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

Appendix V: Tested Measures by DRA Domain (continued)

Note: Scoring is explained in Figure 1.

Table A.V.1b. Tested Functioning Measures Meeting Threshold Criteria

I. Change in Daily Activity Function

Measure	Source	Evidence	Populations	Feasibility	Prevalence	Total Score	Notes
Perceived improvement (in daily problems, social situations, symptoms, accomplishing activities)	ECHO 3.0 (all adult versions), based on four items	4	3	3	3	13	Adult mental/behavioral health consumers; parallel proxy questions developed for children
Improvement on waiver: clients who can do more for themselves now	Participant Experience Survey, Acquired Brain Injury version	3	3	3	4	13	Adults with acquired brain injuries
Percentage of new service recipients whose ADL or IADL assessment score has maintained or improved	Florida Aging (from CHSRA report)	?	4	4	3	not calculated	This measure was not identified by the State but appeared in a summary report.
Degree to which consumers experience an increased level of functioning	Commission on Accreditation of Rehabilitation Facilities	4	5	3	5	17	Tested with multiple disabilities populations
Functional abilities (multiple dimensions, including cognitive and physical)	Mayo-Portland Adaptability Inventory—4	4	3	3	3	13	Adults 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	4	3	3	2	12	Adults with HIV. Tool could be used to assess changes in functioning over time—has not been tested for this.
Improved ability to function (socially, etc.) as a direct result of services received	Mental Health Statistics Improvement Program, Adult Consumer Survey	4	3	3	5	15	Adult mental health consumers; additional functioning items added for the Uniform Reporting System.
Problems with performing daily activities	Quality of Life Assessment Schedule	4	4	3	2	13	Individuals with Alzheimer's. Longitudinal use could reflect changes in ability over time. Constructs are individual; respondents identify important dimensions of quality of life in each domain.

II. Availability of Assistance With Everyday Activities When Needed

Measure	Source	Evidence	Populations	Feasibility	Prevalence	Total Score	Notes
Access to services	National Core Indicators Consumer Survey	4	4	3	5	16	Individuals with intellectual disabilities
Unmet need in ADLs/IADLs (11 measures total)	Participant Experience Survey	4	5	3	5	17	Item present in all three versions (elderly/disabled, mental retardation/developmental disabilities, and acquired brain injury); additional money management item in brain injury tool.
Adequacy and reliability of grocery service, home-delivered meals, homemaker and aide services (several relevant items for each)	Home Care Satisfaction Measure	4	4	3	4	15	Older adults receiving home care services. Items can be used individually or as part of a scale assessing overall satisfaction.
Inability to complete a personal care task due to lack of personal assistance.	Maine Consumer Experience Survey	3	4	3	3	13	Nonelderly adults with physical disabilities who direct their own services. Survey derived in part from Participant Experience Survey.

III. Employment

Measure	Source	Evidence	Populations	Feasibility	Prevalence	Total Score	Notes
Current employment status and change over time	ECHO 3.0, supplemental items	4	3	3	3	13	Tool tested and developed for adult recipients of managed mental health services
Community integrated employment: 6 measures from consumer survey related to community employment	National Core Indicators Consumer Survey	4	4	3	5	16	Developed and tested with intellectually disabled/developmentally disabled population only
Proportion of all individuals who receive daytime supports of any type who are engaged in community integrated employment	National Core Indicators system measure	3	4	3	5	15	Developed for intellectually disabled/developmentally disabled population only
Satisfaction and choice in current job/daily activity (2 measures)	Participant Experience Survey	4	5	3	5	17	Item supported by all three survey versions; applies to nonelderly adults only.
Unmet demand for employment, day program, or volunteer work	Participant Experience Survey	4	5	3	5	17	Item supported by all three survey versions; applies to nonelderly adults only, day program, and volunteer mental retardation/developmental disabilities only
Proportion of people who are satisfied with their job or day program	National Core Indicators Consumer Survey	4	4	3	5	16	Individuals 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 services	National Core Indicators Basic Profile Report	3	4	4	5	16	Individuals with intellectual disabilities
Supported employment for individuals with severe and persistent mental illness	National Association of State Mental Health Directors	4	3	4	2	13	Individuals with severe and persistent mental illness
Degree of employment retention and average monthly income of consumers who are employed	Commission on Accreditation of Rehabilitation Facilities	4	5	3	5	17	Tested with multiple disabilities populations
Experience with work and school (subjective and objective dimensions, including current employment status)	Lehman Quality of Life Scale	4	3	3	2	12	Nonelderly adults with severe mental illness
Paid employment status	Mayo-Portland Adaptability Inventory—4	4	3	3	3	13	Adults 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.
Competence/productivity scale	Schalock Quality of Life Questionnaire	4	4	3	4	15	Adults with intellectual disabilities. This scale really assesses experience and satisfaction with current employment, not whether participants are working.

