Florida PACE Centers is an innovative program of personalized health and support services for seniors age 55 and older, many of whom are frail elderly, meet nursing home criteria and live at home. Based on a concept that was initially introduced 35 years ago, the name PACE stands for Program of All Inclusive Care for the Elderly. Thats exactly what the centers provide: independent living accommodations, along with an extensive range of preventive, primary, acute and long-term care services, transportation to medical appointments, activities and more. Florida PACE, an affiliate of the Miami Jewish Home and Hospital for the Aged (MJHHA), is the largest and most comprehensive not-for-profit, non-sectarian, geriatric healthcare system in the southeastern U.S.
About two years ago, Florida PACE engaged The Doug Williams Group to help design a quality improvement initiative for the PACE centers.
“The Doug Williams Group was chosen, in large part, because of its broad healthcare experience that included managed care programs,” says Dan Brady, Florida PACE executive director. This was important, he says, because PACE operates as a managed care model.
Initially, Brian Wilson, a consultant with The Doug Williams Group, began working closely with PACE to examine quality issues and lay the groundwork for the quality improvement effort. A great deal of research was undertaken to give the initiative a strong foundation.
“We started by performing a thorough assessment of all PACE services,” says Wilson. “This helped us determine the most important areas to probe for improvement, as well as those that were most quantifiable.” Brady says this helped PACE board members identify which areas to measure, and, ultimately, resulted in great success.
Brady next wanted to measure client satisfaction. He asked The Doug Williams Group to develop a way to measure satisfaction with the PACE program among both patients and primary caregivers. “We developed a telephone survey based on the areas we had identified during the quality improvement initiative,” says Wilson. It included questions related to transportation, activities, medical care, home care and overall care.”
Late last year, The Doug Williams Group began implementing the surveys on a quarterly basis. Unlike many surveys, this one uses a 100 percent sample, which means that each patient and participant gets a phone call every three months. In addition to including a number of opportunities for rating surveyed areas, the questionnaire allows for participant comments. It also asks if, a participant has indicated a bad experience, if that person would like to receive a call from a PACE representative. Brady says that, while client satisfaction was remarkably high, it became apparent that there were some areas in which improvement was needed. They included transportation, communication and dining.
Wilson notes that all surveys are anonymous, unless a surveyed client requests to be contacted in response to a concern or suggestion. He also cites a challenge in that theres really no national benchmark data against which they can compare survey results. This means that the PACE program benchmarks against themselves and uses trends in survey results to determine areas of excellence or areas of needed improvement.
Another key part of the initiative was the formation of quality improvement teams to address such areas as medical care and safety. “The teams are comprised of a cross-section of PACE employees and include physicians, nurses, CNAs and others,” says Wilson, who facilitated the teams first few meetings, until they were self-sufficient.
Since the initiative has been in place, PACEs satisfaction scores have been steadily increasing. In December 2005, Wilson says the overall score was 4.35 (out of five), a number that rose in March to 4.47, and most recently in June, to 4.55.
Brady says hes very satisfied with the expertise The Doug Williams Group has brought to Florida PACE. “Our experience has been extremely positive. Theyve very knowledgeable and know what theyre doing.”
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