October 27, 2004 Work Group Meeting Minutes
Cohen Center, Hallowell, Maine

Present:  Stirling Kendall (facilitator), Deb Parker Wolfenden, Linda Huff, John Baillargeon, Nat Hussey, Danny Westcott (Muskie), Chris Zukas Lessard, Chandra Murphy, Kathryn Kazenski, David Hutchins, Stephanie Crystal Wolfstone-Francis, Patt Williams 

The meeting began at 1:30 p.m. Deb Parker Wolfenden chaired the meeting.

1. Check-In and Roll Call
Deb invited participants to introduce themselves.

2. Mission Statement and Vision Statement
Deb read the Work Group’s revised vision statement: “All of us together, in community with equality in rights and dignity, in pursuit of happiness and fulfillment.”

3. Meeting Minutes
The Work Group approved the minutes of July 28, 2004 with a minor revision.

4.  Review of the Agenda
Deb reviewed the agenda, and then turned the meeting over to Danny to introduce Julie Fralich. Julie was invited to discuss her work funded through Maine’s 2001 Real Choice Systems Change grant on developing a common set of quality measures for Maine’s home and community-based services.

5.  Quality Indicators for Home and Community-Based Living
To open the discussion on quality assurance, Danny reviewed Julie’s April 28th presentation to the Work Group on performance measurement. At that meeting, Julie talked about the purpose of measuring performance, what and how to measure, and how often. Why measure? What gets measured tends to be improved. What should be measured? Topics for measurement include: areas of concern; areas that can be meaningfully influenced; and areas where data is reasonably available and reliable.

At this meeting Julie presented, for Work Group review and discussion, her draft final report of the grant-funded Quality Indicators project entitled, “Quality Choices for Maine, Quality Indicators for Home and Community-Based Services.” The goal of the project was to identify a set of core quality indicators that could be used to assess the performance of Maine’s Home and Community-Based Services system across programs serving elders and persons with physical disabilities, persons with physical disabilities who self-direct their services, and persons with MR/DD.

Julie reported that during the project period Quality TAG and staff inventoried quality measures from consumer surveys, provider surveys, and claims data and selected a core set that came to be known as “dashboard indicators”. These indicators address 7 areas of focus or domains of quality using CMS’s Quality Framework (e.g., participant access, person-centered service planning, safeguards, rights, and satisfaction; provider capacity; and system performance), and provide a quick way to see how well the home and community-based system is performing.

The Work Group asked Julie to explain why the Quality TAG and staff selected or omitted certain indicators and the purpose and/or meaning of others. For example, why was an indicator measuring the time people have to wait for needed services omitted, and for what purpose are you interested in knowing the proportion of people taking nine or more psychotropic medications?

The Work Group also offered some cautionary notes when interpreting findings, such as that found with lower than expected cervical cancer screenings for women with disabilities. Low numbers may result from non-accessible medical facilities and procedures rather than provider indifference. And finally, in addition to appropriate use of language, have as evidence of cultural competence, the knowledge of values and mores of certain groups (e.g., Indian tribes as matriarchal).

After addressing the questions raised by the Work Group, Julie thanked them for their comments and noted that she is keeping a “parking lot” for recommendations not otherwise addressed in existing instruments for the next group to consider.

6. Top Three Roadmap Recommendations
Following the July Work Group meeting, several members suggested that we use the October meeting to shorten the list of Roadmap recommendations under consideration for developing performance indicators. So, at this meeting we asked the Work Group to vote for its top three categories of Roadmap recommendations.

With Stirling facilitating, the Work Group first discussed the criteria it would use for making the selections. Two were identified: what I think is most important; and what I think is most doable. Work Group members then made their selections by placing colored dots next to the list of recommendation categories printed on flip chart paper and taped to the wall. Each person used red dots to vote for the three recommendations that they thought were the most important, and blue dots to vote for the three recommendations that they thought were most achievable. With the dots tallied, the three categories that garnered the most votes were Organized Consumer Advocacy, Funding and Planning, and Waiting Lists. The Work Group reviewed the recommendations under these categories and identified specific issues to resolve and recommendations to discuss at the January meeting.

7. Other Business
As time was running out, Danny gave brief updates and reports on items of interest including: the status of Quality Choices I projects (7 projects complete, 6 continuing for at most another year); the status of three 2004 Systems Change applications (Comprehensive Systems Reform and Affordable Housing not funded; MH Systems Transformation funded); notice of the November 1st Commissioners’ Meeting with Steering Committee members; and report of changes in leadership at the DD Council, BMS, and BEAS.  

8. Next Meeting
The next two Work Group meeting is scheduled for January 26, 2005 from 1:30 p.m. to 4:00 p.m. at the Cohen Center in Hallowell.