STAR-QI: A Performance Measurement Application – the State

STAR-QI:A Performance

Measurement Application – the State and Provider

PerspectiveDawn Lambert-Wacey NYS OASAS

[email protected]

August 1, 2009 – NIATx/SAAS Summit ‘09

mailto:[email protected]

Presentation Overview:Strengthening Treatment Access and Retention

– Quality Initiative (STAR-QI)

State and Provider perspectives on:• Developing a web application for process

improvement (PI). • Benefits of using STAR-QI in conjunction with

the NIATx principles and aims for PI• Feedback Loops• Next Steps• Demonstration Questions are welcome and encouraged

STAR-QI – A Performance Measurement Application

NIATx and STAR-SI in NY• Currently 10% of outpatient programs are

involved in one of 2 cross-state initiatives:– NIATx 200 (with NIDA) Clinical trial

designed to evaluate the cost effectiveness of field-tested process improvement strategies for addiction treatment.

– The Strengthening Treatment Access and Retention-State Implementation (STAR-SI) (SAMHSA-CSAT and The Robert Wood Johnson Foundation)


https://www.niatx200.net/Home/Home.aspx

https://www.niatx200.net/Home/Home.aspx

https://www.niatx.net/Content/ContentPage.aspx?NID=11

https://www.niatx.net/Content/ContentPage.aspx?NID=11

• Customer Focused (providers conduct walk-throughs)

• Providers collect and use data to improve client access and retention, reinforcing a patient centered approach to treatment.

• Change teams implement change projects using an iterative rapid cycle PDSA (Plan-Do-Study-Act) process.

• Rapid Cycles need REAL TIME DATA


NIATx Principles:

The NIATX aims:• Increased admissions• Increased engagement/retention• Reduced waiting time • Reduced no-shows and retention

in outpatient treatment.

NY could report some

Needed more data…


NIATx Aims:

1st Request

Assess(1 or 2)

3rdService

2nd Service

Admit(1st Service)

4thService Discharge

Successful Treatment Completion

No-shows to Admit

Continuation from 1st to 4th treatment service

Admissions Time from 1st Request to 1st Treatment/Admit

NY Data Needs for STAR-QI:

Development of STAR-QI

• State PDSA – rapid cycle development

• Excel system base (“NY’icized” NIATx)

• Same interface as Client Data System

• NIATx/STAR-SI/State staff acted as Subject Matter experts (SME)

• SME and IT team built requirements/ business edits/report meta-template.

• Result: On-time roll-out with all specified capabilities.



Data Collection:

Provider Feedback:Linda E. Huber – Horizons Counseling &

Education CenterTwo change projects which focused on increasing

attendance rate for the client’s first appointment resulted in:

• An increase in the number of admission • Reduction in duplication of paperwork due

to increases in client 30 day retention rates. • Increases in staff productivity rates. • Increases in level of staff satisfaction and

commitment.





# AS-4

Name Average Days from First Request to First Clinical Service

Numerator - Column 3Sum of the Days Between First Request and First Clinical

Service

Denominator - Column 4

Total Episodes with First Request for Service and First Clinical Service

Date Label - X Axis First Clinical Service Date

Calc Label - Col. 2- Y Axis

Average Days from First Request (adjusted) to First Clinical Service

Calculation Description

This report shows the number of days from the Adjusted First Request for Service Date to the First Clinical Service Date, as an average of all First Clinical Services between the 'from' and 'through' dates for the report.

Adjusted First Request for Service Date = The First Request for Service date or the Previous Discharge Date, whichever is later. First Clinical Service Date = This is the First Assessment Date. If there is no assessment, then it is the Admission Date.

Report Meta-Template example:

Early Benefits of STAR-QI :

• Infrastructure Development

• Data Literacy

• Multiple Levels of Collaboration

• Improving Access and Retention


SSAProviders

Peer MentorsProgram ManagersProvider Association

Quarterly FAQ Quarterly FAQ SheetSheet

Online Online VideosVideos

User GuideUser GuideData Data

DefinitionsDefinitions

Technical Technical AssistanceAssistance

Feedback Loops:


Provider Feedback:

Frank Mullineux – Long Beach Medical CenterWhat we learned:

• Continuous Developmental Process: “the dinner- party effect.”

• Change was real – focused - data the key.• Learning Organization Developed:

– Team as well as individual development– Inter / Intra organizational development– Leadership / managerial development – Clinical growth


Training/ Documentation

Support

Provider/ Stakeholder

Feedback

ApplicationDevelopment/ Improvement

Maintenance/ Monitoring

STAR-QI


Ongoing feedback Loops:

Ongoing feedback from users:

(via emails, learning collaboratives, technical assistance log, focus groups):

• MORE Reports

• More Flex Items (Used in CM projects)

• More Integration with CDS

• More Data Quality/ Monitoring capability


NY: Next Steps:CSAT TA request for Phase II of STAR-QI:

• Provider needs:– More reports – enhanced and

additional

– Increase ability for data monitoring

– More flex items

– Add flex items to reports

– Increase ease of use



Training Materials – On-line Videos:

NY: Next Steps:CSAT TA request for Phase II of STAR-QI:

• State needs:– Integrate data quality

– Allow county/provider monitoring.

– Training resources (webinars)

– Continue feedback loops

– Ongoing Maintenance



System Documentation:

STAR-QI: Take Home

• Web application developed by the state in collaboration with providers to gather crucial data to track change projects and give immediate real-time feedback on process improvement indicators.

• OASAS used a change project model with feedback from providers and stakeholders to ensure that STAR-QI met their needs.

• On-going feedback leveraged for Phase II development to respond to provider and state needs -the PDSA cycle continues


STAR-QI: Credits/Kudos

• The Year 1 STAR-SI NY providers for their help in “NY-icizing” the original Excel app.

• OASAS IT STAR-QI development team• Linda E. Huber – Horizons Counseling &

Education Center• Frank Mullineux – Long Beach Medical Center • The STAR-SI/NIATx providers for on-going

feedback • Katie Haverly and Vince Fenlon

Web Application, training materials including videos at http://oasasapps.oasas.state.ny.us


http://oasasapps.oasas.state.ny.us/

http://oasasapps.oasas.state.ny.us/

Demonstration:

• Data Entry

• Reporting

• Export

• Data Monitoring


Technology

STAR-QI: A Performance Measurement Application – the State