Appendix V (continued)

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

Note: Scoring is explained in Figure 1.

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

I. Change in Daily Activity Function

MeasureSourceEvidencePopulationsFeasibilityPrevalenceTotal ScoreNotes
Perceived improvement (in daily problems, social situations, symptoms, accomplishing activities)ECHO 3.0 (all adult versions), based on four items433313Adult mental/behavioral health consumers; parallel proxy questions developed for children
Improvement on waiver: clients who can do more for themselves nowParticipant Experience Survey, Acquired Brain Injury version333413Adults with acquired brain injuries
Percentage of new service recipients whose ADL or IADL assessment score has maintained or improvedFlorida Aging (from CHSRA report)?443not calculatedThis 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 Facilities453517Tested with multiple disabilities populations
Functional abilities (multiple dimensions, including cognitive and physical)Mayo-Portland Adaptability Inventory—4433313Adults 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 Survey433212Adults 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 receivedMental Health Statistics Improvement Program, Adult Consumer Survey433515Adult mental health consumers; additional functioning items added for the Uniform Reporting System.
Problems with performing daily activitiesQuality of Life Assessment Schedule443213Individuals 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

MeasureSourceEvidencePopulationsFeasibilityPrevalenceTotal ScoreNotes
Access to servicesNational Core Indicators Consumer Survey443516Individuals with intellectual disabilities
Unmet need in ADLs/IADLs (11 measures total)Participant Experience Survey453517Item 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 Measure443415Older 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 Survey343313Nonelderly adults with physical disabilities who direct their own services. Survey derived in part from Participant Experience Survey.

 

III. Employment

MeasureSourceEvidencePopulationsFeasibilityPrevalenceTotal ScoreNotes
Current employment status and change over timeECHO 3.0, supplemental items433313Tool 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 Survey443516Developed 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 employmentNational Core Indicators system measure343515Developed for intellectually disabled/developmentally disabled population only
Satisfaction and choice in current job/daily activity (2 measures)Participant Experience Survey453517Item supported by all three survey versions; applies to nonelderly adults only.
Unmet demand for employment, day program, or volunteer workParticipant Experience Survey453517Item 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 programNational Core Indicators Consumer Survey443516Individuals 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 Report344516Individuals with intellectual disabilities
Supported employment for individuals with severe and persistent mental illnessNational Association of State Mental Health Directors434213Individuals with severe and persistent mental illness
Degree of employment retention and average monthly income of consumers who are employedCommission on Accreditation of Rehabilitation Facilities453517Tested with multiple disabilities populations
Experience with work and school (subjective and objective dimensions, including current employment status)Lehman Quality of Life Scale433212Nonelderly adults with severe mental illness
Paid employment statusMayo-Portland Adaptability Inventory—4433313Adults 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 scaleSchalock Quality of Life Questionnaire443415Adults with intellectual disabilities. This scale really assesses experience and satisfaction with current employment, not whether participants are working.

 

IV. Friendships

MeasureSourceEvidencePopulationsFeasibilityPrevalenceTotal ScoreNotes
Ability to see friends when client wantsParticipant Experience Survey, mental retardation/ developmental disabilities and acquired brain injury versions453517Similar item appears on both survey versions
People have friends and relationships (4 measures)National Core Indicators Consumer Survey443516Individuals with intellectual disabilities
Degree to which people express satisfaction with relationshipsCommission on Accreditation of Rehabilitation Facilities453517Tested with multiple disabilities populations
Experience with social relations (subjective and objective dimensions, including frequency of social contacts)Lehman Quality of Life Scale433212Nonelderly 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)433515Adult mental health consumers; similar item for youths and families.
Social contact with friends, work associates, and other nonfamilyMayo-Portland Adaptability Inventory—4433313Adults with acquired brain injuries. One known state using; may be others.
Satisfaction with close friendsQuality of Life Scale (modified by Burkhardt)453214Developed and tested with populations with chronic illness
People are supported to maintain relationships with family, friends, and coworkers.Massachusetts Department of Mental Retardation Quality Indicators343313Individuals with intellectual disabilities
General satisfaction with amount of contact with friendsMinnesota Aging and Adult Services Consumer Experience Survey353314Older 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 Survey343313Adults with developmental disabilities. Item includes family and friends.

