1. STATE QUALITY MANAGEMENT SYSTEM FOR TREATMENT IMPROVEMENT Understanding and Using the Information Sanford Starr | Terry Patel | Laura Potts | Kevin Feasel Spring 2012 FINAL John R. Kasich, Governor Orman Hall, Director

2. What is Quality Management? *  Quality Management (QM)  The processes of establishing measures, gathering and reporting data and using data to verify performance; improve services and/or business practices; and make data-driven decisions  The term (QM) is used in healthcare where as “Performance Management” has been used in the substance abuse field * Performance Management for Substance Abuse Treatment Providers. SAMHSA. April 2008. 2 Quality Management - Webinar Series #1 FINAL - Spring 2012

3. Components of QM  “Quality Assurance” is establishing, measuring and identifying and correcting minimal standards of acceptable performance, which is completed by experts and staff  “Quality Improvement” is the process that defines quality according to the needs and preferences of customers and continuously improve services in real time as services are provided  ODADAS’ approach focuses on Quality Improvement 3 Quality Management - Webinar Series #1 FINAL - Spring 2012

4. Research vs. Quality Management  Adds to knowledge and evidence-based practices  Experimental and quasi- experimental designs  Sophisticated techniques and analyses  Led by health/ human services scientists  Takes months to years  Presents evidence of effectiveness and improved services  Internal comparison of data over time  Simple analyses of trends over time  Led by clinical and program staff  Takes a few months ResearchQuality Management 4 Quality Management - Webinar Series #1 FINAL - Spring 2012

5. ODADAS QM Plan 5  To use QM on a statewide level; however data are available to providers and boards for their own use  To start with treatment services and incorporate prevention services at a later date  To develop techniques and strategies to increase performance and share key learnings  To encourage peer support and networking  To continue training and technical assistance Quality Management - Webinar Series #1 FINAL - Spring 2012

6. Implementing the System  Start with measures that impact outcomes *  Retention (in treatment)  Disposition at Discharge  Invite providers and boards to work with ODADAS to determine the utility  Use NIATx for quality improvement purposes  Develop subgroup reports * QM is evolving; this is just a starting point * QM system is evolving; this is the starting point Quality Management - Webinar Series #1 FINAL - Spring 2012 6

7. Retention Indicators  At least one clinical encounter * within the first 14 days post assessment and two additional encounters within the 30-day period (Washington Circle)  At least four clinical encounters * within the first 30 days post assessment (NIATx) * Does not include case management 7 Quality Management - Webinar Series #1 FINAL - Spring 2012

8. Case Management Findings *  State retention rates only:  Case management only – low retention rates  Clinical services only – improved retention rates (~35%)  Case management and clinical services – dramatic increase in retention rates (~60%) * For unbundled case management Quality Management - Webinar Series #1 FINAL - Spring 2012 8

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10. Table Figures - Retention  “All Clients” represents the number of clients * served at a particular provider based on the Unique Provider Identification (UPID) number  “Retained” represents the number of clients who met the retention measure  “Retention Percentages” represent the percent of clients who met the retention measure *Measures are based on unduplicated clients information with admission and discharge records. Admission dates are used in reporting. 10 Quality Management - Webinar Series #1 FINAL - Spring 2012

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14. Interpreting Results  Critical to know:  What the UPID represents  Percentage of clients served are reported in Ohio Behavior Health (OHBH)  Percentage of clients served have admission and discharge records  When services are billed in MACSIS * * Multi-Agency Community Services Information System Quality Management - Webinar Series #1 FINAL - Spring 2012 14

15. How the Results Can be Used 15  What is the direction of change; how do the numbers increase, decrease or remain the same over time?  What are the differences among levels?  Were the figures expected?  Are these the desired results?  What strategies might be used to do better?  Who needs to be involved in making and sustaining improvements? Quality Management - Webinar Series #1 FINAL - Spring 2012

