Developing Quality Measures for Home and Community Care

Background In 1988 HACC ministers agreed on the need for a strategy which would assure quality of care and consumer rights for consumers of HACC-funded services. A consultation process concerned with these issues commenced in 1989. Emerging from this were the Guidelines for the Home and Community Care Program National Service Standards, released by the relevant Commonwealth and State and Territory ministers in 1991. The National Service Standards were grouped around seven broad objectives: accessibility; information and consultation; efficiency and effectiveness; coordination, planning and reliable service delivery; privacy, confidentiality and access to personal information; complaints and disputes; and advocacy. A complete list of the 27 Service Standards is included later in the report (Box 3.1). The responsibility for implementing these standards lay with the States and Territories and continued to be an issue of concern. In 1994, the Report on the Home and Community Care Program presented to the House of Representatives Standing Committee on Community Affairs indicated that while some States had made considerable progress in training service providers on the standards, others were still working out their implementation strategy (HRSCCA 1994). Tasmania was the first State to introduce a monitoring program for the standards. The Tasmanian Government, working with the Australian Community Health Association, had, by 1994, piloted a program for monitoring quality of HACC services using a service review model based on those used by the Community Health Accreditation Standards Project (CHASP). Among the recommendations of the Efficiency and Effectiveness Review of the Home and Community Care Program (DHSH 1995) was the need to ensure the accountability of service providers with regard to the quality of the services they provide. A particular focus was on outcomes for clients. To this end, the Standards Working Group was set up by HACC officials with objectives which included: developing outcome measures for the National Service Standards; developing a consistent national method for obtaining outcome measures on the standards; and considering methods for obtaining consumer input in the assessment of quality in HACC services. From this group a subgroup was formed (the Outcomes Working Group) with the charter of further developing measurable outcomes. This group produced a draft Quality Measures Instrument for the measurement of quality outcomes in HACCfunded agencies. This Instrument was originally intended to be used by service providers for self-assessment. As it developed, however, it came to include consumer feedback (to be incorporated into assessment scores) and both quantitative and qualitative questions regarding service quality. As such, the Outcomes Working Group saw that it was necessary to involve a third party to score agencies against standards 2 according to the qualitative information and consumer input provided regarding the agency. This third party is referred to in this report as an assessor and may be a government project officer, a service provider from another agency, or an independent examiner with no previous involvement with HACC service providers in the region. To this point, the Quality Measures Instrument had not been trialled in agencies, and no method for either collecting the data required by the Instrument, or appraising the data, or scoring agencies against the standards had been developed.