STATE QUALITY MANAGEMENT SYSTEM FOR TREATMENT IMPROVEMENT Understanding and Using the Information Sanford Starr | Terry Patel | Laura Potts | Kevin Feasel

STATE QUALITY MANAGEMENT SYSTEM FOR TREATMENT

IMPROVEMENTUnderstanding and Using the

Information

Sanford Starr | Terry Patel | Laura Potts | Kevin Feasel

Spring 2012FINAL

John R. Kasich, GovernorOrman Hall, Director

What is Quality Management?*

Quality Management (QM) The processes of establishing measures,

gathering and reporting data and using data to • verify performance; • improve services and/or business practices; and • make data-driven decisions

The term (QM) is used in healthcare where as “Performance Management” has been used in the substance abuse field

* Performance Management for Substance Abuse Treatment Providers. SAMHSA. April 2008.

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Quality Management - Webinar Series #1 FINAL - Spring 2012

Components of QM

“Quality Assurance” is establishing, measuring and identifying and correcting minimal standards of acceptable performance, which is completed by experts and staff

“Quality Improvement” is the process that defines quality according to the needs and preferences of customers and continuously improve services in real time as services are provided ODADAS’ approach focuses on Quality

Improvement

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Research vs. Quality Management

Adds to knowledge and evidence-based practices

Experimental and quasi-experimental designs

Sophisticated techniques and analyses

Led by health/ human services scientists

Takes months to years

Presents evidence of effectiveness and improved services

Internal comparison of data over time

Simple analyses of trends over time

Led by clinical and program staff

Takes a few months

Research Quality Management

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ODADAS QM Plan

To use QM on a statewide level; however data are available to providers and boards for their own use

To start with treatment services and incorporate prevention services at a later date

To develop techniques and strategies to increase performance and share key learnings

To encourage peer support and networking To continue training and technical assistance


Implementing the System

Start with measures that impact outcomes*

Retention (in treatment)

Disposition at Discharge Invite providers and boards to work with

ODADAS to determine the utility Use NIATx for quality improvement

purposes Develop subgroup reports

* QM is evolving; this is just a starting point

* QM system is evolving; this is the starting point


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Retention Indicators

At least one clinical encounter* within the first 14 days post assessment and two additional encounters within the 30-day period (Washington Circle)

At least four clinical encounters* within the first 30 days post assessment (NIATx)

* Does not include case managementQuality Management - Webinar Series #1 FINAL - Spring

2012

Case Management Findings*

State retention rates only: Case management only – low retention

rates Clinical services only – improved retention

rates (~35%)

Case management and clinical services – dramatic increase in retention rates (~60%)

* For unbundled case management Quality Management - Webinar Series #1 FINAL - Spring

2012

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Table Figures - Retention

“All Clients” represents the number of clients*

served at a particular provider based on the Unique Provider Identification (UPID) number

“Retained” represents the number of clients who met the retention measure

“Retention Percentages” represent the percent of clients who met the retention measure

*Measures are based on unduplicated clients information with admission and discharge records. Admission dates are used in reporting.





Interpreting Results

Critical to know: What the UPID represents Percentage of clients served are reported in

Ohio Behavior Health (OHBH) Percentage of clients served have

admission and discharge records When services are billed in MACSIS*

* Multi-Agency Community Services Information System


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How the Results Can be Used

What is the direction of change; how do the numbers increase, decrease or remain the same over time?

What are the differences among levels? Were the figures expected? Are these the desired results? What strategies might be used

to do better? Who needs to be involved in making and sustaining improvements?


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Levels of Measures*

Provider Based on UPID

Board 47 combined (ADAMHS) and 3 separate (ADAS)

Region▪ Metropolitan ▪ Rural, Non-Appalachian ▪ Suburban ▪ Appalachian

State* National data will be provided if applicable and available


Metropolitan Region (12)

Allen Butler Cuyahoga Franklin Hamilton Lorain

Lucas Mahoning Montgomery Richland Stark Summit

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Suburban (17)

Auglaize Clark Delaware Fairfield Fulton Geauga Greene Lake Licking

Madison Medina Miami Pickaway Portage Trumbull Union Wood

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Rural, Non-Appalachian (30)

Ashland Ashtabula Champaign Clinton Crawford Darke Defiance Erie Fayette Hancock Hardin Henry Huron Knox Logan

