Appendix V: Tested Measures by DRA Domain

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

Note: Additional information on measures cited can be found in Appendix III.

 

Table A.V.1a. Tested Functioning Measures

I. Change in Daily Activity Function

MeasureSourceNotes
Percentage of patients whose ability to transfer in/out of bed, etc., improves or stays the same between start/resumption of care and discharge (from home health care). Companion measures include improvements in bathing, ambulation, and management of oral medications.Outcome Assessment and Information Set (OASIS)These measures were designed for postacute home health care and may not be appropriate for HCBS populations.
Failure to improve: six measures: bladder incontinence; skin ulcers; Activities of Daily Living (ADLs); locomotion in home; cognitive function; difficulty in communicationMinimum Data Set (MDS)—Home CareFocus of MDS home care measures is more on postacute care; relevance to many HCBS populations may be limited.
Perceived improvement (in daily problems, social situations, symptoms, accomplishing activities)ECHO 3.0 (all adult versions), based on four items. ECHO is the Experience of Care and Health Outcomes Survey.Adult mental/behavioral health consumers; parallel proxy questions developed for children
Percentage of adult mental health consumers and families of child/adolescent mental health recipients reporting positive outcomes from care (multiple dimensions of functioning)Substance Abuse and Mental Health Services Administration (SAMHSA) National Outcome MeasuresData collected for mental health consumers, including those served via Medicaid, but likely not HCBS
Mean change score in physical functional health status of patients receiving physical rehabilitationFocus On Therapeutic Outcomes, Inc. (FOTO).Focus is on postacute care; only a subset of HCBS participants receive physical rehabilitation services.
Improvement on waiver: clients who can do more for themselves nowParticipant Experience Survey, Acquired Brain Injury versionAdults with acquired brain injuries
Percentage of new service recipients whose ADL or Instrumental ADL (IADL) assessment score has maintained or improvedFlorida Aging (from Center for Health Systems Research and Analysis report)This measure was not identified by the State but appeared in a summary report.
Degree to which consumers experience an increased level of functioningCommission on Accreditation of Rehabilitation FacilitiesTested with multiple disabilities populations
Improved ability to function (socially, etc.) as a direct result of services receivedMental Health Statistics Improvement Program, Adult Consumer SurveyMental health population, additional functioning items added for the Uniform Reporting System
Functional abilities (multiple dimensions, including cognitive and physical)Mayo-Portland Adaptability Inventory—4Adults with acquired brain injuries. Tool has been shown to be effective in discerning changes in functional ability over time. One known State using; may be others.
Impact of pain/health on selected functional tasks (walking, ADLs, carrying groceries, etc.)Medical Outcomes Study HIV Health Survey (MOS-HIV)Adults with HIV. Tool could be used to assess changes in functioning over time—has not been tested for this.
Problems with performing daily activitiesQuality of Life Assessment ScheduleIndividuals with Alzheimer's—longitudinal use could reflect changes in ability over time. Constructs are individual—respondents identify important dimensions of quality of life (QOL) in each domain.

 

II. Availability of Assistance With Everyday Activities When Needed

MeasureSourceNotes
Access to servicesNational Core Indicators Consumer SurveyIndividuals with intellectual disabilities
Unmet need in ADLs/IADLs (11 measures total)Participant Experience SurveyItem present in all three versions (elderly/disabled, mental retardation/developmental disabilities, and acquired brain injury); additional money management item in brain injury tool
ADL and IADL unmet need itemsMathematica Waiver Evaluation Consumer SurveyElderly/disabled waiver participants. Item wording is very similar to the Participant Experience Survey.
Self-report of unmet need (scale based on six items)Adequacy of Paraprofessional Home Care instrumentsFrail elderly
Adequacy and reliability of grocery service, home-delivered meals, homemaker and aide services (several relevant items for each)Home Care Satisfaction MeasureOlder adults receiving home care services. Items can be used individually or as part of a scale assessing overall satisfaction.
Are you ever left sitting or lying in the same position so long that it hurts?CAHPS® Nursing Home Survey: long-stay resident. CAHPS® is the Consumer Assessment of Healthcare Providers and Systems.Developed and tested for nursing home settings
Do you/does the client need more help with personal care than s/he is currently receiving?Cash and Counseling Baseline InstrumentIndividuals with disabilities participating in the demonstration project
Do you/does the client need more help with transportation than s/he is currently receiving?Cash and Counseling Baseline InstrumentIndividuals with disabilities participating in the demonstration project
Unmet need for assistance with: personal care; household activities; transportationCash and Counseling Demonstration Expansion: Performance Indicators 
Inability to complete a personal care task due to lack of personal assistance.Maine Consumer Experience SurveyNonelderly adults with physical disabilities who direct their own services. Survey derived in part from Participant Experience Survey.

