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					PEONIES: Making self
determination and self
direction the root of quality
  Sara Karon, Ph.D.
  Director, the PEONIES Project
  Center for Health Systems Research and Analysis

  SDS Conference
  Milwaukee, WI
  October 13, 2009
Purpose of this session

   Explain the role of Personal Experience Outcomes in
    service planning, quality assurance and improvement,
    and especial in Self Determination and Self-Directed
    Services

   Introduce PEONIES, which is a system for using
    Personal Experience Outcomes to accomplish all of
    these things




SDS Conference
Milwaukee, WI October 13, 2009                             2
What are outcomes?

   In general, outcomes are the result of combining things
    (structure) and doing something with them (process)

   Example:
         Take flour, water, sugar, eggs (the things, or structure)
         Mix them and bake (the process)
         Result is a cake (the outcome)




SDS Conference
Milwaukee, WI October 13, 2009                                        3
People are not cakes!

   We can take the same things (personal care assistance,
    transportation, health care, our minds and bodies) and
    use them to achieve different things
         A job of your choosing
         Volunteer activities
         Hobbies
         Feeling strong




SDS Conference
Milwaukee, WI October 13, 2009                               4
What are Personal Experience Outcomes?

   Personal experience outcomes recognize that people
    are not cakes
   Personal experience outcomes are
            Goals,
            Dreams,
            Desires,
            Wishes,
      of what you want your life to be.




SDS Conference
Milwaukee, WI October 13, 2009                           5
Personal Experience Outcomes Areas

   CHOICE                                 PERSONAL EXPERIENCE
       I decide where and with whom
                                               I have relationships with family
        I live.
       I make decisions regarding my
                                                and friends I care about.
        supports and services.                 I work or do other activities
       I decide how I spend my day.            that are important to me.
                                               I am involved in my
   HEALTH AND SAFETY                           community.
       I have the best possible               My life is stable.
        health.
                                               I am respected and treated
       I feel safe.
       I am free from abuse and
                                                fairly.
        neglect.                               I have privacy.




SDS Conference
Milwaukee, WI October 13, 2009                                                 6
Personal Experience Outcome Areas are
NOT Personal Experience Outcomes
   Personal experience outcome areas
         Describe a general concept, but not what you want
         Do not change over time
         Can be used to organize information and measure quality


   Personal experience outcomes
         Describe what you want your life to be like
         Are different for each person
         Can (and should) change over time




SDS Conference
Milwaukee, WI October 13, 2009                                      7
Personal Experience Outcomes Provide Direction


   “If you don’t know where you’re going, you’ll end
    up someplace else”
            Yogi Berra




SDS Conference
Milwaukee, WI October 13, 2009                          8
What do you want your life to be?
      What is important to you?

      What do you want to do or to be?

      Where do you want to do it or be it?

      When do you want to do it or be it?

      How do you want to do it or be it?



SDS Conference
Milwaukee, WI October 13, 2009                9
What do you want now? In the future?

   Some things are good now, and you
    want them to continue

   Some things could be better now, and
    you want them to change now

   Some things are long-term goals,
    and you want to work toward them,
    sometime (now or later)


SDS Conference
Milwaukee, WI October 13, 2009             10
Whether you get support through
       Family Care,
       Family Care Partnership,
       IRIS,
       Any other program, or
       No program at all

thinking about Personal Experience
Outcome Areas Can Help Support Self
Determination

SDS Conference
Milwaukee, WI October 13, 2009        11
Using Personal Experience Outcomes to
Help Develop Support Plans

 What   will it take to achieve or
    maintain your goals?
        People
        Things
        Actions




SDS Conference
Milwaukee, WI October 13, 2009        12
Putting the pieces together

   What are the pieces needed to support your
    goal?
   Do you have these pieces already?
   Are the pieces working for you?
       Is there enough?
       Are they doing what you need?
       Are they working in a way that you
        like?


SDS Conference
Milwaukee, WI October 13, 2009                   13
Whether you help put the pieces together or
someone else does it all for you, this is a
part of self-determination.

You are the one who decides whether things
are working well for you.




SDS Conference
Milwaukee, WI October 13, 2009            14
What is PEONIES?

   Personal Experience Outcomes iNtegrated Interview and
    Evaluation System

   Developed by researchers at the UW-Madison, with
    input and support from stakeholders

   PEONIES uses Personal Experience Outcomes to help
    measure and assure quality of long-term care services



SDS Conference
Milwaukee, WI October 13, 2009                              15
PEONIES Provides Structure for Using
Personal Experience Outcomes

   A structured way to learn about:
       outcomes            that people want

       success          in achieving and maintaining outcomes

       the     supports needed to achieve or maintain outcomes

       how  well people are being supported in their
         outcomes

SDS Conference
Milwaukee, WI October 13, 2009                                   16
PEONIES and Care Management

   Care managers can use PEONIES to help
    learn
       What is important to you
       What you want to continue
       What you want to change
       How to support your goals
       Whether supports are working well for you



SDS Conference
Milwaukee, WI October 13, 2009                      17
PEONIES and Quality

   PEONIES Can Be Used to Learn About Quality
     Are people achieving the outcomes that are
      important to them?
     Are people receiving supports for achieving
      the outcomes that are important to them?




SDS Conference
Milwaukee, WI October 13, 2009                      18
Why Measure Quality?

   Understand each person’s situation



   Look at groups of people to help understand how well
    the system is working
         Are people who get supports from one organization doing better
          than those who get support from a different organization?
         Are certain types of people being more or less supported than
          others?
         Are the services people get being useful to them?


SDS Conference
Milwaukee, WI October 13, 2009                                         19
 I am involved in my community


What percentage of respondents
was able to identify an outcome?       What is the status of the
                                       outcome that was identified?
                                       61% achieved or in progress

    41%
                                100%                                           Was the outcome sufficiently
                                                              All Other
                                                               Status          supported?
                          59%

                                75%                            New            100
                                                             outcome
          Outcome Identified                                                              69
          None identified                                                      75

                                50%
                                                                               50
                                                               In Progress                          31
                                                                               25                             15          15
                                25%

                                                                                  0
                                                               Achieved




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 SDS Conference
 Milwaukee, WI October 13, 2009                                                                                            20
How can PEONIES measures be used?

   Care organizations – identify areas of weakness and
    make improvements
   Care organization – identify areas of strength and help
    others improve
   State – assure that organizations are doing what they
    need to do
   Public – learn how organizations are doing, so we can
    make better choices and can advocate for change




SDS Conference
Milwaukee, WI October 13, 2009                                21
Example of PEONIES measures

                                 Outcome      Outcome    Outcome
  Organization                   Identified   Achieved   Supported
  Organization A                   73%          57%        60%
  Organization B                   71%          55%        45%
  Organization C                   45%          36%        36%
  Organization D                   76%          58%        64%
  TOTAL                            66%          52%        52%




SDS Conference
Milwaukee, WI October 13, 2009                                   22
For More Information

   Contact us at any time with more feedback, comments,
    or questions:
         peonies@chsra.wisc.edu
         Sara Karon (sara@chsra.wisc.edu)
         Mary Schlaak (mary@chsra.wisc.edu)


   Visit our website:
         www.chsra.wisc.edu/peonies/peonies_index.html




SDS Conference
Milwaukee, WI October 13, 2009                             23

				
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