Sustaining Excellence—Making Progress
Using Data to Implement Change
Georgia Department of Behavioral Health, Division of Developmental Disabilities and
Delmarva Foundation
Eddie Towson, Director of Quality Management
Marion Olivier, Director GQMS
Sue Kelly, Senior Scientist
Eddie Towson
• GA DBHDD
• Director of Quality Management
Marion Olivier MSW
• Delmarva Foundation
• Director GA Quality Management System
Sue Kelly PhD
• Delmarva Foundation
• Senior Scientist
Introductions
We will take a look at:
Purpose of Presentation
Where we get the data
How we share the data
Findings from various studies
Quality Improvement Initiatives
System impact?
How Georgia’s DBHDD Division of DD uses performance review data to
implement change
Purpose
Purpose
Training
Review Processes
State and
Regional Policy
Quality Improvement Initiatives
Show how data guide:
Where We Get Data: Delmarva Reviews
Person Centered Reviews (PCR)
Quality Enhancement Provider Reviews (QEPR)
Follow Up with TA Consultation (FUTAC)
PCR
Assess Quality of Life
Support Coordinator Record Review
Provider Record Review
Observation ISP QA Checklist
Individual Interview:
NCI & III
QEPR Assess Provider Systems and Practices
Individual Interview Begins Process
Administrative Review/Qualifications and Training
Observation, when appropriate
Direct Service Provider Interview(s)
Individual Record Reviews
ISP QA Checklist
How We Share Data
• Regular reports to DHBDD
• Ad Hoc reports for DBHDD, Regional
Offices, or providers
• Data Summaries for Quality
Improvement (QI) Councils
• Quality Improvement Studies
Quality Improvement Study Results
Provider Systems and Driver Outcomes (2014)
• Identify predictor outcomes
• Provider performance that impacts driver outcomes
Psychotropic Medication Use: Individuals Who
Recently Transitioned to the Community (2013)
• Trend medication use as individuals transition to the community
• Compare to individuals already living in the community
Outcomes Measured Through PCR Interview
Person
Health
Safety
Community
Person Centered Practices
Choice
Rights
Provider Record Reviews (PRR) to Identify
Predictors of Driver Outcomes
Assess the quality of provider documentation
Review records for all services the individual
receives
Documentation shows how well providers
implement policies and support individuals
served
Provider Systems and Driver Outcomes
Georgia Quality Management System
Driver Outcomes
(Individual Interviews)
Provider Performance
(Record Review from PCR and
QEPR)
Control Variables
Identified by Principal
Component Model
Tested using Logistic
Regression
Strongest Driver Outcome
Person Centered Planning
The person is afforded choice of services and supports.
The person is involved in the design of the service plan.
The person's goals and dreams are reflected in supports and services.
The person is achieving desired outcomes and goals.
Second Driver Outcome
Community Integration and Rights
The person actively participates in decisions concerning his or her life.
The person is educated and assisted to learn about and exercise rights.
The person has opportunities to access and participate in community activities.
The person is developing desired social roles.
Strongest Predictors of Driver Outcomes
(OR = PCP and C/R Odds Ratio)
Strongest predictor of both driver outcomes is if the person is provided a choice of community services and supports (OR 2.52, 3.54)
If provider ensures a choice of services and supports, person is much more likely to have both driver outcomes (OR 2.20, 2.23)
If documentation shows providers assist person to direct supports and services, both driver outcomes are more likely to be present (OR 1.91. 1.86)
Providers who use a person centered focus in their documentation positively impact driver outcomes (OR 1.70, 1.68)
Documenting how the person is progressing toward and achieving desired goals positively impacts driver outcomes (OR 1.57, 1.56)
Having the means to identify health status and safety needs increases the persons community integration (OR 1.77)
Strongest Predictors of Driver Outcomes
(OR = PCP and C/R Odds Ratio)
Key Findings
Providers who offer choice of services and supports,
choice of community supports, or
ensure the person directs services
are 2 to 2.5 times more likely to impact Person Centered Planning, a key driver outcome that impacts overall quality of life for the person
What the Department Did and Continues to Do
Continue to develop and enforce Department policies and standards which reflect Person-Centered Best Practices
Developed and continue to provide training for all stakeholders in the areas of Choice and Self-Direction
Developed and continue to offer one on one technical assistance to providers and individuals
Identified and recognized providers who have developed Best Practices and shared those with all stakeholders
Presented study to QI Councils who used findings to develop the main theme of Choice for QI initiative
Psychotropic/Anticonvulsant Medication Use
Individuals Recently Transitioned to Community (IRTC)
Georgia had a history of ranking above the NCI average (higher utilization of psychotropic meds).
