Collaborative QI in community-based long term care

Background: In a statewide demonstration project funded by The Robert Wood Johnson Foundation, the state of Indiana, vendors, clients, and Indiana University researchers began working together in 1992 to use quality improvement (QI) techniques to improve the delivery of community-based long term care services. QI strategies: These collaborators, working with state Area Agencies on Aging (AAAs) case managers, are implementing two strategies-Normative Treatment Planning (NTP), which standardizes the clinical assessment of client needs and the prescription of services by case managers, and the Client Feedback System (CFS), a systematic method for obtaining feedback from long term care clients on the quality of in-home services. Current status: This community-based long term care project has been implemented in AAAs throughout the state of Indiana, in January 1995 the state's 16 AAAs were randomly assigned to four experimental or control groups to assess the project's effectiveness. In the interim, clients are surveyed by telephone every six months to evaluate their satisfaction with services and clinical needs. Lessons learned: The experience suggests several lessons: (1) build on existing and successful activities; (2) involve a wide range of participants, not just innovators; (3) obtain buy-in from trade and professional associations that represent program participants; (4) turn national attention given to the program into an asset; (5) conduct separate data collection to evaluate an intervention's success; (6) visit the field often; (7) pay as much attention to program implementation as to development; and (8) provide ongoing, informal educational opportunities for the field. Summary and conclusions: This project has resulted in significant movement toward a shared quality improvement vocabulary, information system, and a shared vision of high-quality home care.