1. Personal Experience Survey (PES) Michigan Model Measuring the Quality of Services in the MIChoice Waiver Program

2. PES not PEZ

3. What is the PES? Created under a CMS contract by MetStat Defines “Quality” as services and supports delivered as written in the participant’s care plan. Does not define “Quality” from participant’s wants and desires.

4. PES Components 4 Domains –Access to Care –Choice and Control –Respect and Dignity –Community Integration 66 Standard Questions Additional six Michigan questions

5. Michigan Model Consumers hired to collect data First round collections at 5 sites Second round collection at 3 of 5 sites Telephone interview follow-up

6. Interviewer Training & Support Consumers identified by host site MDRC provided one day on site training PES User Guide assists in training Support provided by MDRC & local site MDRC managed reimbursement Interviewers as contract employees

7. Interviewer demographics 3-6 consumers hired at each site Seniors and People with Disabilities Collectively targeted 40 interviews per site (199 interviews in aggregate) Paid $20/hr. plus travel expense At two sites consumers did data input 3 sites MDRC did data input

8. Quality Indicators: Selected Data First Round Interviews Access to Care –Bathing –Toileting –Groceries Respect and Dignity –Staff Listening Choice and Control –Choice of Staff Community Involvement –Community integration

9. Bathing Questions 1.Is there any special help that you need to take a bath or shower? Needs Help from Another person Does not need help from another person Unclear response No response 2.Do you ever go without a bath or shower when you need one? 3.Is this because there is no one there to help you?

10. Bathing Positive 148 respondents

11. Toileting Questions 1.Is there any special help that you need to get to or use the bathroom? 2.Are you ever unable to get to or use the bathroom when you need to? Yes No Unsure Unclear No response 3.Is this because there is no one there to help you?

12. 57 Respondents Toileting

13. Grocery Questions 1.Is there any special help that you need to get groceries? 2.Are you sometimes unable to get groceries when you need them? 3.Is this because there is no one there to help you? yes No Unsure Unclear No Response

14. Groceries 184 Respondents

15. Questions: Respect of Staff Do the people paid to help you treat you respectfully in your home? –Yes –No –Sometimes –Unsure –Unclear Response –No Response –No staff in home

16. Respect of Staff 198 respondents

17. Question, Choice of Staff Do you help pick the people who are paid to help you? –Yes –No –Unsure –Unclear Response –No Response –No personal care staff

18. Choice of Staff 126 respondents

19. Community Integration/Inclusion Is there anything you want to do outside your home that you don’t do now? –Yes –No –Unsure –Unclear Response –No Response What would you like to do? What do you need to make this happen?

20. Community Involvement 199 respondents

21. Compare Sites: Community Involvement 199 respondents

22. Out of Home Activities Church Volunteer Cultural Activities Get Outside Shopping Senior Center Exercise Library Fishing Visit Friends & Family Garden Visit the sick Sports Make Happen Accessibility Transportation Companionship Money

23. Employment Questions (If respondent is under 65 ask question) Are you working right now? (Yes, No, Unsure, Unclear Response, No Response) What kind of work do you do? Did you help pick the job you have now? Do you like your job? Do you want to work?

24. Demand for Employment 47 respondents

25. Comparison of Indicators 201 respondents

26. Second Round Collected 6 to 12 months after first round collection Will be completed at the end of March.

27. Recommendations - Data Use Individual sites Review data with Care Managers and with Provider Agencies Work in partnership for improvement Agree upon 2-3 Indicators to improve Discuss in Quality Collaborative improvement methods for identified indicators Create impact plan Share learning with collaborative

28. Managing Data Limited to measuring quality of services from consumer point of view Good design of questions – Simple language, Simple questions No ability to adjust the language Easy to manage the data input Difficult to uniquely manipulate the data Can add questions but not put them into the data base.

29. Costs – First Round 199 interviews (aggregate) Average $78/interview –Hourly: $14,078.49 –Mileage: $1,711.60 –Accommodation: $397.61 –Data input: $ 750.00 Other costs: training, internal supervision of interviewers, data input.

30. Consumer Interviewer Site Costs

31. Quality of Interviewers Telephone Survey of 12% of people who had been interviewed twice Results: –100% felt respected and fully open to consumer interviewers –Only 1 of 27 indicated a preference for a waiver agency employee –3 of 27 people would not participate again

32. Cost Recommendations Keep total costs to average $30/interview $25 per interview Continue to pay travel expense Pay $10/hr for data entry, or data entry in organization. Build competent cadre of interviewers at local site (over time less supervision needs)

33. Quality Recommendations Use PES in local quality plans Use consumer interviewers Sites nurture cadre of seasoned interviewers Statewide training program (at MDRC or elsewhere) Maintain third party data collection Sites integrate quality improvement system for interviewers

34. For more information contact: David Youngs DYNS Services, Inc. 517-927-7255 303-200-8392 (fax) 941-744-5732 www.dynsinc.com This initiative was funded by a CMS grant to the Michigan Department of Community Health, and implemented by Michigan Disability Rights Coalition (MDRC). Carolyn Lejuste MDRC 517-333-2477 ext. 21 517-333-2677 (fax) clejuste@gmail.com