If you are a regular reader of my Quality Matters columns, you have heard me discuss the DCH Health Measures and the DD Proxy Measures before. We have a Performance Improvement Project in place, shooting for 100% completion of the measures. And it's not just busywork. I'm going to tell you how we are using this information, and why it matters. But first, let me summarize what they are. In short:
- Health measures
- Are required for all consumers, all ages, all disability types, within the MH/DD network (not substance abuse providers)
- Capture information about a collection of high-prevalence and/or high-risk conditions for our consumers.
- Some are more specific to DD - like does the person need food modification or tube feeding - and some broader. But all apply to all consumers.
- Proxy measures
- Are required for all consumers with a developmental disability.
- Data-wise, this means that Yes is selected under Developmental Disability in the Demographics section in CHIP.
- Describe a range of supports and needs the person has or requires.
Both types of measure are in CHIP documents, called respectively, "Health and Other Conditions" and "DD Proxy Measures." For case managers, these documents are useful tools to help focus on areas of need. Many of the items provide a clear path to service planning. For example, if you check the item saying a consumer has high blood pressure that is not well controlled, you have a ready-made health goal. Or, if a consumer has asthma, a monitoring goal would be appropriate. Same for diabetes; you get the idea. Remember, nationwide, GHS consumers die around 25 years earlier than the general population, related mostly to phyiscal health issues (read the report at: http://www.nasmhpd.org/docs/publications/MDCdocs/Mortality%20and%20Morbidity%20Final%20Report%208.18.08.pdf).
Health and proxy measures are required annually by the Michigan Department of Community Health and by Genesee Health System. The best time to do them is at intake and as you complete the Annual Review. They can then be included in your assessment of current status, and the information will be useful in service planning.
In QM, we are starting to use these measures to find at-risk consumers. For example, we might find a certain combination of health measures that is associated with higher rates of medical hospitalization. Then, we could give case managers a heads-up and help prevent problems for at-risk consumers. Or, noting a DD consumer whose proxy measures identified a large number of psychotropic medications, we might suggest adding or increasing psychological services to help with behavior management. Or, perhaps the measures show a consumer requires a modified diet and has had a lot of respiratory infections - there may be a problem with aspiration, and we can help to focus services to identify what to change.
These are just a couple of examples, but we are always looking at the data and thinking about what our consumers need. Beyond fancy statistics and reports, though, these measures can help you to consider your consumers' needs and resources. They are worth your attention.
We are interested in your experience, too. What scores or patterns on the measures do you see that identify consumers with special needs or high risk? Please share your expertise! Email your thoughts to me at jnigrine@GenHS.org or send me a CHIP message. Thanks!
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