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

CONNECTICUT

Target Population

All people served by the Connecticut Department of Mental Retardation (DMR).

Geographic Focus

Statewide.

Primary Focus

• Establish a comprehensive and efficient data management system to incorporate the data from the State's new Quality Review and Improvement system on an ongoing basis, that will identify individual, provider, and system trends. The new system will effectively address and integrate the Centers for Medicare & Medicaid Services (CMS) Home and Community-Based Services (HCBS) Quality Framework (hereafter, the Quality Framework) functions of design, discovery, remediation, and systems improvement.



• Design self-advocacy activities based on the Quality Framework focus areas of participant access, participant-centered service planning and delivery, provider capacity and capabilities, participant safeguards, participant rights and responsibilities, participant outcomes and satisfaction, and system performance that will develop and enhance consumers' understanding and skills to enable their participation in quality initiatives.

Goals, Objectives, and Activities

Goal: Develop the capacity to input, store, analyze, and report quality indicators of the Department's new quality review system.

Objectives/Activities

• Test application prototype, provide training to pilot users, analyze pilot results, and modify prototype.



• Conduct analyses on identified data sets, produce and apply risk adjustment methodology, train information technology (IT) staff to perform advanced statistical analyses, and risk adjust quality and incident data.



• Develop browser-based message board to respond to regional quality monitor and case manager questions and provide technical assistance in quality review and/or service enhancement.



• Develop browser-based incident reporting capacity, pilot and modify as needed, train users, and implement statewide.



• Implement quality system data application department-wide, revise as needed, finalize application based on pilot results, provide training to quality system application users, and implement statewide.

Goal: Assure and improve quality for individuals living in their own or family homes.

Objectives/Activities

• Establish stakeholder work group to design quality review indicators and review methodologies that support individual preferences, choice, and capacity for assuming risk.



• Pilot review methods and tools and modify as needed.



• Revise policies and procedures related to participant safeguards for people who self-direct supports in their own or family homes based on the work group recommendations.



• Develop emergency and safety related resource and training materials in English and Spanish for consumers and families.



• Coordinate with CT CPASS Grant activities for staff recruitment and emergency backup, and train families and consumers to use web resources.

Goal: Involve individuals and their families in defining, determining, and improving quality.

Objectives/Activities

• Establish a state-level Quality Review and Improvement Council, incorporate quality improvement functions within existing regional and State advisory councils, and expand consumer and family participation in the development and monitoring of improvement plans through those councils.



• Establish DMR Self-Advocate Leadership Institute, to include a Speaker Bureau and Family and Consumer Networks that will develop self-determination training.



• Involve consumers and families in regional and State-level review team activities.

Goal: Develop and provide a wide range of training activities for various participant users of the new quality system.

Objectives/Activities

• Develop orientation and training curricula specific to quality system participant roles (i.e., individuals and families, provider agencies, State-level quality management staff, regional quality monitors, and case management staff).



• Provide training for quality system participants in use of new tools and quality improvement plan development.



• Support consumer involvement in review team activities and quality improvement plan development.



• Provide training to individuals who self-direct on how to use the staff recruitment and emergency backup web-based resources developed through the CT CPASS Grant. Training will be provided by Family and Consumer networks.

Key Activities and Products

• Develop browser-based technology to enable secure, real time data entry and access to DMR applications, and design additional data management systems and modify existing systems to incorporate new quality indicators for analysis, reporting, and follow-up functions.



• Establish a methodology to risk adjust data, establish valid benchmarks and conduct analyses of quality and incident data to identify patterns, trends, and those variables that predict risk.



• Revise all current DMR policies and procedures related to participant safeguards, develop multi-media materials in English and Spanish to support education activities, and provide home safety and emergency preparedness information and resources to individuals and families.



• Establish a Self Advocate Leadership Institute that would develop consumer skills to participate in the Department's quality initiatives, create a Self Advocate Speaker Bureau, and establish Family and Individual Networks to support self-determination.



• Identify areas for training and technical assistance to improve quality review techniques and service enhancements.



• Train families and individuals who are managing their own services to effectively use enhanced web-based recruitment tools to access potential employees for hire, and to utilize local emergency backup staff arrangements.