 

III. Employment

MeasureSourceNotes
People choose where they workCouncil on Quality and Leadership Personal Outcomes MeasuresIndividuals with intellectual or developmental disabilities and people with mental illness
Current employment status and change over timeECHO 3.0, supplemental itemsTool tested and developed for adult recipients of managed mental health services
Community Integrated Employment: 6 measures from consumer survey related to community employmentNational Core Indicators Consumer SurveyDeveloped and tested with intellectually disabled/developmentally disabled (ID/DD) population only
The proportion of all individuals who receive daytime supports of any type who are engaged in community integrated employment.National Core Indicators system measureDeveloped for ID/DD population only
Rate of adult mental health consumers competitively employedSAMHSA National Outcome MeasuresMental health consumers
Satisfaction and choice in current job/daily activity (2 measures)Participant Experience SurveyItem supported by all three survey versions; applies to nonelderly adults only
Unmet demand for employment, day program, or volunteer workParticipant Experience SurveyItem supported by all three survey versions; applies to nonelderly adults only, day program, and volunteer mental retardation/developmental disabilities (MRDD) only
Proportion of people who are satisfied with their job or day programNational Core Indicators Consumer SurveyIndividuals with intellectual disabilities
The proportion of individuals age 18 and over who are supported in community integrated employment compared to the total number of adults who receive day servicesNational Core Indicators Basic Profile ReportIndividuals with intellectual disabilities
People have meaningful work and activity choicesCouncil on Quality and Leadership Basic AssurancesIndividuals with intellectual or developmental disabilities and people with mental illness
Supported employment for individuals with severe and persistent mental illnessNational Association of State Mental Health DirectorsIndividuals with severe and persistent mental illness
Degree of employment retention and average monthly income of consumers who are employedCommission on Accreditation of Rehabilitation FacilitiesTested with multiple disabilities populations
Current employment statusSAMHSA National Outcome MeasuresDeveloped and tested with mental health populations
Proportion of people who participate in inclusive work activitiesQuality Indicators for Medicaid Services to People With Developmental DisabilitiesIndividuals with intellectual disabilities
Experience with work and school (subjective and objective dimensions, including current employment status)Lehman Quality of Life ScaleNonelderly adults with severe mental illness
Paid employment statusMayo-Portland Adaptability Inventory—4Adults with acquired brain injuries. Tool has been shown to be effective in discerning changes in functional ability over time. One known State using; may be others.
Current employment status/demand for employmentMathematica Waiver Evaluation Consumer SurveyElderly/disabled populations
Current employment status and satisfactionSustained employment of people who have psychiatric conditionsAdult mental health consumers who are currently working—not designed or tested for those who are not working
Current employment status and unmet need for employmentPeer Outcomes ProtocolAdult mental health consumers
Employment status, choice, and satisfaction (some comparable items for volunteer activity)Personal Assistance Services (PAS) Impact Survey: Consumer SurveyAdults with spinal cord injuries
Competence/productivity scaleSchalock Quality of Life QuestionnaireAdults with intellectual disabilities. This scale assesses experience and satisfaction with current employment, not whether participants are working.

 

