Karon Sarita L, Tennety Niveda, Schram Bridgette M, Lutzky Steven, Heinemann Allen, Deutsch Anne
RTI International, 3040 East Cornwallis Rd, Research Triangle Park, NC, 27709, USA.
Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA.
Disabil Health J. 2025 Jul;18(3S):101847. doi: 10.1016/j.dhjo.2025.101847. Epub 2025 May 2.
Quality measures can monitor whether home- and community-based services (HCBS) are delivered effectively and support the outcomes desired by persons served. Nonmedical, person-centered quality measures complement Medicaid's HCBS Quality Measure Set.
(1) Determine the aspects of quality most important to HCBS recipients, (2) identify aspects of quality not included in quality outcome instruments, and (3) select and define aspects for new quality outcome measures.
A Participant Council representing HCBS recipients identified aspects of quality important to them. We reviewed person-centered instruments to identify gaps in coverage of concepts related to the National Quality Forum's HCBS quality domains of choice and control, community inclusion, and holistic health and function. Focusing on concepts prioritized by the Participant Council, we identified gaps in current instruments defined as: (1) no instrument addresses the concept; (2) measures not person-centered; (3) measures not outcome-focused; or (4) measures lack evidence of adequate reliability and validity across HCBS populations.
We defined 18 concepts for which adequate measures are lacking and selected nine for further development, including choice and control over (1) living arrangement, (2) how time is spent, (3) money, (4) important relationships, (5) personal expression (6) food and nutrition, and (7) healthcare and health; as well as (8) dignity of risk; and (9) community engagement.
Despite the existence of many HCBS instruments, there remains a need for nonmedical, person-centered concepts to complement Medicaid's HCBS Quality Measure Set. Next steps are to develop and test items that measure these nine concepts.
质量衡量标准可监测基于家庭和社区的服务（HCBS）是否有效提供，并支持服务对象期望的结果。非医疗、以人为本的质量衡量标准是对医疗补助计划的HCBS质量衡量标准集的补充。
（1）确定对HCBS接受者最重要的质量方面；（2）识别质量结果工具中未包含的质量方面；（3）选择并定义新的质量结果衡量标准的方面。
一个代表HCBS接受者的参与委员会确定了对他们来说重要的质量方面。我们审查了以人为本的工具，以确定在与国家质量论坛的HCBS质量领域（选择与控制、社区融入以及整体健康与功能）相关的概念覆盖范围方面的差距。围绕参与委员会确定优先顺序的概念，我们确定了当前工具中的差距，这些差距被定义为：（1）没有工具涉及该概念；（2）衡量标准不是以人为本；（3）衡量标准不是以结果为导向；或（4）衡量标准缺乏在HCBS人群中具有足够可靠性和有效性的证据。
我们定义了18个缺乏适当衡量标准的概念，并选择了9个进行进一步开发，包括对以下方面的选择与控制：（1）生活安排；（2）时间利用方式；（3）金钱；（4）重要关系；（5）个人表达；（6）食物与营养；（7）医疗保健与健康；以及（8）风险尊严；和（9）社区参与。
尽管存在许多HCBS工具，但仍需要非医疗、以人为本的概念来补充医疗补助计划的HCBS质量衡量标准集。下一步是开发并测试衡量这九个概念的项目。
