Appendix III (continued)

Environmental Scan of Measures for Medicaid Title XIX Home and Community-Based Services Measure Scan as of July 5, 2007

IV. Tools and Measures Developed in Academic and Research Settings

Universities

Tool or Measure Set: Client Satisfaction Survey for Home Health Care
Data Source: Consumer survey
Respondent: Consumer
Mode of Data Collection: Self-report, via mail
Total Items/indicators: 35 items
HCBS MS Domains: Access, Person Centeredness/Autonomy, Unmet Need, Health and Welfare
Populations: Home health care clients
Developer: Phyllis Reeder and Shu-Pi Chen, University of Illinois at Chicago
Use history: Pilot study conducted in 1987, results published in 1990
States Currently Using: Unknown
Psychometric Testing: Reliability established using Cronbach's alpha, content validity was established via expert opinion. Evaluation conducted with a small (37 person) convenience sample. Further testing recommended.
Summary: Survey items were generated from three existing scales, with adaptations to make them appropriate for in-home care. The 35 items support four scales—assessment, planning, implementation, and evaluation—and have a five-point Likert response scale. Overall satisfaction is a continuum that can be measured by an interval scale. All items relate to home health nursing staff only, not other types of direct care workers.

Tool or Measure Set: Adequacy of Paraprofessional Home Care Quality
Data Source: Consumer survey
Respondent: Consumer or proxy
Mode of Data Collection: Face-to-face structure interview in clinic or CATI (modes of data collection compared)
Total Items/indicators: Six measures, each is a numeric sum of a number of adverse subitems found to be present
HCBS MS Domains: Safety, Health and Welfare, Unmet Need, Effectiveness, Timeliness, Person Centeredness/Autonomy
Populations: Elders with physical disabilities
Developer: John Capitman et al., Institute for Health Policy, Heller School, Brandeis University
Use history: Unclear if ever used outside of initial study.
States Currently Using: None known
Psychometric Testing: Extensive psychometric testing (interrater, internal consistency, and predictive validity) documented in peer-review article. The authors examined the tools predictive validity with regards to continued community tenure; they also found adequate paraprofessional and informal home care decreased the likelihood of adverse health events.
Summary: The developers defined minimal standards for adequate care based on recommendations of a clinical panel, developed measures of care adequacy based on the standards and compared them to other process and outcome quality indicators. Six measurement areas are: self-report of unmet need; satisfaction with care; morale, adverse health outcomes; objective adequacy rating; and clinician judgment of risk.

Tool or Measure Set: Self-Determination Technology Long Survey
Data Source: Consumer Survey
Respondent: Consumer
Mode of Data Collection: Web based
Total Items/indicators: 56 close-ended items, plus demographics and narrative responses
HCBS MS Domains: Person Centeredness/Autonomy; Quality of Life
Populations: People with psychiatric disabilities who may or may not be receiving services.
Developer: Judith A. Cook, PhD., University of Illinois at Chicago, Department of Psychiatry.
Use history: No date. Tool was developed for the project entitled Advancing Knowledge and Training on Self-Determination, individuals completed online on a voluntary basis.
States Currently Using: None known
Psychometric Testing: Unknown, results were still being analyzed when tool posted online. Multivariate analysis was planned.
Summary: The survey was designed to assess access to and barriers to technology and the level of self-determination in the lives of people with psychiatric disabilities or other mental health concerns. Researchers conducted literature and database reviews to look at other technology surveys, like the Pew survey and the census, and the use of technology among people with disabilities. Literature searches were also conducted on the broad topic of self-determination. Consultations were made with other researchers, particularly in how to mount a web-based survey. Two different consumer groups were developed, one on technology and one on self-determination, to pilot the surveys. Questions were submitted by consumer groups, then narrowed down to the core issues.

