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1 Measuring Quality Using Experience Surveys 2005 Center for Policy and Innovation Quality Assurance and Improvement January 26, 2006
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2 Critical optimism “is the belief that the specific conditions which exist at one moment, be they comparatively bad or comparatively good, in any event may be bettered”. (John Dewey, 1929)
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3 DADS Mission T o provide a comprehensive array of aging and disability services, supports, and opportunities that are easily accessed in local communities. Our key responsibilities to the citizens of Texas include: Working in partnership with consumer, caregivers, service providers, and other stakeholders. Developing and improving service options that are responsive to individual needs and preferences Ensuring and protecting self-determination, consumer rights, and safety.
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4 Purpose Obtain information from the person’s perspective about their experiences Obtain initial baseline of data to build upon Conduct surveys annually in order to trend and analyze Data will point to areas for further exploration
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5 Measuring Quality One of only a few states to undertake a project of this size and scope 1,980 face-to-face surveys in the HCS, TxHmL, ICF/MR, CLASS, DB-MD, CBA, and CWP for 18 years and older
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6 Introduction DADS joined National Core Indicator Project in September 2005 Contracted with NACES Plus Foundation, Inc. to conduct the surveys Interviews conducted May through August Interviews conducted annually to identify trends
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7 Quality Indicators National Core Indicators (NCI) 30 Indicators 4 Domains – Consumer Outcomes – System Performance – Health, Welfare, and Rights – Self-Determination (added by the QA/QI Task Force) Participant Experience Survey (PES) Elderly/Disabled version 39 Indicators 5 Domains – Access to Care – Choice and Control – Respect/Dignity – Community Integration/Inclusion – Self-Determination (added by QA/QI Task Force)
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8 Methodology Proportional sampling based on number of people in each program by county Interviews were conducted in the person’s home unless person chose not to Interviews were conducted in about one-half of the counties across Texas Demographics from DADS automated systems of people receiving services
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9 Training Conducted in April 2005 In person by developers of tools Mock interviews with persons receiving services Regular conference call with interviewers Frequently asked questions collected and distributed
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10 It is important to use the data as a basis for further discussion and inquiry in order to “interpret” or draw conclusions from the results.
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11 Next Steps Internal review of results Share with QA/QI Task Force to: – Review results and identify/prioritize areas for improvement or further study – Develop strategies for making improvements Broader stakeholder input
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12 High-Level Results Majority of people in HCS, TxHmL, ICF/MR, CLASS, DB-MD, and CWP report: – They receive the services they need – Have had a physical exam in the past year – Do not feel lonely
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13 Results - continued Majority of people in HCS, TxHmL, and CLASS are satisfied with where they live Majority of people in HCS, TxHmL, ICF/MR, CLASS, and DB-MD participate in integrated activities in their communities
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14 Results - continued In the HCS, TxHmL, ICF/MR, CLASS, DB- MD, & CWP a low proportion of: – Women had OB/GYN exams in the last year – People have participated in activities of self- advocacy groups – People were provided options about where to live and work – People made choices about important life decisions including: housing, roommates, support staff or providers, daily routines, social activities, job, and services coordination
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15 Results - continued The majority of people in the CWP & CBA Programs: – Are able to eat when they need to because there is someone there to help them. – Have chosen their current job – Like their current job
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16 Results -continued 69% of people in CWP and 39% of people in CBA do not choose their staff but would like to 50% of people in CWP and 64% of people in CBA report an unmet need for community involvement Over one-third of people in CWP who are not elderly would like to work
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17 Home and Community-Based Services (HCS) Highest satisfaction with the following: 93% - “needed” services were available 92% - have had a physical exam in the past year
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18 Home and Community-Based Services (HCS) Lowest satisfaction with the following: 16% - people have participated in activities of self-advocacy groups or other groups that address rights 17% - people make choices about important life decisions including: housing, roommates, support staff or providers, daily routines, social activities, job and services coordination