 

V. Maintenance of Family Relationships

MeasureSourceEvidencePopulationsFeasibilityPrevalenceTotal ScoreNotes
Proportion of people able to see friends and family when they wantNational Core Indicators Consumer Survey443516Measure 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 crisisMental Health Statistics Improvement Program, additional items for Uniform Reporting Systems433515Adults, youth, and families of mental health consumers
Experience with family relations (subjective and objective dimensions, including frequency of family contact)Lehman Quality of Life Scale433212Nonelderly adults with severe mental illness
Satisfaction with relationships with parents, siblings, and other relativesQuality of Life Scale (Burkhardt version for chronic illness)453214Developed and tested with populations with chronic illness
General satisfaction with amount of contact with familyMinnesota Aging and Adult Services Consumer Experience Survey353314Older adults and adults with physical disabilities

 

VI. Community Inclusion

MeasureSourceEvidencePopulationsFeasibilityPrevalenceTotal ScoreNotes
Participants reporting unmet need for community involvementParticipant Experience Survey453517Item 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)453214Modified 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 communityMental Health Statistics Improvement Program; additional items for Uniform Reporting Systems (also National Outcome Measures).433515Adult mental health consumers
Proportion of people who participate in everyday integrated activities in their communities.National Core Indicators Consumer Survey443516Individuals with intellectual disabilities
Outcomes related to senior center use (includes dimensions of community involvement)Performance Outcome Measurement Project Senior Center Participant Survey343515Older 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 Questionnaire443415Individuals with intellectual disabilities
Community connections (multiple items)National Core Indicators Family Survey343515Adults with intellectual disabilities
Providers promote community inclusionEAZI Habilitation Survey343313Families with at least one child with an intellectual disability
Community integration and inclusionNebraska Family Experience Survey333312Families of children receiving HCBS

 

VII. School Attendance

MeasureSourceEvidencePopulationsFeasibilityPrevalenceTotal ScoreNotes
Proportion of children and adolescents for whom there is an increase in educational attainmentCommission on Accreditation of Rehabilitation Facilities453517Tested 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 Needs433212Children with special health care needs

 

VIII. Serious Reportable Events

MeasureSourceEvidencePopulationsFeasibilityPrevalenceTotal ScoreNotes
Medication errors in child residential programsCenter for Quality Assessment and Improvement in Mental Health/Child & Adolescent Residential Psychiatric Programs434213Residential care for children with psychiatric disorders
Patient injury during child/adolescent restraintCenter for Quality Assessment and Improvement in Mental Health/Child & Adolescent Residential Psychiatric Programs434213Residential 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 Variable344415Individuals 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 Variable344415Individuals with intellectual disabilities
Incidence of serious injuries resulting from substantiated incidents of abuse and neglectNational Core Indicators System Variable344415Individuals with intellectual disabilities
Incidence of serious injuries resulting from the use of restraints.National Core Indicators System Variable344415Individuals with intellectual disabilities
Rate of substantiated abuse/neglect investigations/1,000Massachusetts Department of Mental Retardation Quality Indicators343313Individuals 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 disabilitiesOregon Division of Seniors and People With Disabilities454316Data have been collected longitudinally for all three populations.

 

IX. Avoidable Hospitalizations

MeasureSourceEvidencePopulationsFeasibilityPrevalenceTotal ScoreNotes
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 diseaseAHRQ424515Not 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

MeasureSourceEvidencePopulationsFeasibilityPrevalenceTotal ScoreNotes
Percentage of enrollees age 18 years and over who had at least one preventive dental service during the look-back periodWisconsin Department of Health and Family Service, MEDDIC-MS SSI 2007 technical specifications. Medicaid encounter data-driven improvement core measure set for SSI-eligible populations.454316SSI population includes both older adults and people with disabilities.
Percentage of patients who received an influenza immunization during the one-year measurement periodPhysician Consortium for Performance Improvement™444214Adults age 50 and over
Receipt of needed health services (physical, OB-GYN women, dental)National Core Indicators Consumer Survey443516Adults with intellectual disabilities
Degree to which people with identified physical health problems obtain appropriate services and degree to which health status is maintained and improvedCommission on Accreditation of Rehabilitation Facilities453517Tested with multiple disabilities populations
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 Needs433212Children with special health care needs
Access to health and dental services (for children)National Core Indicators Family Survey343515Families with at least one child with an intellectual disability
Visit dentist annually for cleaning and checkupsNew Hampshire Development Services Adult Outcomes Survey343313Adults with developmental disabilities
Current as of June 2010
Internet Citation: Appendix V (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/hcbsapv1b.html