IV. Friendships

MeasureSourceNotes
Ability to see friends when client wantsParticipant Experience Survey, MRDD and acquired brain injury versionsSimilar item appears on both survey versions
People have friends and relationships (4 measures)National Core Indicators Consumer SurveyIndividuals with intellectual disabilities
People have intimate relationships; people have friends.Council on Quality and Leadership Personal Outcome MeasuresIndividuals with intellectual or developmental disabilities and people with mental illness
Degree to which people express satisfaction with relationshipsCommission on Accreditation of Rehabilitation FacilitiesTested with multiple disabilities populations
Satisfaction with friendships and availability of people with whom to do "fun things"Mental Health Statistics Improvement Program, additional items for Uniform Reporting Systems (also National Outcome Measures)Adult mental health consumers, similar item for youths and families
Proportion of people who are supported in having intimate relationships and proportion of people with active natural support networksQuality Indicators for Medicaid Services to People With Developmental DisabilitiesIndividuals with intellectual disabilities
Experience with social relations (subjective and objective dimensions, including frequency of social contacts)Lehman Quality of Life ScaleNonelderly adults with severe mental illness
Social contact with friends, work associates, and other nonfamilyMayo-Portland Adaptability Inventory—4Adults with acquired brain injuries. One known State using; may be others.
Social contact with non-family membersPeer Outcomes ProtocolAdults in peer mental health programs
Satisfaction with close friendsQuality of Life Scale (modified by Burkhardt)Developed and tested with populations with chronic illness
Satisfaction with friendsQuality of Life—Alzheimer's Disease (AD) ScaleIndividuals with mild to moderate Alzheimer's; data provided by participants and caregivers
People are supported to maintain relationships with family, friends, and coworkers.Massachusetts Department of Mental Retardation Quality IndicatorsIndividuals with intellectual disabilities
General satisfaction with amount of contact with friendsMinnesota Aging and Adult Services Consumer Experience SurveyOlder adults and adults with physical disabilities
Get the help needed to keep in touch with family and friends (writing letters, buying presents, telephoning)New Hampshire Development Services Adult Outcomes SurveyAdults with developmental disabilities. Item includes family and friends.
Proportion of people able to see friends and family when they wantNational Core Indicators Consumer SurveyMeasure includes "friends" and "family"; survey does include item specific to family. Individuals with intellectual disabilities.
Communication occurs between people, their support staff, and their families.Council on Quality and Leadership Basic AssurancesIndividuals with intellectual or developmental disabilities and people with mental illness
People are connected to natural support networksCouncil on Quality and Leadership Personal Outcome MeasuresIndividuals with intellectual or developmental disabilities and people with mental illness
Families remain togetherCouncil on Quality and Leadership Personal Outcome Measures for Families of Young childrenFamilies with a young child with an intellectual disability or mental illness
People who feel they would have support needed from friends and family in a crisisMental Health Statistics Improvement Program, additional items for Uniform Reporting SystemsAdults, youth, and families of mental health consumers
Experience with family relations (subjective and objective dimensions, including frequency of family contact)Lehman Quality of Life ScaleNonelderly adults with severe mental illness
Family Involvement Scale (includes items assessing family/friends involvement in treatment)Client-Centered Rehabilitation QuestionnaireOlder adults and adults with physical disabilities; designed to assess experience with postacute (postdischarge) care; may not be relevant to HCBS
Satisfaction with social relationships with familyPeer Outcomes ProtocolAdults with mental illness in peer programs. Only item in the social relationships domain.
Satisfaction with relationships with parents, siblings, and other relativesQuality of Life Scale (Burkhardt version for chronic illness)Developed and tested with populations with chronic illness
Satisfaction with familyQuality of Life—AD ScaleIndividuals with mild to moderate Alzheimer's; data provided by participants and caregivers
General satisfaction with amount of contact with familyMinnesota Aging and Adult Services Consumer Experience SurveyOlder adults and adults with physical disabilities

 