IV. Friendships

Measure	Source	Evidence	Populations	Feasibility	Prevalence	Total Score	Notes
Ability to see friends when client wants	Participant Experience Survey, mental retardation/ developmental disabilities and acquired brain injury versions	4	5	3	5	17	Similar item appears on both survey versions
People have friends and relationships (4 measures)	National Core Indicators Consumer Survey	4	4	3	5	16	Individuals with intellectual disabilities
Degree to which people express satisfaction with relationships	Commission on Accreditation of Rehabilitation Facilities	4	5	3	5	17	Tested with multiple disabilities populations
Experience with social relations (subjective and objective dimensions, including frequency of social contacts)	Lehman Quality of Life Scale	4	3	3	2	12	Nonelderly adults with severe mental illness
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)	4	3	3	5	15	Adult mental health consumers; similar item for youths and families.
Social contact with friends, work associates, and other nonfamily	Mayo-Portland Adaptability Inventory—4	4	3	3	3	13	Adults with acquired brain injuries. One known state using; may be others.
Satisfaction with close friends	Quality of Life Scale (modified by Burkhardt)	4	5	3	2	14	Developed and tested with populations with chronic illness
People are supported to maintain relationships with family, friends, and coworkers.	Massachusetts Department of Mental Retardation Quality Indicators	3	4	3	3	13	Individuals with intellectual disabilities
General satisfaction with amount of contact with friends	Minnesota Aging and Adult Services Consumer Experience Survey	3	5	3	3	14	Older 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 Survey	3	4	3	3	13	Adults with developmental disabilities. Item includes family and friends.

V. Maintenance of Family Relationships

Measure	Source	Evidence	Populations	Feasibility	Prevalence	Total Score	Notes
Proportion of people able to see friends and family when they want	National Core Indicators Consumer Survey	4	4	3	5	16	Measure includes "friends" and "family"; survey includes item specific to family. Individuals with intellectual disabilities.
People who feel they would have support needed from friends and family in a crisis	Mental Health Statistics Improvement Program, additional items for Uniform Reporting Systems	4	3	3	5	15	Adults, youth, and families of mental health consumers
Experience with family relations (subjective and objective dimensions, including frequency of family contact)	Lehman Quality of Life Scale	4	3	3	2	12	Nonelderly adults with severe mental illness
Satisfaction with relationships with parents, siblings, and other relatives	Quality of Life Scale (Burkhardt version for chronic illness)	4	5	3	2	14	Developed and tested with populations with chronic illness
General satisfaction with amount of contact with family	Minnesota Aging and Adult Services Consumer Experience Survey	3	5	3	3	14	Older adults and adults with physical disabilities

VI. Community Inclusion

Measure	Source	Evidence	Populations	Feasibility	Prevalence	Total Score	Notes
Participants reporting unmet need for community involvement	Participant Experience Survey	4	5	3	5	17	Item supported by all three versions; additional community involvement measures related to specific activities such as shopping present in brain injury and mental retardation/developmental disabilities versions
Satisfaction with community activities (several dimensions—participating in recreational activities, socializing, working, attending school, participating in organizations)	Quality of Life Scale (modified by Burkhardt)	4	5	3	2	14	Modified and tested for population with chronic illness. Items in scale can be summed to a single measure.
Percentage of people who feel they belong in their community	Mental Health Statistics Improvement Program; additional items for Uniform Reporting Systems (also National Outcome Measures).	4	3	3	5	15	Adult mental health consumers
Proportion of people who participate in everyday integrated activities in their communities.	National Core Indicators Consumer Survey	4	4	3	5	16	Individuals with intellectual disabilities
Outcomes related to senior center use (includes dimensions of community involvement)	Performance Outcome Measurement Project Senior Center Participant Survey	3	4	3	5	15	Older adults receiving services funded by the Administration on Aging.
Social belonging/community integration scale (several items, including ones related to friendships)	Schalock Quality of Life Questionnaire	4	4	3	4	15	Individuals with intellectual disabilities
Community connections (multiple items)	National Core Indicators Family Survey	3	4	3	5	15	Adults with intellectual disabilities
Providers promote community inclusion	EAZI Habilitation Survey	3	4	3	3	13	Families with at least one child with an intellectual disability
Community integration and inclusion	Nebraska Family Experience Survey	3	3	3	3	12	Families of children receiving HCBS