Marion Mercer Morrow Ottawa Paulding Preble Putnam Sandusky Seneca Shelby Van Wert Warren Wayne Williams Wyandot

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Appalachian (29)

Adams Athens Belmont Brown Carroll Clermont Columbiana Coshocton Gallia Guernsey Harrison Highland Hocking Holmes Jackson

Jefferson Lawrence Meigs Monroe Morgan Muskingum Noble Perry Pike Ross Scioto Tuscarawas Vinton Washington

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MARIONMORROW

KN O X

HENRY

PUTNAM

LAWRENCE

PIKE

ATHENS

COSHOCTON

HOLMES

FAIRFIELD

HOCKING

JACKSON

SCIOTO

HIGHLAND

ROSS

FAYETTEPICKAWAYGREENE

BELMONTMUSKINGUM

MEIGS

VINTON

WASHINGTON

MORGAN

PERRYMONROE

GUERNSEY

P0RTAGE

HARRISON

JEFFERSON

RICHLAND

SENECA

HARDIN

SANDUSKY

LICKING

DELAWARE

MADISON

FRANKLIN

CHAMPAIGN

MAMI

DARKE

PREBLEMONTGOMERY

CARROLL

BROWN

CLER-MONT

HURON

ERIE

ASHLAND

WYANDOT CRAWFORD WAYNE

CUYAHOGALORAIN

SUMMIT

LAKE

ASHTABULA

TRUMBULL

GEAUGA

MAHONING

COLUMBIANASTARK

NOBLE

GALLIA

CLINTONWARREN

SHELBY

WILLIAMS

MERCER

ALLEN

AUGLAIZE

HANCOCK

VAN WERT

FULTONLUCAS

WOOD

OTTAWA

LOGAN

UNION

CLARK

Ohio Regions

BUTLER

ADAMS

MEDINA

TUSCARAWAS

PAULDING

DEFIANCE

HAMILTON

Legend

Appalachian

Rural, Non-Appalachian

Suburban

Metropolitan

Disposition at Discharge Categories Assessment and Evaluation Only (2)

Neutral (8)

Referral (2)

Successful (1)

Unsuccessful (5)


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Assessment and Evaluation Only

Successfully Completed no Further Services Recommended

Client Rejected Recommendations


http://www.google.com/imgres?q=assessment+and+evaluation&hl=en&biw=1280&bih=571&gbv=2&tbm=isch&tbnid=64eBN0pcHvQ_GM:&imgrefurl=http://www.ksu.edu.sa/ADMINISTRATION/RECTORDEPUTIES/UDB/PROGRAMS/RESEARCHCHAIRS/MEDCHAIRS/Pages/Assessment.aspx&docid=hE6jonIlvwDryM&imgurl=http://www.ksu.edu.sa/Administration/RectorDeputies/UDB/Programs/ReSearchChairs/MedChairs/PublishingImages/Assessment.jpg&w=300&h=225&ei=B5T0TrWAGof04QSQsKCSCA&zoom=1&iact=rc&dur=422&sig=116173580796569227674&page=1&tbnh=113&tbnw=151&start=0&ndsp=22&ved=1t:429,r:3,s:0&tx=66&ty=54

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Neutral

Left on Own Against Staff Advice WITH Satisfactory Progress

Incarcerated Due to Old Warrant/Charge from Before Entering Treatment (Satisfactory or Unsatisfactory)

Transferred to Another Facility for Health Reasons

Death Client Moved Needed Services Not Available Other


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Referral and Successful

Referral Referred to Another Program or Service (Satisfactory or Unsatisfactory)

Successful Successful Completion/Graduate


http://www.google.com/imgres?q=achieved+goals&hl=en&sa=G&biw=1280&bih=571&gbv=2&tbm=isch&tbnid=oIDX46-VfzqmzM:&imgrefurl=http://www.exposeknowledge.com/kb/666-achieve-your-goal-easily.aspx&docid=HL2AQfLXZy8IBM&imgurl=http://www.abcdlady.com/2009-07/goal_setting.jpg&w=347&h=346&ei=F8D0TpvTK-GN4gTboMGNCA&zoom=1

