state QUALITY management SYSTEM for treatment IMPROVEMENT Understanding and Using the Information

1. John R. Kasich, Governor Orman Hall, Director state QUALITY management SYSTEM for treatment IMPROVEMENTUnderstanding and Using the Information Sanford Starr | Terry Patel | Laura Potts | Kevin Feasel Spring 2012

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. Quality Management - Webinar Series #1 - 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 Quality Management - Webinar Series #1 - Spring 2012

4. Research vs. Quality Management Research 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 Quality Management - Webinar Series #1 - Spring 2012

5. ODADAS’ QM Plan • 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 - Spring 2012

6. Implementing the System • Startwith 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 - Spring 2012

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 Quality Management - Webinar Series #1 - Spring 2012

8. Case Management Findings* • State retention rates only: • Case management only – low retention rates • Clinical services only – improved retention rates • Case management and clinical services – dramatic increase in retention rates * For unbundled case management Quality Management - Webinar Series #1 - Spring 2012

9. Quality Management - Webinar Series #1 - Spring 2012

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. Quality Management - Webinar Series #1 - 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 - Spring 2012

15. How the Results Can be Used • 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 - Spring 2012

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

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

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

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22. Disposition at Discharge Categories • Assessment and Evaluation Only (2) • Successfully Completed no Further Services Recommended • Client Rejected Recommendations Quality Management - Webinar Series #1 - Spring 2012

23. Disposition at Discharge Categories (continued) • Neutral (8) • 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 - Spring 2012

24. Disposition at Discharge Categories (continued) • Referral (2) • Referred to Another Program or Service (Satisfactory or Unsatisfactory) • Successful(1) • Successful Completion/Graduate Quality Management - Webinar Series #1 - Spring 2012

25. Disposition at Discharge Categories (continued) • Unsuccessful(5) • 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 - Spring 2012

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27. Table Figures – Disposition at Discharge • 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 50th percentile equals the median • Positive to Negative Ratio • Percentage of positive and negative dispositions that are positive Quality Management - Webinar Series #1 - Spring 2012

28. Results Over Time Chart Quality Management - Webinar Series #1 - Spring 2012

29. Disposition Data for Chart Quality Management - Webinar Series #1 - Spring 2012

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31. 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 - Spring 2012

32. Subgroup Reports • Level of Care • Outpatient • Residential • Drug of Choice • Alcohol • Marijuana • Cocaine/Crack • Heroin • Other Opiates • Other Quality Management - Webinar Series #1 - Spring 2012

33. 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 Quality Management - Webinar Series #1 - Spring 2012

34. 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 Quality Management - Webinar Series #1 - Spring 2012

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

36. Quality Improvements (continued) • 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 - Spring 2012

37. Accessing Reports • Login to OHBH - http://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 - Spring 2012

38. 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 • Documentation available on site at “Click Here” or the ODADAS web site– www.odadas.ohio.gov “Services,” NIATx,” “Quality Management System” Quality Management - Webinar Series #1 - Spring 2012

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

40. The End Questions, Comments and Ideas Quality Management - Webinar Series #1 - Spring 2012