Personal Experience Survey (PES) Michigan Model

Measuring the Quality of Services in the MIChoice Waiver Program

PES not PEZ

What is the PES?

• Created under a CMS contract by MetStat

• Defines “Quality” as services and supports delivered as written in the participant’s care plan.

• Does not define “Quality” from participant’s wants and desires.

PES Components

• 4 Domains– Access to Care– Choice and Control– Respect and Dignity– Community Integration

• 66 Standard Questions

• Additional six Michigan questions

Michigan Model

• Consumers hired to collect data

• First round collections at 5 sites

• Second round collection at 3 of 5 sites

• Telephone interview follow-up

Interviewer Training & Support

• Consumers identified by host site

• MDRC provided one day on site training

• PES User Guide assists in training

• Support provided by MDRC & local site

• MDRC managed reimbursement

• Interviewers as contract employees

Interviewer demographics

• 3-6 consumers hired at each site

• Seniors and People with Disabilities

• Collectively targeted 40 interviews per site (199 interviews in aggregate)

• Paid $20/hr. plus travel expense

• At two sites consumers did data input

• 3 sites MDRC did data input

Quality Indicators: Selected DataFirst Round Interviews

• Access to Care– Bathing– Toileting– Groceries

• Respect and Dignity– Staff Listening

• Choice and Control– Choice of Staff

• Community Involvement– Community integration

Bathing Questions

1. Is there any special help that you need to take a bath or shower?

• Needs Help from Another person• Does not need help from another person• Unclear response• No response

2. Do you ever go without a bath or shower when you need one?

3. Is this because there is no one there to help you?

Bathing

12182%

Adverse27

18%Positive

148 respondents

Toileting Questions

1. Is there any special help that you need to get to or use the bathroom?

2. Are you ever unable to get to or use the bathroom when you need to?

• Yes• No• Unsure• Unclear• No response

3. Is this because there is no one there to help you?

Adverse17

30%

Positive40

70%

57 Respondents

Toileting

Grocery Questions

1. Is there any special help that you need to get groceries?

2. Are you sometimes unable to get groceries when you need them?

3. Is this because there is no one there to help you?• yes• No• Unsure• Unclear• No Response

Groceries

Positive13976%

Adverse45

24%

184 Respondents

Questions: Respect of Staff

• Do the people paid to help you treat you respectfully in your home?– Yes– No– Sometimes– Unsure– Unclear Response– No Response– No staff in home

Respect of Staff

Adverse8

4%

Positive19096%

198 respondents

Question, Choice of Staff

• Do you help pick the people who are paid to help you?– Yes– No– Unsure– Unclear Response– No Response– No personal care staff

Choice of Staff

Adverse55

44%

Positive71

56%

126 respondents

Community Integration/Inclusion

• Is there anything you want to do outside your home that you don’t do now?– Yes– No– Unsure– Unclear Response– No Response

• What would you like to do? What do you need to make this happen?

Community Involvement

Positive11759%

Adverse82

41%

199 respondents

Compare Sites: Community Involvement

199 respondents

57.50%

33.33%

52.50%

29.27% 33.33%

42.50%

66.67%

47.50%

70.73% 66.67%

A B C D E

Adverse Positive

Out of Home Activities

• Church• Volunteer• Cultural Activities• Get Outside• Shopping• Senior Center• Exercise• Library• Fishing

• Visit Friends & Family• Garden• Visit the sick• SportsMake Happen• Accessibility• Transportation• Companionship• Money

Employment Questions

(If respondent is under 65 ask question)

• Are you working right now?(Yes, No, Unsure, Unclear Response, No Response)

• What kind of work do you do?

• Did you help pick the job you have now?

• Do you like your job?

• Do you want to work?

Demand for Employment

47 respondents

Adverse16

34%

Positive31

66%

Comparison of Indicators

201 respondents

0

50

100

150

200

250

Groceries Toileting Choice Staff Respect HomeStaff

Comm.Intergration

Employment

Adverse Positive

Second Round

• Collected 6 to 12 months after first round collection

• Will be completed at the end of March.

Recommendations - Data Use

• Individual sites Review data with Care Managers and with Provider Agencies

• Work in partnership for improvement• Agree upon 2-3 Indicators to improve • Discuss in Quality Collaborative

improvement methods for identified indicators

• Create impact plan• Share learning with collaborative

Managing Data

• Limited to measuring quality of services from consumer point of view

• Good design of questions – Simple language, Simple questions

• No ability to adjust the language• Easy to manage the data input• Difficult to uniquely manipulate the data• Can add questions but not put them into

the data base.

Costs – First Round

• 199 interviews (aggregate)

• Average $78/interview– Hourly: $14,078.49– Mileage: $1,711.60– Accommodation: $397.61– Data input: $ 750.00

• Other costs: training, internal supervision of interviewers, data input.

Consumer Interviewer Site Costs

$0.00

$500.00

$1,000.00

$1,500.00

$2,000.00

$2,500.00

$3,000.00

$3,500.00

$4,000.00

$4,500.00

DAAA TCOA UPCAP/M UPCAP/H WMAAA

total hourly mileage data input accomodation

Quality of Interviewers

• Telephone Survey of 12% of people who had been interviewed twice

• Results:– 100% felt respected and fully open to

consumer interviewers– Only 1 of 27 indicated a preference for a

waiver agency employee – 3 of 27 people would not participate again

Cost Recommendations

Keep total costs to average $30/interview

• $25 per interview

• Continue to pay travel expense

• Pay $10/hr for data entry, or data entry in organization.

• Build competent cadre of interviewers at local site (over time less supervision needs)

Quality Recommendations

• Use PES in local quality plans• Use consumer interviewers• Sites nurture cadre of seasoned

interviewers• Statewide training program (at MDRC or

elsewhere)• Maintain third party data collection• Sites integrate quality improvement

system for interviewers

For more information contact:

David Youngs

DYNS Services, Inc.

517-927-7255

303-200-8392 (fax)

941-744-5732

www.dynsinc.com

This initiative was funded by a CMS grant to the Michigan Department of Community Health, and implemented by Michigan Disability Rights Coalition (MDRC).

Carolyn Lejuste

MDRC

517-333-2477 ext. 21

517-333-2677 (fax)

clejuste@gmail.com