Tool or Measure Set: Sustained Employment of People Who Have Psychiatric Conditions
Data Source: Consumer Survey
Respondent: Consumer
Mode of Data Collection: Mail survey
Total Items/indicators: 113 items in survey; including several previously published scales
HCBS MS Domains: Quality of Life
Populations: Mental health consumers who have sustained employment
Developer: Zlatka Russinova, PhD and Nancy Wewiorski, PhD., Boston University, Center for Psychiatric Rehabilitation.
Use history: Tool is copyrighted 2003; survey was mailed to a national sample of mental health consumers who have sustained employment
States Currently Using: None known
Psychometric Testing: Tool includes several scales with known properties, such as the Index of Job Satisfaction. Additional testing planned.
Summary: This lengthy survey was designed to help understand patterns of sustained employment and the predictors of sustained employment among people with psychiatric disabilities. It collects information on current work, satisfaction with current work, work history, everyday life, work in everyday life, challenges at current work, health and mental health, and personal background. Development of this survey included literature and database reviews in the field of employment and psychiatric disability. Extensive consultations were made with researchers both within and outside the institution. Consumer groups piloted the survey and modifications were made based on their input. A combination of closed and open ended questions and standardized instruments were selected.

Tool or Measure Set: Evaluation of Quality of Life Instrument
Data Source: Staff survey
Respondent: Direct care staff
Mode of Data Collection: Self-report
Total Items/indicators: 3 scales based on 18 items
HCBS MS Domains: Health and Welfare, Unmet Need, Quality of Life, Person Centeredness/Autonomy
Populations: Adults with intellectual disabilities served in congregate settings (day programs and group homes)
Developer: Laura Nota, PhD and colleagues at the University of Padua, Italy
Use history: Results of field test published in 2006, extent of current use unknown
States Currently Using: None known
Psychometric Testing: Results of psychometric testing, including internal consistency, and construct, convergent, and discriminate validity are available in a peer-review article.
Summary: Direct care staff members in congregate settings are asked the degree to which they believe a particular consumer is satisfied with various aspects of care received and physical characteristics of the care setting. The three subscales identified during testing include: quality of services received; opportunities for social integration; and environment characteristics. Examples include "How much do you think Mr. /Mrs. is satisfied about the opportunity to speak when he/she so wishes with the staff members" and "...the opportunity to visit stimulating new environments."

Tool or Measure Set: Staff Assessment Person-Directed Care
Data Source: Staff survey
Respondent: Direct care staff
Mode of Data Collection: Self-report, onsite
Total Items/indicators: 50 items rated on a five-point scale
HCBS MS Domains: Person Centeredness/Autonomy; Unmet Need, Quality of Life
Populations: Survey tested with consumers from a variety of long-term care providers, including home health agencies, assisted living facilities, residential facilities, and nursing homes
Developer: Diana White, Linda Newton-Curtis, and Karen Lyons of the Oregon Health and Science University
Use history: This tool was developed for the Oregon Better Jobs Better Care Project, as a means to assess person-directed care (PDC) practices in long-term care settings. The tool was tested with 430 participants in 8 sites. It is unclear if it is still being used.
States Currently Using: Unclear if still used by Oregon
Psychometric Testing: Initial item development was based on a literature review and face validity was established via expert review. Factor analysis conducting with field test results.
Summary: Factor analysis of the field test revealed five person-directed care constructs: personhood, comfort-care, autonomy, knowing the person and support for relationships; and three environmental support constructs: support for work with residents; person-directed environment for residents; and management/structural support. Staff were asked to rate their feelings/perceptions regarding statements about consumer experience and support, along a five-point scale.

Tool or Measure Set: Client-Centered Rehabilitation Questionnaire
Data Source: Consumer survey
Respondent: Consumer
Mode of Data Collection: Mail survey
Total Items/indicators: 7 scales, derived from 35 items
HCBS MS Domains: Person Centeredness/Autonomy, Coordination of Long-Term Care and Other Services, Health and Welfare, Unmet Need, Quality of Life
Populations: Elders and adults with physical disabilities, including spinal cord injuries and acquired brain injuries
Developer: Cheryl Cott, PhD and colleagues, University of Toronto
Use history: Use outside of academic study unknown
States Currently Using: None known
Psychometric Testing: Phase III testing consisted of a mail field test to assess validity and reliability (test-retest and internal consistency). Results are available in a peer-review article.
Summary: This survey was designed to assess experience with rehabilitation services posthospitalization. The domains and items developed based on literature review, consumer focus groups and expert consultation. In Phase II of the study, the survey items were cognitively tested. Subscales include: decisionmaking; education; outcome evaluation; family involvement; emotional support; physical comfort; and continuity/coordination.