ADA Settlement: moving individuals from institutions to community settings
IRTC vs. Comparison Group
For each group we calculated:
Average Medication Use Rates
Calculated confidence intervals with 95% Confidence
Levels and +/- 5%
Prevalence Rates
Difference of Proportions
Significance Test
Average Number of Medications
Both groups show statistically significant increase
1.01 1.09
1.18 1.26 1.31
1.40 1.48
1.56 1.65
1.74 1.83
1.91 1.98
0.68 (6 mo prior)
0.83 (3 mo prior)
1.17 (Transition)
1.84
0.0
0.5
1.0
1.5
2.0
2.5
Mean, Comparison (N=4,371) Mean, IRTC (N=151)
Medication Use Prevalence Rates (>=1)
Both groups show statistically significant increase
19% 20% 21% 22% 23% 25% 26% 27% 28% 30% 31% 32% 32%
32%
41% 44%
0%
25%
50%
75%
100%
1/1/2010 4/1/2010 7/1/2010 10/1/2010 1/1/2011 4/1/2011 7/1/2011 10/1/2011 1/1/2012 4/1/2012 7/1/2012 10/1/2012
Comparison (N=12,722) IRTC (N= 325)
Transition
• Examine reasons for the increased medication use over time and the increase prior to transitioning from the institution.
• Analyze current transition process and modify as needed to ensure providers and support coordinators are trained and prepared for individuals with complex challenges.
• Explore the demographic disparities identified in this study.
• Identify individuals at high risk who may need medication management and oversight
What the Department Did and Continues to Do
New Results
For the first time in 7 years, Georgia dropped below the NCI average for psychotropic
medication use.
Regional & Statewide QI Councils
• Established in Oct 2008
• Representation
– Self Advocates
– Parent Advocates
– Providers & Support Coordination
– Key Regional & State Representation
– Advocacy Organizations
Role of the Councils Use Data to:
Take Action
Make Changes
Remediate
Improve Quality
Council Improvement Projects
To Increase Person Centered Practices
• Changed statewide policy to improve efficiency of the ISP Addendum process
• Piloted a project to ensure all goals in ISP are person centered (increased from 6% to 25%)
• Created a video for parents and self advocates, with individuals telling what person centered practices mean to them
https://www.dfmc-georgia.org/
Council Improvement Projects
to Enhance Information by Developing:
• Guidelines for Choice
• Brochure and Guide for Supported Employment
Council Improvement Projects
to Address Health and Safety
Virtual and face to face training to help individuals and staff recognize assault, neglect and exploitation.
Council Improvement Projects
to Address Health and Safety
Council Improvement Projects
to Address Health and Safety
Data From Delmarva Reports Guide Training
Examples of results from data that guided evidentiary-based training curriculum (FY 10-11):
Provider has a means to identify person’s health status and safety needs (PRR - 22.5%)
If providing medication management or administration, rules/regulations and best practice guidelines are followed (PRR - 46.5%)
Annual informed consent for psychotropic medication use is present (ISP – 18.6%)
All required and applicable assessments are completed: Nursing assessment, Psychosocial review, and Physician summary (ISP – 64.2%)
Data From Delmarva Reports Guide Training
Examples of evidentiary-based training curriculum:
Safety Beyond the Basics
Quality Medication Management and Healthcare Overview
Documentation 101
Quality Health and Safety Management for Nurses and DDPs
Percentage Point Increase (pts)
FY10-11 to FY14-15
Service provider documentation (PRR) shows
• Individual is achieving desired goals ( 16 pts).
• When providing medication oversight and/or management, proper rules, regulations and best practice guidelines are followed ( 11 pts).
• Provider meets all waiver documentation requirements ( 10 pts)
Percentage Point Increase (pts) ISP Expectations
FY10-11 to FY14-15
Support Coordinator ensures ISP
• Has at least one goal that reflects the person’s hopes and dreams ( 12 pts).
• Includes an annual informed consent for psychotropic medications ( 11 pts).
Percentage Point Increase (pts) ISP Expectations
FY10-11 to FY14-15
All 4 criteria present on ISP expectations:
• Percent centered important to/for ( 28 pts)
• Service Summary ( 20 pts)
• Rights, Psychotropic Medications, Behavior Supports Section ( 25 pts)
• SIS is complete and identified needs are addressed in the ISP ( 22 pts)
• Health and Safety Review Section completed ( 45 pts)
What Was the Impact For Individuals
Individual outcomes: comparing
combined results from July 2008 – June 2011 to July
2014 – March 2015
• Average increase in outcomes of 7.2 percentage points
• 8 of 15 Outcome Indicators have improved by 5 percentage points or more
Individual (III) Outcomes: Percentage Point Increase (pts)
July 2008 – June 2011 to July 2014 – March 2015
The person is:
• Safe or has self-preservation skills. ( 14 pts)
• Educated and assisted to learn about and exercise rights. ( 14 pts)
• Involved in the design of the service plan. ( 13 pts)
• Actively participating in decisions concerning his or her life. ( 10 pts)
Outcome results for July 2014 – March 2015,
compared to July 2008 – June 2011
Pertaining to Goals:
• The person is achieving desired outcomes and goals. ( 12 pts)
• The person's goals and dreams are reflected in supports and services. ( 10 pts)
WRAP UP: Lessons Learned
Importance of transparency
Know your audience
Provide guidance to your audience
Stay involved
Be empowered and persistent
Please Feel Free to Contact us with
feedback and suggestions!
Eddie Towson:
Marion Olivier:
Sue Kelly:
