Quality Assurance and Quality Improvement in Home and Community-Based Services (QA/QI)

VERMONT

Target Population

Persons with disabilities who are eligible for the four home and community-based services (HCBS) waivers within the Department of Aging and Independent Living (DAIL).

Geographic Focus

Statewide

Primary Focus

Ensure the health and well-being of individuals receiving HCBS waiver services within Vermont's community-based, long-term care system by providing a comprehensive quality assurance and quality improvement management system in all four HCBS waivers utilizing the Centers for Medicare & Medicaid Services (CMS) HCBS Quality Framework.

Goals, Objectives, and Activities

Goal: Develop a Quality Management Plan addressing all four HCBS waiver programs.

Objectives/Activities

  • Develop a Quality Management Committee (QMC) to function as an active workgroup in the development and implementation of a quality management system for all four of the State's HCBS waivers.
  • Assess the current quality management systems within the four HCBS waivers.
  • Develop new service standards that include quality in the design and delivery of services.
  • Implement the strategies outlined in the Quality Management Plan within the four HCBS waivers.

Goal: Include consumers, their families, and community members as active participants in Vermont's quality management activities.

Objectives/Activities

  • Develop quality indicators with consumers and families as part of the QMC and contract with consumer and family advocacy organizations to convene focus forums on the quality indicators.
  • Develop methods to directly engage consumers and their families in a discovery process that elicits their experiences with the services received.
  • Develop a role for direct consumers to participate in a pilot by including them on State quality review teams; recruiting, hiring, and providing training to two 0.5 FTE consumers; and evaluating the effectiveness of consumers in assessing the quality of services for other consumers.
  • Develop methods to include consumer and family involvement in the development of service provider remediation plans and utilize consumers and families on the QMC to provide training during implementation of the new Quality Management Plan.

Goal: Develop and implement quality management activities to improve supports and services to Vermont's elder citizens and those with disabilities.

Objectives/Activities

  • Research promising quality assurance practices and methods of gathering data and information, develop and implement multiple methods of discovery, develop technical assistance manuals, and implement service provider agreements that include quality assurance practices.
  • Develop and implement relevant and timely methods of remediation; design a system that has participant safeguards, presents timely feedback, addresses issues proactively, and addresses issues requiring immediate action; and develop formats for remediation plans that include consumer and family input.
  • Research, develop, and implement methods of public reporting on the quality of services and develop information that includes data from existing sources and new methods developed as a result of grant activities.

Goal: Develop a technology-based system to manage and analyze critical incidents.

Objectives/Activities

  • Research Web-based methods of tracking and reporting critical incidents.
  • Train all providers on the uses of the system.
  • Develop reporting and follow-up formats and protocols for critical incidents.

Goal: Develop an ongoing system of technical assistance to all providers of services across age and disability groups and provide training to service recipients and relevant staff.

Objectives/Activities

  • Assess the training needs of stakeholders involved in the implementation of the new Quality Management Plan, develop an initial training plan to "roll out" the plan, and train stakeholders on the plan.
  • Develop a system of technical assistance to service providers in the delivery of quality services. Identify training needs and develop training plans with service providers.

Key Activities and Products

  • Assess the current quality management systems within the four HCBS waivers, develop new service standards, and implement the strategies outlined in the Quality Management Plan within the four HCBS waivers.
  • Develop quality indicators with consumers and families and contract with consumer and family advocacy organizations to convene focus forums to seek feedback on the quality indicators.
  • Develop methods to directly engage consumers and their families in a discovery process.
  • Include direct consumers on State quality review teams; recruit, hire, and train two 0.5 FTE consumers; and evaluate the effectiveness of consumers in assessing the quality of services for other consumers.
  • Develop methods to include consumer and family involvement in the development of service provider remediation plans, and utilize consumers and families to provide training during implementation of the Quality Management Plan.
  • Research promising quality assurance practices and methods of gathering data, develop and implement multiple methods of discovery, develop technical assistance manuals for information gathering activities, and implement service provider agreements.
  • Develop and implement relevant and timely methods of remediation, design a system with participant safeguards, and develop formats for remediation plans that include consumer and family input.
  • Research, develop, and implement methods of public reporting on the quality of services, and develop information that includes data from existing sources and new methods developed as a result of grant activities.
  • Research Web-based methods of tracking and reporting critical incidents, train all providers on the uses of the system, and develop reporting and follow-up formats and protocols for critical incidents.
  • Assess the training needs of stakeholders involved in the implementation of the new Quality Management Plan, develop an initial training plan to "roll out" the plan, and provide training to stakeholders on the plan.
  • Develop a system of technical assistance to services providers in the delivery of quality services, and identify training needs and develop training plans with service providers.

Consumer Partners and their Involvement in Implementation Activities

Consumers and their families will (1) participate in a QMC to assist in the development of the quality management system and (2) participate in all grant activities, including problem analysis, planning, implementation, monitoring, and evaluation.

Public and Private Partners and their Involvement in Implementation Activities

  • Quality assurance staff and waiver administrative staff within each of the four HCBS waiver programs (within the Divisions of Developmental Services, Vocational Rehabilitation, and Advocacy and Independent Living) will be involved in the assessment of current quality management activities and in the design, development, and implementation of the Quality Management Plan.
  • The Center on Disability and Community Inclusion (CDCI) at the University of Vermont will research promising quality assurance practices and methods of gathering data and information, and develop a technical assistance manual, and make recommendations for a public reporting format. The Center is also expected to provide an evaluation of the project.
  • Consumer organizations and service provider organizations—including Green Mountain Self-Advocates, ARC of Vermont, Community of Vermont Elders, American Association of Retired Persons, Vermont Center for Independent Living, and the Brain Injury Association of Vermont—will provide statewide focus forums (to gather input from various stakeholders) and develop independent methods of feedback and information gathering during development of the quality management system.
  • A consultant will be hired to develop and implement a technology-based critical incident management system within the HBCS waiver programs. The consultant will work collaboratively with the Department's information and technology staff.
  • Technical assistance and training will be provided by contracted consultants, waiver administrative staff, and through partnerships with service providers and consumer and family advocacy organizations.
  • Service and trade organizations—such as the Vermont Council of Developmental and Mental Health Providers, Head Injury/Stroke Independence Project, Vermont Association of Adult Day Services, Area Agencies on Aging, and Vermont Assembly of Home Health Agencies—will be (1) contracted to provide focus forums to gather information on specific objectives; (2) actively involved in the QMC; and (3) involved in developing quality indicators, methods of feedback, quality improvement plans, and provider agreements.

Advisory Body, Committee, or Task Force

  • The QMC will participate in decision making on grant activities, make recommendations for changes in current practice, actively assist in development of the Quality Management Plan, participate in information gathering activities related to the development of the plan, participate in reviewing consultant proposals, recommend new quality management activities, participate in ongoing quality improvement activities, and assist in the development of documents and products such as the quality service standards.
  • A Quality Management Development Specialist will be hired to oversee the development of the Quality Management Plan, act as the grant manager and facilitate the development and ongoing activities of the QMC.

Formative/Process Evaluation Activities

The State anticipates contracting with CDCI to provide an evaluation component for the project. Ongoing evaluation and feedback mechanisms will be built into the design throughout the development and implementation phases of this initiative.

Summative/Outcome Evaluation Activities

CDCI will address stakeholder involvement in the QMC, collaboration among stakeholders, incorporation of the CMS HCBS Quality Framework, and data collection design and sustainability. Consumers and family members will be included in the design, delivery, and implementation of the evaluation methodology. The State also anticipates contracting with CDCI to research promising quality management activities.

Strategies to Ensure Sustainability

  • Organizational efficiencies are anticipated by implementing a single quality management system rather than four separate systems. Quality management activities will become embedded in the service delivery within the four HCBS waiver programs. The State anticipates redirecting collective resources and current waiver administrative staff to sustain the quality management activities designed through the grant initiative.
  • The State expects that the QMC will continue to work on quality improvement activities after the grant ends. The State also expects that consumers and their families will continue in their roles on the Committee, continue to be actively involved in the multiple discovery processes, participate on provider evaluation teams through existing resources, and continue in their quality improvement and technical assistance roles.
  • The resource guide developed will continue to provide guidance to individuals implementing quality management and feedback methods, and the methods developed will become routinely implemented within the four HCBS waivers. As a regular part of quality management, remediation plans and quality improvement plans will be expected to address identified deficiencies.
  • The technology system developed will be implemented and will serve the HCBS waiver programs after the grant ends. Maintenance and future development will be supported through State funds, if needed, to ensure an ongoing, responsive technology system.
  • The ongoing system of technical assistance to support service providers will continue using existing State resources and training funds within DAIL after the grant ends.