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Ohio Quality Management System for Treatment Improvement DRAFT -1 BACKGROUND The state quality management system for treatment services is a requirement of the Substance Abuse Mental Health Services Administration (SAMHSA), Substance Abuse Prevention and Treatment (SAPT) Block Grant. The Department must demonstrate the capacity and capability to make data-driven decisions based on performance measures. ODADAS received technical assistance through SAMHSA in early 2011 from Dr. Alan Kott, former Evaluation Director for the New York Office of Alcoholism and Substance Abuse Services to develop a state-level system. The ODADAS Advisory Council, Planning and Outcomes Committees reviewed several states quality or performance management systems and in the end, the Department decided to roll out the system with treatment services using existing data (from OHBH and MACSIS) and quality improvement strategies. A system for prevention services is forthcoming once the Prevention Investment Planning and Reporting (PIPAR) system is enhanced. Quality management is a part of the Department’s overall data project, “Rounding-Up Results.” Click here for a one-page outline of quality management and outcomes. PURPOSE The purpose of the state quality management system for alcohol and other drug treatment services is to collect and use information to improve efficiencies or show the effectiveness of services. ODADAS is using two treatment measures at four levels for the initial implementation of the system. The two measures are retention and disposition at discharge, and the four levels are provider, board, region and state. National data will also be provided if applicable and available. RETENTION Two indicators are being used for retention: Washington Circle and NIATx. The Washington Circle indicator is defined as at least one clinical encounter within the first 14 days post assessment and two additional encounters within the 30-day period. The NIATx indicator represents at least four clinical encounters within the first 30 days post assessment. Clinical encounters do not include case management services, which is measured separately. NOTE: Episode of care is defined as the period of services between the beginning of a treatment service (admission) and the termination of services (discharge) for a prescribed treatment plan. Episodes are distinguished when there is a 30-day period or laps in services or a client changes level of care with a different agency; however, for quality management data analysis purposes only, a change in level of care is being considered a new episode of care regardless of if it is within the same agency or a different agency. DISPOSITION AT DISCHARGE The 18 different dispositions at discharge have been grouped into five categories for quality management: Assessment Only, Neutral, Referral, Successful and Unsuccessful. Assessment Only dispositions include the two dispositions in the Assessment and Evaluation Only group: •Successfully Completed No Further Services Recommended; and •Client Rejected Recommendations. Eight dispositions are considered Neutral: •Left on Own Against Staff Advice WITH Satisfactory Progress; •Incarcerated Due to Old Warrant/Charge from Before Entering Treatment (Satisfactory or Unstaisfactory); •Transferred to Another Facility for Health Reasons; •Death; •Client Moved; •Needed Services Not Available; and •Other. The Referral category also consists of two dispositions: •Referred to Another Program or Service (Satisfactory or Unsatisfactory). The Successful category consists of only one disposition: •Successful Completion/Graduate. There are five Unsuccessful dispositions: •Left on Own Against Staff Advice WITHOUT Satisfactory Progress; •Involuntarily Discharged Due to Non-Participation; •Involuntarily Discharged Due to Violation of Rules; and •Incarcerated Due to Offense Committed While in Treatment/Recovery (Satisfactory or Unsatisfactory). THE REPORTS There are three, one-page reports for the two measures: two for the retention indicators and one for the disposition at discharge information. There are also summary reports for each. The information in the reports is based on unduplicated client information when there is both an admission record and a discharge record that is linked to a Unique Provider Identification (UPID) number. Client admission dates are used for the reporting quarters. The UPID represents the ODADAS certified program site number, which is the physical address of the site. The retention reports provide results for five quarters beginning with the first quarter of state fiscal year (SFY) 2011, i.e. July 1, 2010 to September 30, 2010. For subsequent reports, the oldest quarter is dropped and a new quarter added. Results are not final until a SFY reporting period is completed, which usually occurs by November after the end of the fiscal year. Results for the current SFY are cumulative totals. The deposition at discharge reports are based on SFY; therefore, results during a current fiscal year are also cumulative totals. STRENGTHS The reports are simple and easy to understand and provide information about what might be happening at a provider, board, region or state level. The quality management measures provide information that may lead to asking questions, which can identify possible areas to target for improvement such as capacity issues, quality of care and organizational culture. Quality management creates a culture of quality where customers are the focus, data are used to drive decisions and team work solves problems, thereby increasing