Integrating person-centered, outcome-driven long-term care planning and quality assurance: The PEONIES approach

Recent years have witnessed an expansion of Medicaid programs of community-based long-term supports and services for people with disabilities. There is general consensus that, compared to institutionally-based services, these programs are preferred by consumers and generally less costly. There is no consensus, however, on how to assess the outcomes of such programs. Various approaches have been used, many of which share a focus on specific aspects of quality of life (e.g., living situation, choice and control, community involvement, safety, health). These approaches to measurement, have faced some limitations. The PEONIES approach was developed to address three specific limitations of previous quality measurement approaches: (1) the lack of consumer voice in measurement; (2) the failure to integrate assessments of quality into care planning; and (3) the lack of transparency between external and internal quality assurance and quality improvement activities.

The PEONIES approach (Personal Experience Outcomes: iNtegrated Interview and Evaluation System) was developed for the Wisconsin Department of Health and Family Services. It uses semi-structured interviews to identify specific outcomes of importance to consumers; determine the current status of these outcomes; identify supports and services necessary to support achievement of the desired outcomes; and assess the adequacy and acceptability of the necessary supports/services to the consumer. This detailed, consumer-specific information is used to generate measures that can be aggregated and reported as quality indicators at the systems level.

We will describe the historical evolution that led to this approach, the development of the PEONIES approach, and the resultant process and tools.