National Core Indicators™ Using data to examine systems-level cultural competence 1
AGENDA 01 01 03 03 What can the data tell us? ➢ Examples es of ho how NC NCI can n be be us used ed to ex explor ore e que questions s cul cultural competency y in n supp upport rt sys systems The Bas asics 02 02 04 04 ➢ Qua Quality measurement Looking ahe Loo ahead in n NC NCI ➢ Wha What is NC NCI ➢ Curr urrent limitations ➢ How ow do does es it work rk? ➢ Fut uture e oppor pportunities es ➢ Wha What que questions s can n NC NCI answ nswer er? 2
THE HE BASICS 3
DD Blueprint: Quality Framework Culture of Best Level 3 – Drivers of Quality Views Quality Level 2 – Outcome Measures Opportunity Opportunity to improve to improve Ceiling Level 1 – Performance Measures Basic QI and Floor CAPS Sub Floor Foundation/ Sub Level: Compliance Program Audits; Formal Licensing Reviews; measures Waiver Assurance Measures; Incident Reporting
• Compliance with minimum standards gets your blueprints approved, but does not make the house a home • Meeting these standards is the floor , not the ceiling • Go beyond for systemic improvement 5
From the base to the top- all measures matter Customer satisfaction, personal experience, outcomes Internal process improvement (Timeliness, accuracy and cost) Med reports; Annual physical health exams; Incident Mgmt; Mortality Reporting Medicaid Waiver Assurances/PM’s
Key Components of All Quality Systems: ➢ Quality by Perception ➢ Quality by Fact
Quality by Fact / Quality by Perception Quality by Fact- Quality by Perception- • evidentiary, indisputable, tend • opinion, impression, influenced to be binary, can be “proven” by values, senses, emotions, but nonetheless present Quality Management Systems take a both/and approach, rather than either/or approach to these measure types
National Core Indicators™ • Provides both perception (peoples expectations and insight ) and fact (actual services, dx, dates, etc.) • Provides all three Voices: • Customer • Workforce • Process or operations
What is National Core Indicators™? • 1997: NASDDDS, HSRI and State DD Agencies came together with a common goal • Look at system performance related to outcomes • Besides looking at numbers such as people served, and types of services being received, they wanted to see how services affected people’s lives and quality of life → customer satisfaction & outcomes • NCI looks at performance in several areas, including: employment, community inclusion, choice, rights, satisfaction and health and safety 10
11 In-Person Survey • Background Information Section • Data collected from existing systems data. • Age, gender, has a job, preventive care, etc. • Section I: Subjective, opinion-based questions only answered by person receiving services in face-to- face conversation • Section II: Fact- based questions. How many times…? How Does NCI Proxy can participate. Adult Family, Child Family, and Family/Guardian Collect Data? Surveys >> mail surveys – separate sample In Person Survey Staff Stability Survey >> sent directly to providers – gaining information about turnover rates, wages, benefits.
National Core Indicators offers a unique view • Individual characteristics of people receiving services • Outcomes sorted by where people live (residence type) • Activities people engage in during the day including work outcomes • The nature of their experiences with the supports that they receive (e.g., with case managers, ability to make choices, self-direction) • The context of their lives – friends, community involvement, safety • Health and well-being, access to healthcare
NCI surveys provide valuable information from people who are receiving supports and their families and is well Photo credit: situated to examine the https://www.thinkculturalhealth.hhs.gov/clas cultural and linguistic competence of systems. 13
2017-18 NCI In-Person Survey AZ 493 CA 8280 CO 405 Examining NCI DC 416 IN 739 data in the 10 MI 650 NCCC states NY 515 UT 401 VT 331 WI 987 Total 13217 14
What is this person’s race and ethnicity? (reported from existing records) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% AZ CA CO DC IN MI NY UT VT WI NCI Average* American Indian or Alaska Native Asian Black or African American Pacific Islander White Hispanic/Latino Other race not listed Two or more races * Average of state averages 15