Tool or Measure Set: Home Care Satisfaction Measure
Data Source: Consumer Survey
Respondent: Consumer
Mode of Data Collection: Face-to-face structured interview
Total Items/indicators: 60 survey items are used to generate overall composite scores, as well as scores for 5 subscales
HCBS MS Domains: Unmet Need, Effectiveness, Access, Timeliness, Person Centeredness/Autonomy, Quality of Life
Populations: Elders with physical disabilities
Developer: Scott Geron, PhD and colleagues, Boston University School of Social Work
Use history: Tool was field tested with 228 frail, low-income elder home care recipients. Peer-review article describing results published in 2000. A handful of States have used this tool for HCBS quality.
States Currently Using: None reported use
Psychometric Testing: The survey was developed using consumer input obtained via focus groups; early version of items were pretested with consumers and factor analysis was used to select the final item set. During the field test, the developers examined reliability via test-retest and concurrent validity by calculating Pearson correlation coefficients. The authors found significant social desirability effects; results of psychometric testing available in a journal articles.
Summary: Respondents are asked to rate their agreement with statements about services using a 5-point Likert-type scale. Items are grouped into five service areas: case management; grocery service; home health aide services; homemaker service; and home-delivered meal service. Examples include "Often the food is so bad I don't eat it" and "Generally my home health aide knows what to do."

Tool or Measure Set: Service Adequacy and Satisfaction Instrument
Data Source: Consumer Survey
Respondent: Consumer (limited proxy responses)
Mode of Data Collection: Face-to-face structured interview
Total Items/indicators: 47 survey items support 5 subscales
HCBS MS Domains: Unmet Need, Effectiveness, Person Centeredness/Autonomy, Quality of Life
Populations: Home care recipients age 60 and over
Developer: Jane K. Straker, Suzanne R. Kunkel, Robert A. Applebaum, Scripps Gerontology Center, Miami University, Oxford, Ohio
Use history: Fielded in two planning and service areas in northeastern and southwestern Ohio with clients from Ohio's Medicaid HCBS waiver program. Each PASSPORT agency serves approximately 1000 clients. Currently in use by the Council on Aging of Southwestern Ohio in their PASSPORT Medicaid waiver program and a county tax-levy funded home care program. A database maintained by the Council on Aging includes several years of provider-level data.
States Currently Using: Ohio
Psychometric Testing: Data collected by case managers in two Area Agencies on Aging during field testing. Factor analysis examined domains and internal scale reliabilities were conducted for each domain. Reliability and validity test results available in peer-review article.
Summary: This instrument is designed to examine client satisfaction with home delivered meals, personal care, and homemaker services, as well as problem handling and unmet service needs. The 12 items for personal care and homemaker services are the same; but have been tested for each type of worker. They are also applicable to providers who provide both services. The instrument was developed after a project that tested consumer satisfaction of Ohio's PASSPORT clients using the Home Care Satisfaction Measure (HCSM) and case managers to collect data. Case managers identified issues with the HCSM that made it difficult for case managers to administer. These included some difficult wording as well as issues such as "worker is my friend" which are in direct opposition to the policies of Ohio's HCBS. This instrument, which evolved from the HCSM, was designed to provide case managers with a tool that they could administer to their clients.

Tool or Measure Set: Center for Health Systems Research and Analysis (CHSRA) Home Care Quality Indicators
Data Source: Consumer Survey and Administrative Data
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 11 concepts/indicators
HCBS MS Domains: Safety, Health and Welfare
Populations: Home care recipients
Developer: Center for Health Systems Research and Analysis (CHSRA), University of Wisconsin of Madison
Use history: Publication date not known
States Currently Using: None known
Psychometric Testing: Prevalence measures derived from OASIS. Psychometric properties of OASIS well established.
Summary: Concepts/indicators were created to provide guidance for potential areas in which further analysis may be required. Concepts/indicators are intended to be used to flag potential challenges or strengths as part of a larger more comprehensive quality assurance and improvement system. OASIS assessment items are used to collect data related to indicators. Focus areas include accidents, cognitive patterns, elimination and incontinence, emotional well-being, pain, physical functioning and skin integrity. This work grew out of CHSRA's work in developing nursing home quality of care measures.