VII. School Attendance

Measure	Source	Evidence	Populations	Feasibility	Prevalence	Total Score	Notes
Proportion of children and adolescents for whom there is an increase in educational attainment	Commission on Accreditation of Rehabilitation Facilities	4	5	3	5	17	Tested with multiple disabilities populations
Number of days child (with special health care needs) missed school during the last year due to illness or injury.	National Survey of Children With Special Health Care Needs	4	3	3	2	12	Children with special health care needs

VIII. Serious Reportable Events

Measure	Source	Evidence	Populations	Feasibility	Prevalence	Total Score	Notes
Medication errors in child residential programs	Center for Quality Assessment and Improvement in Mental Health/Child & Adolescent Residential Psychiatric Programs	4	3	4	2	13	Residential care for children with psychiatric disorders
Patient injury during child/adolescent restraint	Center for Quality Assessment and Improvement in Mental Health/Child & Adolescent Residential Psychiatric Programs	4	3	4	2	13	Residential care for children with psychiatric disorders
Incidence of serious injuries reported among people with mental retardation/developmental disabilities in the course of service provision during the past year.	National Core Indicators System Variable	3	4	4	4	15	Individuals 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 Variable	3	4	4	4	15	Individuals with intellectual disabilities
Incidence of serious injuries resulting from substantiated incidents of abuse and neglect	National Core Indicators System Variable	3	4	4	4	15	Individuals with intellectual disabilities
Incidence of serious injuries resulting from the use of restraints.	National Core Indicators System Variable	3	4	4	4	15	Individuals with intellectual disabilities
Rate of substantiated abuse/neglect investigations/1,000	Massachusetts Department of Mental Retardation Quality Indicators	3	4	3	3	13	Individuals 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) people with developmental disabilities	Oregon Division of Seniors and People With Disabilities	4	5	4	3	16	Data have been collected longitudinally for all three populations.

IX. Avoidable Hospitalizations

Measure	Source	Evidence	Populations	Feasibility	Prevalence	Total Score	Notes
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 disease	AHRQ	4	2	4	5	15	Not 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

Measure	Source	Evidence	Populations	Feasibility	Prevalence	Total Score	Notes
Percentage of enrollees age 18 years and over who had at least one preventive dental service during the look-back period	Wisconsin Department of Health and Family Service, MEDDIC-MS SSI 2007 technical specifications. Medicaid encounter data-driven improvement core measure set for SSI-eligible populations.	4	5	4	3	16	SSI population includes both older adults and people with disabilities.
Percentage of patients who received an influenza immunization during the one-year measurement period	Physician Consortium for Performance Improvement™	4	4	4	2	14	Adults age 50 and over
Receipt of needed health services (physical, OB-GYN women, dental)	National Core Indicators Consumer Survey	4	4	3	5	16	Adults with intellectual disabilities
Degree to which people with identified physical health problems obtain appropriate services and degree to which health status is maintained and improved	Commission on Accreditation of Rehabilitation Facilities	4	5	3	5	17	Tested with multiple disabilities populations
Children with special health care needs not receiving routine preventive care (includes reasons why); parallel item for dental care	National Survey of Children With Special Health Care Needs	4	3	3	2	12	Children with special health care needs
Access to health and dental services (for children)	National Core Indicators Family Survey	3	4	3	5	15	Families with at least one child with an intellectual disability
Visit dentist annually for cleaning and checkups	New Hampshire Development Services Adult Outcomes Survey	3	4	3	3	13	Adults with developmental disabilities

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Current as of June 2010

Internet Citation: Environmental Scan of Measures for Medicaid Title XIX Home and Community-Based Services Measure Scan as of July 5, 2007: Appendix V: Tested Measures by DRA Domain (continued). June 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/hcbs/hcbsreport/hcbsapv1b.html