Quality

In our last update on HCBS quality (CMS Interim Procedural Guidance Update: May 28, 2004) we announced changes to the Interim Procedural Guidance (IPG) and offered further clarification of the review process. This communication announces additional changes to the IPG and the release of two technical assistance products.

This review is part of a new series of reports, “Closing the Quality Gap: Revisiting the State of the Science.” The series provides a critical analysis of existing literature on quality improvement strategies and issues for topics identified by the 2003 Institute of Medicine report, “Priority Areas for National Action: Transforming Health Care Quality.” To continuously assess progress toward quality, AHRQ identified people with disabilities as a priority population in this report.

The Office of Inspector General’s (OIG) body of work examining Medicaid personal care services (PCS) has found significant and persistent compliance, payment, and fraud vulnerabilities that demonstrate the need for Centers for Medicare & Medicaid Services (CMS) to take a more active role with States to combat the issues. This document summarizes OIG’s PCS work and, on the basis of the analysis of this work in the aggregate, offers recommendations to improve the integrity of Medicaid PCS.

This brief provides recommendations for conducting high quality systematic reviews. Systematic reviews can be useful for policy decision makers to draw accurate lessons from a large assortment of relevant studies because they identify, assess, and synthesize key pieces of evidence on policy or program effectiveness. Increasing high quality systematic reviews will provide decision makers with a greater number of useful evidence summaries that can inform decision making.

This report examines how health care outcomes for general medical care have been assessed for people with disabilities within the rubrics of care coordination and quality improvement. A total of 15,513 articles were screened; very few were direct examples of work conducted from the perspective of disability as a complicating condition. Capturing the disability perspective will require collaboration of measurement efforts across medical interventions, rehabilitation, and social support provision.

This report compares long-term care (LTC) for older adults delivered through Home and Community-Based Services (HCBS) with care provided in nursing homes (NHs) by evaluating (1) the characteristics of older adults served through HCBS and in NHs; (2) the impact of HCBS and NH care on outcome trajectories of older adults; and (3) the per person costs of HCBS and NH care, costs for other services such as acute care, and family burden.

This report details development of the Agency for Healthcare Research and Quality (AHRQ)’s Quality Indicators (QI) for the HCBS population. It includes key sections: 1) the introduction section providing background on the HCBS QI development project. 2) the methods section on an overview of the QI development process, 3) results of details of empirical analyses performed to support QI, 4) the concluding thoughts section providing a discussion of interpretation of the indicators.

This report seeks to understand quality care from a unique perspective; the individual receiving or accessing paid care services and support in their own home. The Consumer Voice convened interviews, surveys, and a national focus group to determine how consumers define quality care, pinpoint needed care improvements and recommend policy actions to provide more access to quality home care. This report provides consumers with an opportunity to speak out and contribute to shaping the policies.

This brief establishes a basis for key system transformation activities necessary to create a high quality, person centered care system for older adults and people with disabilities. What is the ideal person-centered system? Read about ways to unite the fragmented system.

This document offers recommendations for improving the efficiency and effectiveness of Older Americans Act (OAA) services upon its reauthorization. Recommendations are made under each Title of the Act. More general recommendations include increasing interaction and coordination with other federal programs that deliver services for older adults such as the Low-Income Energy Assistance Program (LIHEAP), Senior Corps, and Adult Protective Services.