Tool or Measure Set: Medical Outcomes Study HIV Health Survey (MOS-HIV)
Data Source: Consumer Survey
Respondent: Consumer
Mode of Data Collection: Can be administered face-to-face, via telephone interview, or self-reported
Total Items/indicators: 35 items
HCBS MS Domains: Quality of Life, Health and Welfare
Populations: Individuals with HIV/AIDS
Developer: Johns Hopkins University, School of Hygiene and Public Health
Use history: Widely used in clinical trials for HIV/AIDS treatment
States Currently Using: None known
Psychometric Testing: The MOS-HIV has been shown to be internally consistent, correlate with concurrent measures of health, discriminate between distinct groups, predict future outcomes and be responsive to changes over time in the peer-review literature.
Summary: The 35-item questionnaire includes ten dimensions (health perceptions, pain, physical, role, social and cognitive functioning, mental health, energy, health distress and quality of life (QOL)) and takes approximately 5 minutes to complete. Subscales are scored on a 0-100 scale (a higher score indicates better health) and physical and mental health summary scores can be generated. The instrument has been approved by the Medical Outcomes Trust.

Tool or Measure Set: QUOTE—HIV
Data Source: Consumer survey
Respondent: Consumer
Mode of Data Collection: Mail survey
Total Items/indicators: 27 items; 13 generic and 14 HIV specific
HCBS MS Domains: Access, Person Centeredness/Autonomy, Unmet Need, Health and Welfare, Coordination of Long-Term Care and Other Services
Populations: Adults with HIV/AIDS
Developer: C.F. Hekkink and colleagues, Academic Medical Center, University of Amsterdam
Use history: Field tested with 44 HIV-positive individuals, results published in 2003.
States Currently Using: None known
Psychometric Testing: Psychometric testing included internal consistency and content and face validity; results available in a peer-review article.
Summary: An HIV-specific version of the QUOTE questionnaire was developed by the authors to measure the quality of care of patients infected with HIV from the patient's perspective. Focus groups generated 27 items relating to service delivery, ranging from "Can easily be reached by telephone" to "Maintain confidentiality about my HIV status." Quality of care items were formulated as both performance and importance items. Respondents were asked to rate all 27 items with respect to three different types of providers: general practitioners, specialists, and AIDS nursing consultants.

Tool or Measure Set: Personal Assistance Services (PAS) IMPACT Survey: Consumer Survey
Data Source: Consumer Survey
Respondent: Consumers filled out the form with assistance as necessary. However, personal assistants did not answer questions for participants
Mode of Data Collection: Self-report
Total Items/indicators: 103 items on the initial survey, followup survey appears to be identical
HCBS MS Domains: Health and Welfare, Person Centeredness/Autonomy, Quality of Life, Unmet Need
Populations: Adults with spinal cord injuries who hire personal assistances
Developer: University of Missouri/Columbia, Department of Health Psychology. Principal Investigator: Laura H. Schopp, PhD, ABPP.
Use history: The survey was created for the project entitled Individualized Management of Personal Assistant/Consumer Teams (IMPACT), and was administered to participants at the conclusion of a workshop.
States Currently Using: None known
Psychometric Testing: Not described.
Summary: Development of this survey included literature review of the status of personal assistance services (PAS). Consultations were made with researchers within and outside the institution, particularly National Institute on Disability and Rehabilitation Research (NIDRR) and non-NIDRR funded researchers in PAS. Several consumers also served on the development team. The survey collects information on medical and nonmedical issues relevant to PAS: pneumonia, skin care, bowel and bladder; team building, relationship issues between a person with a disability and personal assistant, and effective management of PAS by consumers (assertiveness and management training). It does touch on sensitive issues: sexuality, bowel and bladder, and issues related to reporting of attendant or consumer abuse. The survey unearths problems in the consumer-assistant relationship that may need to be addressed, for example stealing or abuse. Choice and satisfaction items are often impaired with "importance" items to assess how much the respondent values choice.

