Report

This is the second of three papers synthesizing the ideas and practices of states as they seek to improve the quality of home and community based services (HCBS) and supports for older persons and persons with disabilities.
In 2003, the Centers for Medicare & Medicaid Services (CMS) awarded grants to 19 states to enhance their quality management (QM) programs for HCBS programs. CMS contracted with the Community Living Exchange Collaborative to assist states in their grant activities by promoting information exchange and facilitating discussions on topics of common interest. As part of its work with the Community Living Exchange Collaborative, the Muskie School of Public Service, together with grantee states, identified three priority topics for working papers:
1. Quality Management (QM) Roles and Responsibilities
2. Discovery Methods for Remediation and Quality Improvement
3. Data Analysis and Use of Performance Measures

This paper will specifically address the following questions:

This paper describes the EMS-related projects that the 45 states receiving funding from the Medicare Rural Hospital Flexibility (Flex) Program proposed to conduct in fiscal year 2004-2005. Since the first full year of funding, the number and range of EMS improvement activities proposed has increased substantially. Because of the variability across states in the specifics of EMS activities proposed in grant applications, a method was sought that would create a logical framework for classifying activities, in order to better understand the types of EMS challenges that states are trying to address with Flex funding. The project team identified the Rural and Frontier EMS Agenda for the Future (R/F Agenda) as an appropriate guide document for cataloging and describing state proposed activities. The EMS activities were assigned to one or more of fourteen EMS attributes from the R/F Agenda. State Flex grant funds are not sufficient to ameliorate all rural EMS problems. Use of the R/F Agenda for classifying state Flex activities not only allows for identification of EMS problem areas that are most frequently being addressed with the use of Flex grant funds, but also identifies those challenges that likely need to be addressed through other mechanisms. This report will provide the EMS, rural health, and federal policy constituencies with an overview of the extent to which nationally recognized rural EMS challenges are being addressed with Flex program funding.

The authors studied the early impact of Part D on older or disabled Medicaid beneficiaries who had prescription drug coverage prior to Part D through MaineCare ("dual eligibles") or the DEL benefit; local and statewide organizations that work with and advocate for Medicare beneficiaries, which often stepped forward to help make Part D work for the beneficiaries; and Medicare beneficiaries who were not duals or DEL enrollees.

Presenting numbers and patterns is a critical component of data analysis. Once analyses have been completed, the next step involves sharing key findings with staff and stakeholders and using findings as a basis for decision-making. There are a number of ways to present data and the challenge is in constructing an effective visual. This paper provides an overview of the most frequently used formats and includes tips on how to select among the different types.