reviewed and responded to. Action plans negotiated and tracked on line.
Organized – all findings can be sorted by person, place, provider, service type, assessment methodology, region, state.
Integrated – Findings from other systems entered (Behavior Review, Unusual Incidents, Abuse and Neglect Findings, Mortality Review)
Closes the Loop- manages follow-up without duplicating data entry
13
Reporting, Informing, Monitoring, Closing
Informs Certification Review decisions with longitudinal data instead of one-time snapshot
Informs and permits on-going performance evaluation of providers through trend monitoring by the regions and central office, on-demand
Informs choice of consumers and families by providing easy to read report cards
Informs Quality Improvement Councils with comparative findings from across providers and the state
Regional and State level monitoring activities can target QI needs if trends are noted or trigger enhanced contract oversight activities
Tracks and closes corrections and actions
14
The QSR will include the vendor’s self-assessment and quality improvement planning activities to evaluate the effectiveness of their own service and quality management systems
Findings from all levels of interaction with the department will continually inform on-going quality improvement efforts by vendors and DDS
Integrating QSR Certification Process with Existing Activities
15
QSR and Vendor Certification
The QSR for Vendor Certification combines regional review information along with a Vendor’s performance data from incident reporting, abuse/neglect, PRC and HRC, mortality review, financial audits etc. for a biennial retrospective review
A sample of individuals from each service is selected to conduct the consumer and service State Level reviews
Information for consumers and services may validate other findings, reinforce evidence that the Vendor has systematically improved, or suggest that performance may not be consistent with other findings
16
Certification is Service Specific
Individual Support Habilitation- Person’s Own Home
Supports in a Family Home
Self-Directed Supports Day Service Option Sheltered Work Supported Employment
– Individual and Group Individualized Day
Support
Family Respite Center Case Management Community Living
Arrangement, 4 or more Consumers
Community Living Arrangement, 3 or Fewer Consumers
Public Residential Center
QSR Tools are Tailored to Each QSR Tools are Tailored to Each ServiceService
17
Vendor Certification Reporting
Findings are reported for all individuals who have been evaluated by Case Managers and Regional Quality Monitors. The findings are included with the results from a specific sample of individuals for the State Level Certification Review
Service findings are discussed with Vendors in the context of their Quality Improvement Planning
Performance expectations will continue in Consumer Rights, Individual Plan Implementation, Consumer Health and Welfare, and Environmental Safety
Vendor performance benchmarks will be defined and adjusted over time as reviews are completed
Findings will be posted on the DDS web site for Families and Consumers using easy to understand aggregate reports by the QSR Personal Outcomes, Support Expectations, and Focus Area summaries for Vendor services reviewed
18
Additional Components Contributing to Vendor Certification Review
The following DDS Quality System components will contribute to Certification Review Findings:
PRC and HRC Committees Medication Administration Regulations Incident and Abuse / Neglect Reporting and
Follow-up Mortality Reviews Resource Administration and Monitoring Complaints Financial Audits
19
Licensure Transition to the QSR
CLAs will still need a “license” to operate and maintain DSS funding requirements
This “licensing” will occur at the time of the Vendor Certification QSR for each home
Regional staff complete Environmental Safety Reviews of each home each year. The Quality Indicators address all Physical Environment elements found in regulation
Regional staff also complete a broader review of at least one consumer per home each year
Central Office staff conduct consumer reviews at a sample of locations operated by the Vendor at the time of the Certification Review
Corrective Action Plans will continue to be required for select Quality Indicators that affect Consumers’ Health and Welfare during Regional and State Level Reviews
20
Reference
Quality Service Review DDS HCBS Waivers Supports and Services Provider Forms DDS Manual – Service Delivery Fire Safety and Emergency Guidelines
For More Information On...For More Information On...
Please see the DMR web site: http.www.ct.gov/dds