a sense of ownership of processes. LIMITATIONS A variety of factors can affect, influence or impact the information in the reports; therefore, caution must be used in interpreting or making judgment about the results. It is important to know what the data represent before drawing any conclusions or using the information for decision making. The following are some of the factors that can limit the utility of the reports: > It is critical to know what the UPID represents. A UPID could represent a single program at a single site for a single agency; however, a UPID could represent multiple programs at a single site or even multiple programs at multiple sites, including different levels of care since services are billed under one UPID number at some agencies. > Reports contain information on clients that have both an admission and discharge records in the Ohio Behavioral Health (OHBH) system. Some agencies do not report or report in a timely manner discharge information; therefore, some client information may not be captured. > For quality management purposes, a change in level of care is being considered a new episode of care; therefore, the number of episodes of care may be inflated. > There may not be consistency in how the dispositions at discharge are being recorded within and among providers. > The timeliness of entering client and billing information into the data systems can affect the results. If the information is entered after a reporting period, then results will be affected. QUALITY IMPROVEMENT At the state level, ODADAS is looking at the extreme results or outliers to help determine what appears to work well and what appears to be not working well. The Department works with providers who volunteer to participate in the project. Validity and reliability will also be considered, i.e. the degree to which the measures are actually being measured (validity) and if the information is being collected in the same way each time (reliability). Working with the volunteer providers, ODADAS will use the NIATx model for process improvement to implement the Plan, Do, Study and Act (PDSA) cycle as a means to make changes at agencies to get the desired results. For more information about NIATx visit At the state level, ODADAS is looking at the extreme results or outliers to help determine what appears to work well and what appears to be not working well. The Department works with providers who volunteer to participation in the project. Validity and reliability will also be considered, i.e. the degree to which the measures are actually being measured (validity) and if the information is being collected in the same way each time (reliability). Working with the volunteer providers, ODADAS will use the NIATx model for process improvement to implement the Plan, Do, Study and Act (PDSA) cycle as a means to make changes at agencies to get the desired results. For more information about NIATx visit www.odadas.ohio.gov, Services>NIATx or visit www.niatx.net. FOR MORE INFORMATION Click here for a list of definitions used in the state quality management system. For further information, please contact the Ms. Terry Porter Patel, Division of Planning, Outcomes and Research at Terry.Patel@ada.ohio.gov or 614-752-8807. LIBRARY Webinar Series - #1: April 25 to May 3, 2012 For the Power Point only CLICK HERE. For the complete webinar CLICK HERE. DISCLAIMER Information in the quality management reports are based on current information in the Ohio Behavior Health (OHBH) system and the Multi-Agency Community Services Information System (MACSIS). ODADAS is not responsible for the information in the data systems. If the data systems do not capture ten (10) or more observations in a cell, the report is suppressed. Also, only clients with both admission and discharge records are reported. 04/26/12
> It is critical to know what the UPID represents. A UPID could represent a single program at a single site for a single agency; however, a UPID could represent multiple programs at a single site or even multiple programs at multiple sites, including different levels of care since services are billed under one UPID number at some agencies.
> Reports contain information on clients that have both an admission and discharge records in the Ohio Behavioral Health (OHBH) system. Some agencies do not report or report in a timely manner discharge information; therefore, some client information may not be captured.
> For quality management purposes, a change in level of care is being considered a new episode of care; therefore, the number of episodes of care may be inflated.
> There may not be consistency in how the dispositions at discharge are being recorded within and among providers.
> The timeliness of entering client and billing information into the data systems can affect the results. If the information is entered after a reporting period, then results will be affected.
QUALITY IMPROVEMENT At the state level, ODADAS is looking at the extreme results or outliers to help determine what appears to work well and what appears to be not working well. The Department works with providers who volunteer to participate in the project. Validity and reliability will also be considered, i.e. the degree to which the measures are actually being measured (validity) and if the information is being collected in the same way each time (reliability). Working with the volunteer providers, ODADAS will use the NIATx model for process improvement to implement the Plan, Do, Study and Act (PDSA) cycle as a means to make changes at agencies to get the desired results. For more information about NIATx visit