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19 Texas Home Living (TxHmL) Highest satisfaction with the following: 93% - “needed” services were available 93% - do not feel lonely
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20 Texas Home Living (TxHmL) Lowest satisfaction with the following: 14% - women have had an OB/GYN exam in the past year 9% - people have participated in activities of self-advocacy groups or other groups that address rights 7% - people report having been provided options about where to live 16% - people indicate that most staff who come to their home treat them with respect * *72% reported having no staff who come to their home
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21 Intermediate Care Facilities for Persons with Mental Retardation (ICF/MR) Highest satisfaction with the following: 98% - “needed” services were available 96% - have had a physical exam in the past year
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22 Intermediate Care Facilities for Persons with Mental Retardation (ICF/MR) Lowest satisfaction with the following: 12% - have participated in activities of self- advocacy groups or other groups that address rights 16% - report having been provided options about where to live 15% - report having been provided options about where to work 9% - people make choices about important life decisions about; housing, roommates,support staff or providers, daily routines, social activities, job, and services coordination
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23 Community Living Assistance and Support Services (CLASS) Highest satisfaction with the following: 93% - “needed” services were available 96% - have had a physical exam in the past year
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24 Community Living Assistance and Support Services (CLASS) Lowest satisfaction with the following: 10% - women have had an OB/GYN exam in the past year 14% - people report having been provided options about where to live 9% - people report having been provided options about where to work
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25 Deaf-Blind with Multiple Disabilities (DB-MD) Highest satisfaction with the following: 98% - “needed” services were available 90% - have had a physical exam in the past year 92% - do not feel lonely Results are valid plus or minus 9.4 percent because of the small sample size.
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26 Deaf-Blind with Multiple Disabilities (DB-MD) Lowest satisfaction with the following: 15% - people have participated in activities of self-advocacy groups or other groups that address rights 10% - people report having been provided options about where to live 10% - people report having been provided options about where to work 15% - people have an “advocate” or someone who speaks on their behalf
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27 Deaf-Blind with Multiple Disabilities (DB-MD) Lowest satisfaction with the following: 18% - people report that service coordinators help them get what they need 20% - people who report that they feel safe in their home 20% - people who report that they feel safe in their neighborhood 20% - people whose basic rights are respected by others
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28 Consolidated Waiver Program (CWP) Using the NCI Survey Highest satisfaction with the following: 88% - “needed” services were available 84% - do not feel lonely 78% - have had a physical exam in the past year Results are valid no more than plus or minus 9.6 percent because of the small sample size.
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29 Consolidated Waiver Program (CWP) Using the NCI Survey Lowest satisfaction with the following: 4% - women have had an OB/GYN exam in the past year 20% - people have participated in activities of self-advocacy groups or other groups that address rights 6% - people report having been provided options about where to live 18% - people make choices about important life decisions including: housing, roommates, support staff or providers, daily routines, social activities, job, and services coordination
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30 Consolidated Waiver Program (CWP) Using the PES Survey Major findings from the PES indicators: 3% - are not treated respectfully by staff in their homes 3% - are verbally abused by current staff Results are valid plus or minus 4.6 percent because of the small sample size.
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31 Consolidated Waiver Program (CWP) Using the PES Survey Other major findings: 69% - do not choose their care staff, but would like to 50% - report an unmet need for community involvement Results are valid plus or minus 12.5 percent because of the small sample size.
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32 Community Based Alternatives (CBA) Using the PES Survey Major findings from the PES indicators: 3% - sometimes go without a meal because there is no one there to help them 3% - are unsure who to report staffing problems to or would report staffing problems to “no one” 2% - are sometimes unable to eat because there is no one there to help them
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33 Community Based Alternatives (CBA) Using the PES Survey Other major findings: 37% - earn enough money to buy the things they want 39% - do not choose their care staff, but would like to 64% - report an unmet need for community involvement
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