VI. Community Inclusion

MeasureSourceNotes
Participants reporting unmet need for community involvementParticipant Experience SurveyItem supported by all three versions; additional community involvement measures related to specific activities such as shopping present in BI and MRDD versions
Percentage of people who feel they belong in their communityMental Health Statistics Improvement Program, additional items for Uniform Reporting Systems (also National Outcome Measures)Adult mental health consumers
Satisfaction with community activities (several dimensions—participating in recreational activities, socializing, working, attending school, participating in organizations)Quality of Life Scale (modified by Burkhardt)Modified and tested for population with chronic illness. Items in scale can be summed to a single measure.
The proportion of people who participate in everyday integrated activities in their communities.National Core Indicators Consumer SurveyIndividuals with intellectual disabilities
Community indicators: (1)People contribute to their communities; (2) People live in communities; 3) People achieve personal goals and outcomes in communities; and (4) People have responsibilities in the community.Council on Quality and Leadership Shared ValuesIndividuals with intellectual or developmental disabilities and people with mental illness. Companion measures available for children and youth.
Community indicators: (1) Use environment; (2) Live in integrated environments; (3) Interact with other members of the community; (4) Perform different social roles; and (5) Participate in the life of the community.Council on Quality and Leadership Personal Outcome MeasuresIndividuals with intellectual or developmental disabilities and people with mental illness. Companion measures available for children and youth.
Outcomes related to senior center use (includes dimensions of community involvement)Performance Outcome Measurement Project (POMP) Participant SurveyOlder adults receiving services funded by the Administration on Aging
Proportion of people who participate in integrative community activitiesQuality Indicators for Medicaid Services to People With Developmental DisabilitiesIndividuals with intellectual disabilities
Social isolation with distressMDS-Home Care Quality IndicatorsFocus of MDS home care measures is more on postacute care; relevance to many HCBS populations may be limited.
Social/recreational activities (2 items)Mathematica Waiver Evaluation Consumer SurveyFocus of MDS home care measures is more on postacute care; relevance to many HCBS populations may be limited.
Community activities in past 7 days (4 items)Peer Outcome ProtocolElderly/disabled waiver participants
Social belonging/community integration scale (several items, including ones related to friendships)Schalock Quality of Life QuestionnaireMental health consumers in peer programs
Community connections (multiple items)National Core Indicators Family SurveyAdults with intellectual disabilities
Providers promote community inclusionEmpowering Arizona's Individuals Habilitation SurveyFamilies with at least one child with an intellectual disability
Community integration and inclusionNebraska Family Experience SurveyFamilies of children receiving HCBS

 

VII. School Attendance

MeasureSourceNotes
Children with increased school attendanceSAMHSA National Outcome MeasuresMental health population
Proportion of children and adolescents for whom there is an increase in educational attainmentCommission on Accreditation of Rehabilitation FacilitiesTested with multiple disabilities populations
Number of days child (with special health care needs) missed school during the last year due to illness or injuryNational Survey of Children With Special Health Care Needs, 2001Children with special health care needs

 

VIII. Serious Reportable Events

MeasureSourceNotes
Falls with injuryAmerican Nurses AssociationResidential care, nursing sensitive (may not apply)
Medication errors in child residential programsCenter for Quality Assessment and Improvement in Mental Health/Child & Adolescent Residential Psychiatric ProgramsResidential care for children with psychiatric disorders
Patient injury during child/adolescent restraintCenter for Quality Assessment and Improvement in Mental Health/Child & Adolescent Residential Psychiatric ProgramsResidential care for children with psychiatric disorders
Patient death or disability associated with patient elopement for more than 4 hours.National Quality ForumResidential care
Patient suicide or attempted suicide resulting in serious disability while being cared for in a health care facility.National Quality ForumResidential care
Patient death or serious disability associated with medication error (wrong drug, dose, patient, time, rate, preparation, or mode of administration)National Quality ForumResidential care
Patient death or disability associated with a burn incurred from any source while being cared for in a health care facilityNational Quality ForumResidential care
Patient death associated with a fall while being cared for in a health care facilityNational Quality ForumResidential care
Patient death associated with use of restraints or bedrails while being cared for in a health care facilityNational Quality ForumResidential care
Abduction of a patient of any ageNational Quality ForumResidential care
Sexual assault of a patient within or on the grounds of a health care facilityNational Quality ForumResidential care
Death or significant injury resulting from a physical assault that occurs within or on the grounds of a health care facilityNational Quality ForumResidential care
Emergent care for improper medication administration or medication side effectsOASISOASIS measures were designed for Medicare postacute care; not relevant for HCBS.
Incidence of serious injuries reported among people with MR/DD in the course of service provision during the past year.National Core Indicators System VariableIndividuals with intellectual disabilities
Proportion of people who were victims of selected crimes reported to a law enforcement agency during the past year, by type of crime (rape, aggravated assault, and theft)National Core Indicators System VariableIndividuals with intellectual disabilities
Incidence of serious injuries resulting from substantiated incidents of abuse and neglectNational Core Indicators System VariableIndividuals with intellectual disabilities
Incidence of serious injuries resulting from the use of restraintsNational Core Indicators System VariableIndividuals with intellectual disabilities
Neglect or abuseMDS—Home Care Quality IndicatorsFocus of MDS home care measures is more on postacute care; relevance to many HCBS populations may be limited.
Ratio of injuries to client daysChimes Performance MetricsIndividuals with intellectual disabilities. Includes all injuries, regardless of impact.
Ratio of ER visits to client daysChimes Performance MetricsIndividuals with intellectual disabilities. Includes all ER visits, regardless of impact.
Ratio of medication errors to client daysChimes Performance MetricsIndividuals with intellectual disabilities. Includes all medication errors, regardless of impact.
Rate of substantiated abuse/neglect investigations/1,000Massachusetts Department of Mental Retardation Quality IndicatorsIndividuals with intellectual disabilities
Percentage of seniors and adults with disabilities who are reabused within 12 months of first substantiated abuse: (a) seniors, (b) adults with disabilities, (c) persons with developmental disabilitiesOregon Division of Seniors and People With DisabilitiesData have been collected longitudinally for all three populations.

