Continuous Quality Improvement

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                  Continuous Quality Improvement
 Who Is CQI?
   n the Philadelphia Department of Behavioral Health and Intellectual Disabilities Services
 I (DBHIDS), the Continuous Quality Improvement (CQI) Department functions as a coordinating
 unit to lead DBHIDS in improving systems quality and performance. In this role, CQI provides
 the linkages between data/analytic/research units within DBHIDS to address data and quality
 issues that are aligned with strategic objectives. CQI promotes the integration of planning, mea-
 surement, and coordination of performance improvement activities to improve quality of care. By
 providing measurement and analytical expertise, CQI promotes data-driven decision-making to
 improve systems of care for behavioral health.


 What Is Quality?

      �   Safe: avoiding injuries
      �   Effective: providing services based on scientific knowledge to all who could benefit
          and refraining from providing services to those not likely to benefit
      �   Consumer-centered: providing care that is respectful of and responsive to
          individual consumer preferences, needs, and values, and ensuring that consumer values
          guide all clinical decisions
      �   Timely: reducing wait times and sometimes harmful delays for both those who receive
          and those who give care
      �   Efficient: avoiding waste, including waste of equipment, supplies, ideas, and energy
      �   Equitable: providing care that does not vary in quality because of personal
          characteristics such as gender, ethnicity, geographic location, and socio-economic status

 THE ImPorTanCE of DaTa

 outcome measurement data are essential elements of sound decision support and quality
 management systems. Such data capture information about who receives what services and with
 what results, i.e., data that reflect service processes and outcomes.

 Every data point reflects an individual. As a collective, data allows us to measure changes at the
 aggregate level such as at the program, provider, agency or system level.

 In behavioral health, it is incumbent upon all of us to document and account for our efforts to
 meet consumer needs and expectations in both quantitative and qualitative ways. outcome mea-
 surements greatly advance such accountability. By becoming a data-informed system, we hold
 our providers and ourselves accountable for providing access to services, engaging clients with
 respect and encouragement to optimize services used, providing clinically effective services, and
 having outcomes that sustain recovery/resiliency in the community.

DBHIDS/CBH PROVIDER MANUAL REV.2011
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GuIDanCE for QualITy InITIaTIvES

Key to CQI guidance for quality initiatives is the concept of “continuous.” as the model indicates,
the improvement process is continuous, starting from plan formulation to action. Evaluation ad-
dresses questions regarding plan impact and where improvements can be made. using data from
monitoring and evaluation, improvements are made to the plan, leading to increased performance
and system quality.

Performance assessment should incorporate individual values and aspirations and encompass
clinical outcomes, clinical and support processes, recovery outcomes and customer satisfaction.
measurement of these components throughout the various levels of the behavioral health system
would provide a balanced, system-wide perspective on service utilization. The goal is to develop
and implement measures that are based on DBHIDS’s mission, vision, and strategic plan and to
support sound management.

In its coordinating role, CQI fosters the improvement process across the Department. CQI encour-
ages evaluations across the systems and where needed, provides analytical expertise in use of data
to improve performance.

CQI is responsible for the following data/analytic/research activity areas:


   �   Program Evaluation
   �   Service System Evaluation
   �   Data Infrastructure oversight
   �   State reporting
   �   Quality Improvement leadership
   �   Provider Performance Evaluation


ProGram EvaluaTIon

In this area, CQI is responsible for evaluation plan design, data collection and monitoring, and
analyses to evaluate program performance. Based on analyses results, CQI assesses program for
quality including effectiveness and where appropriate, develops recommendations for program
improvements. Through evaluation of DBHIDS’ initiatives, CQI activities in this area inform Qual-
ity Council discussions and the Department’s planning efforts. For system-wide issues, CQI con-
tributes policy briefs for DBHIDS’ discussions on policy and system changes.

SErvICE SySTEm EvaluaTIon

as part of ongoing service system evaluation, CQI had developed system metrics to monitor
service use on a monthly basis. These metrics allow CBH to monitor system use on a timely basis
with close to real time data.