Tool or Measure Set: Lehman Quality of Life Interview
Data Source: Consumer survey
Respondent: Consumer
Mode of Data Collection: Structured Interview
Total Items/indicators: 143 items
HCBS MS Domains: Quality of Life, Safety, Unmet Need, Health and Welfare
Populations: Persons with severe mental illness
Developer: Anthony Lehman, MD, MPSH, University of Maryland School of Medicine
Use history: First developed in 1982; subject to multiple revisions to improve psychometric properties and shorten instrument. Used in numerous published studies.
States Currently Using: Unknown
Psychometric Testing: Information on the psychometric properties of this tool has been established and widely published.
Summary: Structured, self-report instrument administered by lay interviewers. Core version includes a global satisfaction measure, along with objective and subjective measures in eight focus areas: Living Situation; Daily Activities and Functioning; Family Relations; Social Relations; Finances; Work and School; Legal and Safety Issues; and Health. The level of satisfaction items use a fixed interval scale, originally developed for a national quality of life survey.

Tool or Measure Set: Quality of Life Scale
Data Source: Consumer interview
Respondent: Consumer
Mode of Data Collection: Self-administered or structured interview
Total Items/indicators: 16 scalable items
HCBS MS Domains: Quality of Life
Populations: Healthy adults and adults with chronic conditions
Developer: Developed by psychologist John Flanagan in the 1970s. Subsequently adapted and tested for populations with chronic illness by Caroline Burckhardt of the School of Nursing, Oregon Health Sciences University.
Use history: Used extensively with a variety of chronically ill populations.
States Currently Using: Unknown
Psychometric Testing: Information on the psychometric properties of this tool (reliability and validity) has been established and published in the peer review literature.
Summary: Tool assesses satisfaction in 16 areas, using a 7-point satisfaction/dissatisfaction scale. Areas include socializing, intellectual development, independence, relationship with friends, and health (among others).

Return to Appendix III Contents

 

Institutes and Other Research Organizations

Tool or Measure Set: Assessment of Chronic Illness Care
Data Source: Self-assessment by provider organizations
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 28 items
HCBS MS Domains: Qualified Providers, Coordination of Long-Term Care and Other Services, Person Centeredness/Autonomy
Populations: Individuals with chronic illness
Developer: Amy Bonomi, MacColl Institute for Healthcare Innovation, Center for Health Studies, Group Health Cooperative of Puget Sound
Use history: Instrument first published in 2000
States Currently Using: Tool is designed for managed care organizations, extent of current use unknown.
Psychometric Testing: Initial testing found the tool is responsive to changes resulting from quality improvement efforts in health care settings.
Summary: The Assessment of Chronic Illness Care was developed to help organizational teams identify areas for improvement in their care for chronic illnesses. The tool is based on six areas of system change suggested by the Chronic Care Model that have been shown to influence quality of care—linkages to community resources, self-management support, decision support, delivery system design, clinical information systems, and organization of the health system. The self-analysis can be conducted with respect to the chronic condition(s) of the organization's choice. Each item is assessed along an 11-point scale indicating the degree of implementation.

Tool or Measure Set: Hermann Core Measure Set
Data Source: Administrative data, including the Minimum Data Set (MDS)
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 28 core measures
HCBS MS Domains: Access, Safety, Health and Welfare, Coordination of Long-Term Care and Other Services
Populations: Individuals with mental health and substance use disorders, includes adults and children and inpatient and outpatient settings.
Developer: Richard C. Hermann, Center for Quality Assessment and Improvement in Mental Health, Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center
Use history: Core measure set selected by a multistakeholder panel through a formal consensus process and published in 2004.
States Currently Using: Extent of use is unknown.
Psychometric Testing: Information on the testing results of individual measures is reported in the measure set.
Summary: Measures are organized into the following categories: treatment; safety; access; assessment; continuity; coordination; and prevention. Items in the measure set have been rated using the evidence rating criteria developed by AHRQ to assess the research evidence supporting the association between the underlying clinical processes and patient outcomes. Statistical benchmarks have been developed for 12 of the measures, based on 1994-95 administrative data on care received by Medicaid beneficiaries in six States.

