Using System Level Quality Measures to Improve Home and Community-based Services in Maine

The purpose of this project was to identify a set of quality measures that could be used to profile the performance of Maine’s home and community based care (HCBS) system. The long term care system in Maine has been significantly restructured in the last five years. Funding for home care services has more than doubled and now represents approximately 20% of Medicaid and State funding for LTC. This has led to increased interest in assuring the quality of services that are being provided and developing ways to improve the delivery of services and outcomes for consumers. Using assessment data from the Maine MECARE system, residential care facilities and nursing facilities, an initial set of potential indicators was examined. Key stakeholders identified priority areas for quality improvement. The Bureau of Elder and Adult Services identified, prevalence of falls, as the first area to initiate a quality improvement activity. The Bureau of Elder and Adult Services convened a multi-disciplinary group of professionals in Maine to learn more about existing fall evaluation and prevention programs. Using practice guidelines published in the Annals of Internal Medicine, the Bureau is currently examining a number of fall intervention and prevention strategies. This project represented a first step in using long term care assessment data to improve the quality of home and community based services in Maine. Recommendations for future work include: Continue to build support for quality measures through the involvement of key opinion leaders and stakeholder groups. Identify a short list of quality indicators that represent multiple dimensions of quality. Identify at least one chronic condition for a quality improvement activity. Develop, pilot and make available consumer friendly reports to the public on Maine’s home and community based care system Develop a plan to maintain a sustainable and qualified workforce of people who provide home and community based services