Consumer Partners and their Involvement in Implementation Activities

• The Department will establish a work group of consumers, family members, public, and private provider staff with the support of fire safety professionals, the University of Connecticut Cooperative Education Center, medical and psychological services professionals and others, to design quality indicators and improvement methodologies in the areas of home safety and emergency preparedness, and participant safeguards.



• Consumers will participate in the quality review and improvement planning processes through roles on review teams, participation in consumer outcome interviews and membership on State and regional quality improvement councils.



• Status reports will be made by staff responsible for grant goals and objectives with the assistance of participating consumers and family members.

Public and Private Partners and their Involvement in Implementation Activities

Public Partners

• The State departments of Social Services and Information Technology will interface with the lead agency as needed and will participate on the grant's steering committee.



• The Office of Policy and Management (the Governor's budget office), the Office of Protection and Advocacy, DMR Private Provider Council, and DMR Self Advocacy Council will participate on the grant's steering committee.



• The Council on Mental Retardation (an advisory council of family members appointed by the Governor and Legislature to advise the DMR Commissioner) and the CT Planning Council on Developmental Disabilities will participate on the grant's steering committee.

Private Partners

• Arc CT, Connecticut Private Providers Association, Connecticut Association of Non-Profits, CT People First, CT Family Support Council, and the Braceland Center on Aging of Harftord Hospital will participate on the grant's steering committee.



• Subcontractors will be hired for the technology-related activities, for various training and materials development activities, and for statistical analyses, risk adjustment, and benchmarking activities.

Advisory Body, Committee, or Task Force

The grant's steering committee, composed primarily of family members and consumers (i.e., more than 51 percent), and provider staff and other State agencies, will provide ongoing direction and feedback in all aspects of grant implementation and evaluation.

Formative/Process Evaluation Activities

• Monitoring of progress toward goals and timelines will be accomplished through regular supervisory meetings between staff responsible for particular grant activities and the project directors.



• The project directors will meet bi-monthly with the steering committee to report status on progress, barriers encountered and removed, seek input on next steps, and determine the need to modify actions and timelines.



• The steering committee, in conjunction with key project staff, will analyze on an ongoing basis what activities have been successful and can be built upon; what barriers are encountered, how they can be reduced or eliminated, and by whom; and what actions and strategies are still needed to reach the stated goals.



• Information from this ongoing evaluation and reflective learning process will be shared with stakeholders at large through regularly occurring meetings at the State and regional levels, and on a periodic basis through specially scheduled learning network meetings for various stakeholder groups and department managers and supervisors.

Summative/Outcome Evaluation Activities

The steering committee will develop a final report to evaluate the grant's achievement of outcomes.

Strategies to Ensure Sustainability

In the early stages of the grant, the steering committee will assist the project directors and key staff to develop a plan for sustainability and assure that steps toward allocating financial and personnel resources and processes are in place as the activities of the grant progress. Elements of the sustainability plan will include the following:

• The cost of necessary hardware to support the quality data management system, including laptops or hand held devices for data input will be absorbed by the DMR's information technology budget.



• DMR Staff Development and Information Management and Technology departments will assume the financial and resource responsibility for providing ongoing training for department staff to maximize use of the quality data management system and development of skills necessary to perform basic and advanced statistical analyses.



• DMR Staff Development will assume responsibility for the continuation of training for quality system participants and users, including dedication of staff and financial resources to develop and provide training as well as to support development of associated materials.



• The department will project the need for funds to support the ongoing need for consultation in statistical analyses beyond the term of the grant.



• The central office Director of Self-Determination position was recently created and assigned to the Staff Development department to design and manage self-determination-related training activities, as well as consumer and self advocacy functions, including the Leadership Institute and Individual and Family Networks.



• The department will use already established regional and State advisory councils with family and consumer membership to perform quality improvement functions that are proposed as a new and ongoing responsibility for these existing groups.



• The department has the existing infrastructure at both the State and regional levels to continue the quality improvement initiative as it evolves beyond the term of the grant, with Case Management, Resource Administration, Information Management and Technology, Staff Development, Quality Improvement, and Quality Management staff.