Unsuccessful

Left on Own Against Staff Advice WITHOUT Satisfactory Progress

Involuntarily Discharged Due to Non-Participation

Involuntarily Discharged Due to Violation of Rules

Incarcerated Due to Offense Committed While in Treatment/Recovery (satisfactory or unsatisfactory)


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Table Figures – Disposition at Discharge

Number of Client Episodes Period of time between admission and discharge for

each level of care The number of episodes for all discharge categories

Percent Percentage of episodes for each of the discharge

categories Percentile

The dispersion of measures as related to zero—the 50th percentile equals the median

Successful to Unsuccessful Ratio Percentage of successful and unsuccessful dispositions

that are successfulQuality Management - Webinar Series #1 FINAL - Spring 2012

Provider Results Over Time

4/2011 - 3/2012

7/2011 - 6/2012

10/2011-9/2012

1/2012-12/2012

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

Assessment OnlyNeutralReferralSuccessfulUnsuccessful


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Disposition Data for Chart

Assessment Only Neutral Referral Successful Unsuccessful

4/2011 - 3/2012 4.64 3.93 62.62 7.74 21.07

7/2011 - 6/2012 5.85 4.53 57.10 9.25 23.21

10/2011-9/2012 4.22 4.82 61.75 8.30 20.79

1/2012-12/2012 1.00 1.00 64.20 8.02 19.75


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Review - Basis for Reports

Unduplicated client data (at the provider level)

from existing data in OHBH and MACSIS Admission dates are used for reporting; last

admission is used when there are multiple admissions in a quarter

Data only reported for clients with both an admission record and a discharge record

Clinical services are used to determine retention

Any change in a level of care is considered a new Episode of Care (not the case for OHBH)

UPID is used for provider data


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Subgroup Reports

Level of Care Outpatient Residential

Drug of Choice Alcohol Marijuana Cocaine/Crack Heroin Other Opiates Other Drugs


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Subgroup Reports - Population Groups

Age Adolescents (12-17)

Young adults (18-25)

Adults (18+)

Older adults (60+)

Criminal justice Deaf or hard of

hearing Dually diagnosed

Gender Mental health

history Methamphetamin

e using Opiate using Poly-substance

using Referral

disposition Service member

or veteran

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Why This QM Approach Now? To respond to the Substance Abuse

Treatment and Prevention (SAPT) Block Grant States must demonstrate the capacity and

capability to make data-driven decisions based on performance measures

ODADAS received SAMHSA Technical Assistance Planning and Outcomes Committees Other states’ systems

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Quality Improvements

Programmatic Better serve needs of clients Improve client outcomes Improve program efficiencies

Policy Inconsistent Missing Unclear


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Quality Improvements (continued)

Procedural Clinical Administrative

Human Resource* Caution: Position descriptions, supervision, training

and communication factors need to be explored before aligning results with people

Other Combination of factors such as funding, staffing,

facilities, operations, etc. * It is usually best to target improvements at the organizational level


Accessing Reports

Login to OHBH - http://prod.ada.ohio.gov Choose “Production” as environment Choose “OHBH” as application Choose “Reports” from main menu Click the link “Quality Management

Reports” at the far right side of the page


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http://prod.ada.ohio.gov/

http://prod.ada.ohio.gov/

Accessing Reports (continued)

Each PDF file is labeled with the measure, date and subgroup (if applicable)

Files are ordered by ascending UPID numbers

Use (“CTRL-F” or go to “Edit” then “Find”) to locate your report by UPID or provider name

Summary reports are also available Supporting documentation available on

site at “Click Here” or the ODADAS web site: www.odadas.ohio.gov, “Services,” NIATx,” “Quality Management System”


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http://www.odadas.ohio.gov/

Next Steps

Complete the webinar series to introduce the system

Organize questions and comments; determine utility Make modifications to reports and

documentation Recruit volunteers to work with ODADAS Test new ideas (as applicable)

Develop subgroup reports Encourage networking and peer support Continue webinars series and technical

assistance


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The End

Questions, Comments and Ideas

[email protected] 614-644-8316

[email protected] 614-752-8807Quality Management - Webinar Series #1 FINAL - Spring 2012

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mailto:[email protected]

mailto:[email protected]

Documents

STATE QUALITY MANAGEMENT SYSTEM FOR TREATMENT IMPROVEMENT Understanding and Using the Information Sanford Starr | Terry Patel | Laura Potts | Kevin Feasel