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 In partnership with the City sister agencies and external research entities, CQI contributes to cross-
 system analyses and longitudinal studies. Incorporating other service information allows these
 analyses and studies to examine behavioral health service population from within a larger frame-
 work.

 DaTa InfraSTruCTurE ovErSIGHT

 as a dominant/heavy and intense user of the DBHIDS data systems, CQI provides leadership in
 data governance for DBHIDS. In this area, CQI contributes to standard clinical definitions, adhoc
 reporting, management of data requests, and recommendations for system enhancement.

 STaTE rEPorTInG

 as part of HealthChoices contract requirement, CQI develops and provides Community Behav-
 ioral Health’s annual CQI plan to Pennsylvania Department of Public Welfare. CQI is responsible
 for the annual and quarterly Program Evaluation Performance Summary (PEPS) reports as well as
 any Performance Improvement Plans (PIPs).

 QualITy ImProvEmEnT lEaDErSHIP

 In compliance with the Health Choices Contract, CBH holds regular Quality Council meetings. In
 its quality leadership capacity, CQI convenes and facilitates Quality Council on a monthly ba-
 sis. Discussions at Quality Council vary and may include any of the following: Provider Profile
 measurements and report development, Pay-for-Performance, Preferred Provider Development,
 Program Evaluation results (outcomes) and Studies; System metrics Development; Quality Im-
 provement Plans; Complaints and Grievance Trending; under or over utilization/Penetration
 Trends; State/Contract Compliance, reporting & DBH outstanding Corrective action Plans; Status
 & findings from review of outcomes & Indicators; Policies & Procedures for Quality oversight;
 Recommendations from Clinical Review Committee re Quality Improvement Changes.

 ProvIDEr PErformanCE EvaluaTIon

 Beginning in 2007, CQI initiated meetings with providers to start the development of provider
 profiles that includes performance measures, baseline thresholds and performance goals. The first
 provider profile reports were issued in 2009. The baseline series reported on 2007 Inpatient Psychi-
 atric Services and 2008 Children’s Residential Treatment. In 2010, CQI issued 2009 series for these
 two levels of care as well as a new series on Drug & alcohol residential rehabilitation Services. In
 addition to continuing with the current levels of care that CBH has issued reports on, CQI plans to
 develop provider profile series for the other remaining levels of care.

 Provider profiles are:
     �    Data-oriented report series to measure change at the System and the Provider level
     �    Intended to profile a Provider in CBH network on their performance on key quality
          measures
     �    Include contextual data on who (e.g. demographic information) and how (e.g. length
          of stay) were served by said Provider


DBHIDS/CBH PROVIDER MANUAL REV.2011
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                                     Using results from Provider Profiles,
                                         CQI led the development of
                                         Pay-for-Performance (P4P)


P4P is used for the following:
   �   as a payment model rewards providers for meeting certain performance measures for
       quality and efficiency
   �   Providers under this arrangement are usually rewarded for meeting pre-established
       targets for delivery of healthcare services
   �   Qualifications for P4P will be used to inform the Preferred Provider process


Throughout the development process, CQI consistently asked for provider input, posting dis-
cussions, meeting summaries, presentations & baseline results on our website. Providers’ input
included:


    Suggested measures
    Participation in focus groups
    Review & vetting of operational definitions
    Recommended differential weighting for P4P
    Initiating quality improvement plan(s) in response to performance results in provider
       profiles


Based on input from the various stakeholders, a P4P matrix was finalized for 2010, which led to
the first instance of performance pay for CBH’s providers in 2010. CQI anticipates continuing to
develop and issue new series of provider profiles for additional levels of care, revising and issuing
current series for Inpatient Psychiatric, Children’s residential, D & a residential rehabilitation,
and expanding pay for performance to all levels of care.


CQI welcomes input to any of our data/analytic/research activity areas. Provider inputs are espe-
cially welcome for the provider performance process and CQI will continue to encourage ideas
and discussions to improve the process and vet the resultant profile reports.




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