slide 3 Key Concepts Performance monitoring What you do How well you do it Do you accomplish something Process, quality, capacity, outcomes The window Baselines and standards Risk or case mix adjustment
slide 4 Performance Monitoring Part of much larger cycle of program design and implementation Performance - this is about definitions Inputs, outputs, or the relationship between inputs and outputs? Monitoring - This is about data collection and analysis Important with respect to investment - are you getting something back?
slide 6 Process of care Referral, intake, and assessment Service planning, link to interventions Reassessment, follow-up, case closure
slide 7 Quality of Care Human resources Physical plant and equipment Practice protocols - evidence base Supervision Consumer feedback Agency management around practice model fidelity
slide 8 Capacity Enough trained workers Enough office space Enough funding Enough information Enough is defined by the relationship between process, quality, and outcomes
slide 9 Outcomes Depends on the program and intervention Well-being Safety Family provides stable nurturing Education Health Behavioral health
slide 10 Process, Quality, and Outcomes Highly interdependent Quality depends on a process Process is different than quality Quality without outcomes is ‘inefficient’ Agencies invest in process, quality, and capacity
slide 11 The Window Performance happens in time Improvement is change in performance over time Sampling in time is difficult but critical
slide 12 Clinical Experience in Time: (Each line represents the start and end of service within the window)
slide 13 Sampling Inception Process vs child How much time do you have to observe the process?
slide 14 Baselines and Standards Baseline is a measure taken prior to intervention Standards of practice and performance The usual as in standard practice Fidelity or compliance Standards are better suited to process and quality; baselines are better suited to outcomes
slide 15 Risk or Case Mix Adjustment An important question when facing variation in performance: Is the variation a function or performance or the result of client differences Children/families have different outcomes for reasons that are intrinsic to them Baseline mortality rates differ by age Adjustment for case mix refers to taking the intrinsic differences into account somehow when measuring outcomes
slide 16 Case Mix Adjustment Applied Case mix adjustment makes more sense for outcomes, less so for process and quality Process/quality standards apply to all children, given the process standard applies in the first instance (differential diagnosis) Baselines for outcomes should be adjusted Standards don’t work as well for outcomes because of the random component.