16. Levels of Measures *  Provider  Based on UPID  Board  47 combined (ADAMHS) and 3 separate (ADAS)  Region ▪ Metropolitan ▪ Rural, Non-Appalachian ▪ Suburban ▪ Appalachian  State * National data will be provided if applicable and available 16 Quality Management - Webinar Series #1 FINAL - Spring 2012

17. Metropolitan Region (12)  Allen  Butler  Cuyahoga  Franklin  Hamilton  Lorain  Lucas  Mahoning  Montgomery  Richland  Stark  Summit 17 Quality Management - Webinar Series #1 FINAL - Spring 2012

18. Suburban (17)  Auglaize  Clark  Delaware  Fairfield  Fulton  Geauga  Greene  Lake  Licking  Madison  Medina  Miami  Pickaway  Portage  Trumbull  Union  Wood 18 Quality Management - Webinar Series #1 FINAL - Spring 2012

19. Rural, Non-Appalachian (30)  Ashland  Ashtabula  Champaign  Clinton  Crawford  Darke  Defiance  Erie  Fayette  Hancock  Hardin  Henry  Huron  Knox  Logan  Marion  Mercer  Morrow  Ottawa  Paulding  Preble  Putnam  Sandusky  Seneca  Shelby  Van Wert  Warren  Wayne  Williams  Wyandot 19 Quality Management - Webinar Series #1 FINAL - Spring 2012

20. Appalachian (29)  Adams  Athens  Belmont  Brown  Carroll  Clermont  Columbiana  Coshocton  Gallia  Guernsey  Harrison  Highland  Hocking  Holmes  Jackson  Jefferson  Lawrence  Meigs  Monroe  Morgan  Muskingum  Noble  Perry  Pike  Ross  Scioto  Tuscarawas  Vinton  Washington 20 Quality Management - Webinar Series #1 FINAL - Spring 2012

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22. Disposition at Discharge Categories  Assessment and Evaluation Only (2)  Neutral (8)  Referral (2)  Successful (1)  Unsuccessful (5) Quality Management - Webinar Series #1 FINAL - Spring 2012 22

23. Assessment and Evaluation Only 23  Successfully Completed no Further Services Recommended  Client Rejected Recommendations Quality Management - Webinar Series #1 FINAL - Spring 2012

24. Neutral 24  Left on Own Against Staff Advice WITH Satisfactory Progress  Incarcerated Due to Old Warrant/Charge from Before Entering Treatment (Satisfactory or Unsatisfactory)  Transferred to Another Facility for Health Reasons  Death  Client Moved  Needed Services Not Available  Other Quality Management - Webinar Series #1 FINAL - Spring 2012

25. Referral and Successful 25  Referral  Referred to Another Program or Service (Satisfactory or Unsatisfactory)  Successful  Successful Completion/Graduate Quality Management - Webinar Series #1 FINAL - Spring 2012

26. Unsuccessful  Left on Own Against Staff Advice WITHOUT Satisfactory Progress  Involuntarily Discharged Due to Non-Participation  Involuntarily Discharged Due to Violation of Rules  Incarcerated Due to Offense Committed While in Treatment/Recovery (satisfactory or unsatisfactory) Quality Management - Webinar Series #1 FINAL - Spring 2012 26

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28. Table Figures – Disposition at Discharge 28  Number of Client Episodes  Period of time between admission and discharge for each level of care  The number of episodes for all discharge categories  Percent  Percentage of episodes for each of the discharge categories  Percentile  The dispersion of measures as related to zero—the 50 th percentile equals the median  Successful to Unsuccessful Ratio  Percentage of successful and unsuccessful dispositions that are successful Quality Management - Webinar Series #1 FINAL - Spring 2012