Race/ethnicity vary significantly by state 100% • For this presentation, using three 90% race/ethnicities to demonstrate capacity of 80% NCI data to look at racial/ethnic differences 70% • Racial/ethnic composition of 60% states vary significantly 50% • Differences in outcomes 40% by race/ethnicity could be 30% based on state 20% differences, rather than actual race/ethnic 10% disparity. 0% • Further, deeper analysis is AZ CA CO DC IN MI NY UT VT WI NCI needed understand those Avg. differences White Black/African American Hispanic
What is this person’s primary language? (Reported from existing records) CA additional English Other response options: AZ 92.9% 7.1% CA 81.7% • Spanish CO 98.0% 2.0% • Mandarin DC 99.0% 1.0% • Tagalog IN 99.7% 0.3% • Vietnamese MI 97.4% 2.6% NY 94.1% 5.9% • Korean UT 97.2% 2.8% • Arabic VT 94.9% 5.1% • Armenian WI 96.8% 3.2% • Farsi NCI 95.2% 3.3% Average* * Average of state averages 17
100% 90% • People of different 80% race/ethnicities live in 70% different residence types 60% • Differences in outcomes 50% by race/ethnicity could be 40% based on state 30% differences, rather than 20% actual race/ethnic 10% disparity. • Further, deeper analysis is 0% White Black/African Hispanic NCI Average needed to understand American Foster care or host home those differences Parents/relative's home Own home or apartment Group residential setting (e.g., group home) ICF/IID, nursing facility or other institutional setting
Other demographic/personal characteristics Is this person a parent? Guardianship 100% Hispanic 90% 7% 80% 70% 60% 50% 40% Black/African American 9% 36% 40% 30% 23% 20% 10% 0% White 4% White Black/African Hispanic American 0% 2% 4% 6% 8% 10% Yes, in guardianship relationship. Full, limited, or level can't be distinguished. Yes, is a parent to at least one child/adult child Hispanic respondents significantly less likely Black/African American respondents significantly to be in guardianship relationship more likely to be a parent 19
Examples of differences by race/ethnicity that NCI can show White respondents significantly more likely to be reported to have a diagnosis of mood, anxiety, psychotic and/or other mental illness. NCI allows one to look at differences by White: 48.7% Black/AA 40.5% Hispanic: 38.5% race/ethnicity in the following: • Diagnosis (for example, ASD, CP, Down, Hispanic respondents significantly less likely to take at least one medication to treat mood, FSD, etc.) anxiety, psychotic disorders • Health conditions (for example: White: 49.8% Black/AA 42.7% Hispanic: 29.3% Cardiovascular disease, diabetes, high blood pressure, Alzheimer or other dementia, etc.) Hispanic respondents significantly less likely to speak as their preferred means of communication White: 77.6% Black/AA 78.5% Hispanic: 69.5% 20
Relationships 1 2 3 4 Do you have friends Can you see your Do you ever feel Can you go on a date that you like to talk friends when you lonely? if you want to? to or do things with? want to? No, not often : Yes, can date or is No, does not have Yes: living with partner: White : 53.7% friends: White : 80.1% White : 77.6% Black/AA : 56.7% White : 11.2% Black/AA : 83.5% Black/AA : 73.2% Hispanic : 59.9% Black/AA : 11.5% Hispanic : 76.9% Hispanic : 71.8% Hispanic : 18.1% 21
Rel eligious/spiritual pr practi actice in n the the pas past mo month 100% 90% 80% Who did you usually go with? 70% Hispanic 60% 46% 50% 44% Black/AA 40% 33% 30% White 20% 10% 0% 20% 40% 60% 80% 100% 0% White Black/AA Hispanic Alone Friends Family Housemates or co-workers Staff 22
Guardianship Of those with guardianship, Hispanic Has guardianship — limited, full, or unknown respondents are significantly more level likely to have a guardian that is a 100% family member, and significantly less 90% 80% likely to have a public guardian or 70% public administrator. 60% 50% 40% 36% 40% Hispanic 30% 23% Black/AA 20% 10% White 0% White Black/AA Hispanic 0% 20% 40% 60% 80% 100% Family Friend Public guardian or administrator Other 23
Benchmarking with the Life decisions scale Includes choice of: residence, roommates, work, day activity, and staff 90% 84% 80% Average 64% 70% 60% 50% 47% 40% 30% 20% 10% 0% Results of this scale are risk adjusted. Variables used as risk adjusters are: level of mobility, support needed for behavior, level of ID, and age.
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