 

IX. Avoidable Hospitalizations

MeasureSourceNotes
Prevention Quality Indicators: set of measures that can be used with hospital inpatient discharge data to identify quality of care for conditions for which good outpatient care can potentially prevent the need for hospitalization or for which early intervention can prevent complications or more severe diseaseAHRQNot all measures may apply; hospital utilization data not available for all States or all payers (e.g., Medicaid) within a State.

 

X. Receipt of Recommended Preventive Health Care

MeasureSourceNotes
Recommendations of evidence-based preventive services for primary care released by the U.S. Preventive Services Task Force (USPSTF)AHRQThe task force has identified nearly 100 recommended counseling and screening procedures; not all apply to all populations (e.g., some are specific to children or pregnant females).
Screening tests for adults with intellectual disabilitiesWilkinson, et al.Adaptation of USPSTF recommendations for people with intellectual disabilities. Other population-specific guidelines for preventive care likely exist, but identifying them all exceeds the scope of this scan.
Proportion of people who have received routine, preventive health care in the past year and proportion of people who have had a dental exam in the past 12 monthsQuality Indicators for Medicaid Services to People With Developmental DisabilitiesIndividuals with intellectual disabilities
Percentage of women who had a mammogram during the measurement year or the year prior to the measurement yearCMS/NCQANeed to adjust for age.
Percentage of women who received one or two Pap tests during the measurement year or the 2 years prior to the measurement yearNCQA (HEDIS®)Women
Percentage of patients who received an influenza immunization during the one-year measurement periodPhysician Consortium for Performance Improvement™Adults age 50 and older
Percentage of adolescents who are on time with recommended immunizations—hepatitis B (Hep B), measles-mumps-rubella (MMR), tetanus, and verification of varicella immunityInstitute for Clinical Systems Improvement (ICSI)Recommendation only
Percentage of 2-year-olds who are on time with their primary series of immunizations—diphtheria-tetanus-pertussis, polio, MMR, pneumococcal conjugate (PCV7), varicella (VZV), Haemophilus influenzae type b (HiB), Hep BInstitute for Clinical Systems Improvement (ICSI)Recommendation only
Percentage of patients with all Level I preventive services (e.g. mammogram, hearing test, depression screening, smoking cessation, etc.) on time according to the guideline delivery scheduleInstitute for Clinical Systems Improvement (ICSI)Recommendation only
Percentage of enrolled members 2 through 21 years of age who had at least one dental visit during the measurement yearNCQA—HEDISChildren
Well-child visits in the 3rd, 4th, 5th, and 6th years of life: percentage of members who were 3, 4, 5, or 6 years old during the measurement year who received one or more well-child visits with a primary care practitioner during the measurement yearNCQA—HEDISChildren
Percentage of enrollees age 18 years and over who had at least one preventive dental service during the look-back period (MEDDIC-MS SSI)Wisconsin Department of Health and Family Services, MEDDIC-MS SSI 2007 technical specifications. Medicaid encounter data-driven improvement core measure set for SSI-eligible populations.Developed for managed care enrollees
Children with special health care needs not receiving routine preventive care (includes reasons why); parallel item for dental careNational Survey of Children With Special Health Care Needs, 2001Children with special health care needs
Adult access to preventive/ambulatory health careHEDIS 2007Measure developed for managed care
Access to health and dental services (for children)National Core Indicators Family SurveyFamilies with at least one child with an intellectual disability
Visit dentist annually for cleaning and checkupsNew Hampshire Development Services Adult Outcomes SurveyAdults with developmental disabilities
Current as of June 2010
Internet Citation: Appendix V: Tested Measures by DRA Domain: 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/hcbsapv.html