Tool or Measure Set: Home Care Quality Measures for MDS-HC Version 2. 0
Data Source: Data are drawn from the Minimum Data Set
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 22 measures
HCBS MS Domains: Unmet Need, Health and Welfare, Quality of Life
Populations: Recipients of federally funded home care services
Developer: InterRAI, a 20-country network of researchers and collaborators responsible for the development and application of the Resident Assessment Instrument/Minimum Data Set series of instruments.
Use history: Measures were published in 2001 and are available in the public domain.
States Currently Using: Michigan
Psychometric Testing: Results of international reliability studies have been published
Summary: Measures are calculated using data elements from the Minimum Data Set for Home Care (MDS-HC), Version 2. 0. Detailed specifications for determining numerators and denominators also include information for risk adjustment. The major focus areas for the measures include nutrition, medication, incontinence, ulcers, physical function, cognitive function, safety/environment, and pain. Several measures assess lack of improvement in function (failure to improve/incidence of decline in ADLs), as well as more clinical outcomes (incidence of skin ulcers). The development process included a literature review and focus groups. Of the 73 items under consideration, 22 were chosen based on criteria of relevance, prevalence, variability, underlying psychometric properties, and denominator size.

Tool or Measure Set: Framework for Coordinate Care Organization (CCO) Measures
Data Source: Administrative data, Providers, Consumer Surveys
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 26 concepts
HCBS MS Domains: Safety, Effectiveness, Person Centeredness/Autonomy, Timeliness, Efficiency, Equity, Access, Qualified Providers, Coordination of Long-Term Care and Other Services, Health and Welfare, and Administrative Oversight
Populations: Adults with physical disabilities and/or chronic conditions and adults with severe and persistent mental illness
Developer: Center for Health Care Strategies, adapted from the Disability Appropriate Care Model
Use history: Framework developed in 2005. Recommended for use to create a multisite quality improvement project.
States Currently Using: Unknown
Psychometric Testing: Concepts not fully developed as measures.
Summary: Framework was provided in the 2005 report, Measuring the Effectiveness of Managed Care for Adults with Disabilities. The Framework was developed to create a common quality measurement process across managed care programs for adults with disabilities. Focus areas include community resources and policies; health system organization of care; self management support; delivery system design; decision support; clinical information systems; informed active patient; and prepared proactive practice team.

Tool or Measure Set: Coordinate Care Organizations (CCOs) Recommended Community Integration Measures
Data Source: Administrative data, Medicaid Claims Data, Providers, and Consumer Surveys
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 15 indicators
HCBS MS Domains: Safety, Effectiveness, Person Centeredness/Autonomy, Efficiency, Access, Coordination of Long-Term Care and Other Services, Health and Welfare, Administrative Oversight, and Quality of Life
Populations: Adults with physical disabilities and/or chronic conditions and adults with severe and persistent mental illness
Developer: Center for Health Care Strategies, adapted from A.F. Lehman (1983), CARF (1998), SAMHSA, and United States Psychiatric Rehabilitation Association (2001)
Use history: Measures recommended for all Coordinated Care Organizations in 2005.
States Currently Using: Measures are being implemented in the seven CCO sites located in Minnesota, North Carolina, New York, Wisconsin (2 sites), Massachusetts, and Vermont.
Psychometric Testing: Measures adapted from other, established measure sets
Summary: Measured identified in 2005 report, Measuring the Effectiveness of Managed Care for Adults with Disabilities. Community integration measures focus on program responsiveness to participant needs; client-driven services and support; personal dignity; community and employment status; relationships; health and service status; physical, emotional, and financial well being; safety; and self-advocacy. Other measures were provided for preventative care, secondary conditions, cost and utilization, and clinical care.

Tool or Measure Set: Peer Outcomes Protocol
Data Source: Consumer survey
Respondent: Consumer
Mode of Data Collection: Face-to-face interviews
Total Items/indicators: Unknown
HCBS MS Domains: Effectiveness, Person Centeredness/Autonomy, Timeliness, Efficiency, Equity, Access, Health and Welfare, Unmet Need, and Quality of Life
Populations: Adults with severe and persistent mental illness
Developer: Program in Consumer Studies and Training at the Missouri Institute of Mental Health, St. Louis. Funded by the National Research Training Center on Psychiatric Disability at the University of Illinois-Chicago
Use history: Development of tool, field test, and distribution of evaluation protocol was a four phase project that took place from 1996-2001.
States Currently Using: None known
Psychometric Testing: Criterion-related validity testing as well as reliability testing conducted.
Summary: The Peer Outcomes Protocol was developed by consumers and can be administered by consumers. The Protocol was built on peer support philosophy and it is used to measure outcomes and satisfaction related to community-based peer support programs. Specific focus areas include demographics, service use, housing and community life, employment, quality of life, well-being, and program satisfaction. The tool can be conducted using all seven focus areas of separated to ease burden of the interview.