29. Provider Results Over Time Quality Management - Webinar Series #1 FINAL - Spring 2012 29

30. Disposition Data for Chart Assessment OnlyNeutralReferralSuccessfulUnsuccessful 4/2011 - 3/20124.643.9362.627.7421.07 7/2011 - 6/20125.854.5357.109.2523.21 10/2011-9/20124.224.8261.758.3020.79 1/2012-12/20121.00 64.208.0219.75 Quality Management - Webinar Series #1 FINAL - Spring 2012 30

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32. Review - Basis for Reports  Unduplicated client data (at the provider level) from existing data in OHBH and MACSIS  Admission dates are used for reporting; last admission is used when there are multiple admissions in a quarter  Data only reported for clients with both an admission record and a discharge record  Clinical services are used to determine retention  Any change in a level of care is considered a new Episode of Care (not the case for OHBH)  UPID is used for provider data Quality Management - Webinar Series #1 FINAL - Spring 2012 32

33. Subgroup Reports  Level of Care  Outpatient  Residential  Drug of Choice  Alcohol  Marijuana  Cocaine/Crack  Heroin  Other Opiates  Other Drugs Quality Management - Webinar Series #1 FINAL - Spring 2012 33

34. Subgroup Reports - Population Groups  Age  Adolescents (12-17)  Young adults (18-25)  Adults (18+)  Older adults (60+)  Criminal justice  Deaf or hard of hearing  Dually diagnosed  Gender  Mental health history  Methamphetamine using  Opiate using  Poly-substance using  Referral disposition  Service member or veteran 34 Quality Management - Webinar Series #1 FINAL - Spring 2012

35. Why This QM Approach Now?  To respond to the Substance Abuse Treatment and Prevention (SAPT) Block Grant  States must demonstrate the capacity and capability to make data-driven decisions based on performance measures  ODADAS received SAMHSA Technical Assistance  Planning and Outcomes Committees  Other states’ systems 35 Quality Management - Webinar Series #1 FINAL - Spring 2012

36. Quality Improvements 36  Programmatic  Better serve needs of clients  Improve client outcomes  Improve program efficiencies  Policy  Inconsistent  Missing  Unclear Quality Management - Webinar Series #1 FINAL - Spring 2012

37. Quality Improvements (continued) 37  Procedural  Clinical  Administrative  Human Resource *  Caution: Position descriptions, supervision, training and communication factors need to be explored before aligning results with people  Other  Combination of factors such as funding, staffing, facilities, operations, etc. * It is usually best to target improvements at the organizational level Quality Management - Webinar Series #1 FINAL - Spring 2012

38. Accessing Reports  Login to OHBH - http://prod.ada.ohio.govhttp://prod.ada.ohio.gov  Choose “Production” as environment  Choose “OHBH” as application  Choose “Reports” from main menu  Click the link “Quality Management Reports” at the far right side of the page Quality Management - Webinar Series #1 FINAL - Spring 2012 38

39. Accessing Reports (continued)  Each PDF file is labeled with the measure, date and subgroup (if applicable)  Files are ordered by ascending UPID numbers  Use (“CTRL-F” or go to “Edit” then “Find”) to locate your report by UPID or provider name  Summary reports are also available  Supporting documentation available on site at “Click Here” or the ODADAS web site: www.odadas.ohio.gov, “Services,” NIATx,” “Quality Management System” www.odadas.ohio.gov Quality Management - Webinar Series #1 FINAL - Spring 2012 39

40. Next Steps  Complete the webinar series to introduce the system  Organize questions and comments; determine utility  Make modifications to reports and documentation  Recruit volunteers to work with ODADAS  Test new ideas (as applicable)  Develop subgroup reports  Encourage networking and peer support  Continue webinars series and technical assistance Quality Management - Webinar Series #1 FINAL - Spring 2012 40

41. The End Questions, Comments and Ideas Sanford.Starr@ada.ohio.govSanford.Starr@ada.ohio.gov614-644-8316 Terry.Patel@ada.ohio.govTerry.Patel@ada.ohio.gov614-752-8807 Quality Management - Webinar Series #1 FINAL - Spring 2012 41