FRANKLIN COUNTY ADAMH BOARD SYSTEM QUALITY IMPROVEMENT PLAN

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FRANKLIN COUNTY ADAMH BOARD SYSTEM QUALITY
IMPROVEMENT PLAN
SQI
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A framework for the planning, implementation and
continuous evaluation of system quality and
performance improvement.
PURPOSE
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What does SQI hope to accomplish?

• Improve quality
• Promote accountability
• Promote understanding
• Improve outcomes
• Identify areas of concern
• Monitor performance
• Feedback mechanism
• Improve data collection efforts

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APPROACH
Plan, Do, Check, Act (PDCA) Cycle For
Continuous Quality Improvement Projects

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RATIONALE

• To standardize quality indicators that have
• Statutory references
• Comparability (benchmark ability statewide and
  nationally)
• Significance and improvability (together as a
  system, we can make a difference)
• Current existence in the data systems

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Quality Indicator

• An indicator is a measure for which
• we have data, that helps quantify the
  achievement of a desired result.
• Friedman, M. (1997). A guide to developing and
  using
• performance measures in results-based
  budgeting.
• Washington, D.C. The Finance Project.
  Retrieved
• August 3, 2001 from the World Wide Web
• http//financeproject.org/measures.html.

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How will the SQI data be used?

• Provider Stat
• ADAMH Stat
• Feedback mechanism
• Identify areas for quality improvement
• Collaborate with providers to improve the service
  delivery system
• Establish goals, standards
• Inform Public Stakeholders

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What indicators will ADAMH track?

• System QI Report 1 with the following domains
• ACCESS
• APPROPRIATENESS
• OUTCOMES
• 1The report indicators were developed by an ADAMH
  internal system quality improvement work group

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How were indicators selected?

• Researched existing national indicators
• MHSIP (Mental Health Statistics Improvement
  Program)
• NASMHPD (National Association of State Mental
  Hospital Program Directors)
• Used existing Statewide outcomes
• Data existing in the system (MACSIS)
• With benchmarking in mind
• Relative strength/importance of the data

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Types and Sources of Data

• Consumer Outcomes
• Consumer Satisfaction
• Behavioral Health Data
• Claims
• Eligibility

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Domains consist of the following

• Goals
• Indicators
• Data Source
• Time Period Sample Size
• Rationale
• Notes Limitations

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ACCESS

• Average lag between assessment to first
  face-to-face
• The percentage of service recipients receiving
  only one day of service
• The percentage of service recipients receiving
  multiple crisis services
• The percentage of special population service
  recipients (physically disabled)
• Average resources spent

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APPROPRIATENESS

• Are service recipients actively involved in
  decisions concerning treatment?
• of people connected to primary healthcare (BH)
• Do people discharged from inpatient services
  receive ambulatory services within seven (7)days?
  
• Do people discharged from emergency care receive
  services in three (3) days?

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OUTCOMES

• Are service recipients receiving services that
  promote recovery?
• of people who experience decreased
  psychological stress or symptoms (adults and
  children)
• Decrease in substance use/impairment
• of people who experience increased level of
  functioning
• of inpatient readmissions within 30 days of
  discharge (PCS)
• Disposition at discharge (BH)

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How will SQI be monitored?

• A selective set 1 of Q/PI tracking activities
  will be monitored through the following forums
• ADAMH Stat (quarterly)
• Provider Stat (quarterly)
• Collaborative QI Advisory Work Group (quarterly)
• 1The selection will be based on importance and
  feasibility of reporting (thru databases or data
  warehouse)

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What happens with SQI information?

• The SQI information will be disseminated to
• ADAMH Stat
• addresses the Boards performance and
  accountability with regard to its Strategic
  Business Plan
• Provider Stat
• QI Advisory Group

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What is Provider Stat?

• Review meeting with each provider based upon
• Data-driven, agency-supplied defendable
  information
• Incorporation of clinical/programmatic
  operational aspects of contract providers
  business

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Provider Stat Monitoring Oversight Uses

• Inter-team
• Fiscal Program Clinical Outcomes
  Evaluation
• Mutual Accountability Data-Driven
• Board ?? Provider
• Early Warning System
• Fiscal Instability/Stability
• Clinical/Programmatic Instability/Stability
• System Averages - Comparisons

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Provider Stat Monitoring Oversight Uses

• Participants
• Provider staff
• ADAMH Board staff
• Consumer Family Advisory Board
• ADAMH Board of Directors
• County Commissioners staff

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BENEFITS

• ADAMH and Provider
• Data-driven Not anecdotal
• Measures are replicable for Providers
• Early Warning System
• Individual Performance/System Average
• Respectful/Productive Dialogue
• Monitoring Tool
• Useful for other accreditation activities

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What is the ADAMH SQI Team?

• An internal team consisting of The Director of QI
  and Select ADAMH staff members (Clinical,
  Evaluation and IS staff) who will review results
  from the SQI Reports to
• Identify trends/and/or patterns, undesirable
  variations, set thresholds and performance
  specifications at provider and system levels.
• Provide guidance on system level policy,
  procedures and operational definitions.

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What is the ADAMH SQI Team?

• Provide technical assistance, or derive/recommend
  plans of action or solutions to address issues
  identified above.
• Continuously assess, ensure and promote provider
  CQI activities including input from the consumer,
  consumers significant others (including
  auxiliary treatment providers) and the primary
  providers workforce.
• Conduct site visits/audits to implement the
  recommended actions of the Collaborative QI
  Advisory Work Group, and/or to offer technical
  assistance to providers.

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ADAMH SQITeam

• Chris Kovell, SCCO
• Julie Erwin-Rinaldi, VP of Network Svcs
• Dean Kauffman, VP Planning, Evaluation and QI
• Mina Chang, Director of Evaluation (now Lindsey
  Ladd)
• Joetta Roberts, Director of QI
• Kappy Madenwald, Clinical Director
• Bill Evans, CIO
• Michael Smith, Systems Analyst

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What is the SQI Advisory Group?

• Purpose
• To provide opportunities for communication and
  collaboration between the Board and providers to
  improve quality and performance.
• Comprised of the following individuals
• Select ADAMH Staff
• Provider QI/Clinical representatives

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Challenges

• Special needs populations
• Risk Adjustment
• Establishing benchmarks
• Involving stakeholders
• Integrating with other internal and external
  performance measure efforts.

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Looking Ahead

• Now collecting and analyzing IS data for Contract
  Years 03-04.
• Internal work groups.
• Keeping an eye on national performance measure
  activities.
• Setting desired thresholds for system performance
  and benchmarking
• Using Risk Adjustment