Tool or Measure Set: National Inventory of Mental Health Quality Measures
Data Source: Multiple
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: More than 300 measures; a search for measures in the "home and community" setting yielded 23 measures in the 7 specified quality domains
HCBS MS Domains: Access, Safety, Person Centeredness/Autonomy, Coordination of Long-Term Care and Other Services
Populations: Individuals receiving mental health and substance abuse services
Developer: Measure set compiled and maintained by The Center for Quality Assessment and Improvement in Mental Health (CQAIMH). The organization comprises faculty and staff from the Institute for Clinical Research & Health Policy Studies at Tufts-New England Medical Center, Tufts University School of Medicine and Harvard University.
Use history: Database is available in the public domain
States Currently Using: Select measures in the set are likely being used by State mental health programs nationwide
Psychometric Testing: Information about testing is available for individual measures in the inventory. Each measure is rated according to the AHRQ evidence levels used in the Measures Clearinghouse.
Summary: This is a searchable database of process measures for quality assessment and improvement in mental health and substance abuse care. It includes more than 300 measures developed by government agencies, researchers, clinician/professional organizations, accreditors, health systems/facilities, employer purchasers, consumer coalitions, and commercial organizations. Measure specifications are drawn from developer source materials; a directory of developers provides contact information to obtain further information about individual measures. Information about the measures' clinical rationale and evidence base was developed by CQAIMH staff.

Tool or Measure Set: Mayo-Portland Adaptability Inventory-4
Data Source: Consumer survey
Respondent: Consumer, Significant other, Single Professional, Professional Consensus
Mode of Data Collection: Written, onsite
Total Items/indicators: 35
HCBS MS Domains: Health and Welfare, Quality of Life
Populations: Adults with acquired brain injuries
Developer: Muriel D. Lezak, PhD, ABPP & James F. Malec, PhD, ABPP, The Center for Outcome Measurement in Brain Injury
Use history: In 2005 Kentucky piloted the inventory with 3 providers and 135 consumer volunteers. Consumers were given the inventory when they initially entered the waiver for persons with brain injuries, annually, and then when consumers exited from waiver. Results were such that Kentucky is developing waiver regulations to require providers to use these indicators to measure consumer outcomes.
States Currently Using: Kentucky
Psychometric Testing: Tool has been shown to be sensitive to measuring changes in functional and psychosocial status.
Summary: The inventory was developed to assist in the clinical evaluation of people during the period following the acquired brain injury and to assist in evaluating rehabilitation programs designed to serve this population. The inventory covers four focus areas: 1) Abilities; 2) Adjustment; 3) Participation; 4) Preexisting and Associated Conditions.

Tool or Measure Set: Integrated Care Program: Performance Measures Recommendations
Data Source: Data for measures in measure set drawn from existing instruments and measure sets and utilization data.
Total Items/indicators: 11 measures plus the OASIS measure set
HCBS MS Domains: Access, Coordination of Long-Term Care and Other Services, Unmet Need
Populations: Elders with physical and cognitive disabilities (dual eligibles with disabilities).
Developer: Measure set assembled by researchers from the Center for Healthcare Strategies, Inc. and the Boston University School of Public Health
Use history: Proposed measure set published in 2006.
States Currently Using: Extent of current use unknown
Psychometric Testing: Measures are drawn primarily from existing measure sets whose reliability and validity have already been established.
Summary: This list of recommended measures was developed specifically for monitoring participants in Special Needs Plans, which serve dually eligible (Medicaid and Medicare) elders and adults with disabilities, as well for Medicaid recipients with disabilities. Goal was to identify measures that were available and broadly applicable. Workgroup members developed a framework, conducted a measure scan and sought State feedback before articulating the measure set. Data sources and tools recommended include OASIS, the National Core Indicators project, the Indiana Medicaid Select Consumer Survey, the Care Transition Measures consumer survey, and the ECHO consumer survey.
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Page last reviewed June 2010
Internet Citation: Appendix III (continued): Environmental Scan of Measures for Medicaid Title XIX Home and Community-Based Services Measure Scan as of July 5, 2007. June 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/hcbs/hcbsreport/hcbsapiiib.html