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STAR-QI:A Performance
Measurement Application – the State and Provider
PerspectiveDawn Lambert-Wacey NYS OASAS
August 1, 2009 – NIATx/SAAS Summit ‘09
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)
STAR-QI – A Performance Measurement Application
• 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
STAR-QI – A Performance Measurement Application
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…
STAR-QI – A Performance Measurement Application
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.
STAR-QI – A Performance Measurement Application
STAR-QI – A Performance Measurement Application
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.
STAR-QI – A Performance Measurement Application
STAR-QI – A Performance Measurement Application
STAR-QI – A Performance Measurement Application
STAR-QI – A Performance Measurement Application
# 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
STAR-QI – A Performance Measurement Application
SSAProviders
Peer MentorsProgram ManagersProvider Association
Quarterly FAQ Quarterly FAQ SheetSheet
Online Online VideosVideos
User GuideUser GuideData Data
DefinitionsDefinitions
Technical Technical AssistanceAssistance
Feedback Loops:
STAR-QI – A Performance Measurement Application
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
STAR-QI – A Performance Measurement Application
Training/ Documentation
Support
Provider/ Stakeholder
Feedback
ApplicationDevelopment/ Improvement
Maintenance/ Monitoring
STAR-QI
STAR-QI – A Performance Measurement Application
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
STAR-QI – A Performance Measurement Application
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
STAR-QI – A Performance Measurement Application
STAR-QI – A Performance Measurement Application
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
STAR-QI – A Performance Measurement Application
STAR-QI – A Performance Measurement Application
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 – A Performance Measurement Application
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
STAR-QI – A Performance Measurement Application
Demonstration:
• Data Entry
• Reporting
• Export
• Data Monitoring
STAR-QI – A Performance Measurement Application