Phase 1: Identifying Critical Domains and Subdomains of HCBS Outcomes

In June of 2016, the National Quality Forum (NQF) released its framework for Home and Community-Based Services (HCBS) quality measurement.  The framework, developed by several panels of experts is designed to drive the development of outcome measures in the HCBS area.

The purpose of Phase 1 of the RTC/OM measure development process is to obtain input from a diverse set of disability stakeholder groups at a national level with respect to what they believe are the most important personal outcomes and indicators of quality assurance to measures associated with Home and Community Based Services and to incorporate this input into the National Quality Forum’s framework for HCBS outcome measurement.                                                

There are a number of groups that directly or indirectly experience the impact of HCBS services or are involved in their provision. In order to ensure that stakeholder input into the NQF framework was comprehensive and reflected the views of many different stakeholders, the RTC/OM has carried out more than 50 discussion groups across the country that included:

  • People with disabilities who receive HCBS services including individuals with physical disabilities (PD), intellectual and developmental disabilities (IDD), traumatic brain injury (TBI), mental health conditions (MH), and a variety of disabilities associated with the aging process (ARD);
  • Family members of persons receiving home and community-based services including both family members who are involved in providing such supports and those who are not;
  • Representatives from a wide variety of organizations who provide HCBS to persons with disabilities; and
  • HCBS program administrators and policy-makers at both state and national levels.

In order to facilitate discussion about all areas of the National Quality Forum’s HCBS outcome measurement framework, RTC/OM staff employed a specific method for facilitating group process, known as Participatory Planning and Decision Making or PPDM. PPDM is a process used to bring together like-groups of stakeholders that allows participants to contribute ideas and provide importance weightings with respect to any number of the critical issues.  Using this approach, information was gathered as to:

  • Those areas of the NQF’s HCBS measurement framework stakeholders  believed were most important to measure
  • Areas and outcomes that were viewed as critical to measure that were not included in the framework, and
  • The importance of each of these areas.

After completing data collection efforts in the Spring 2017, RTC/OM staff are currently using both quantitative and qualitative analysis methods to: ascertain those personal outcomes and areas of quality assurance stakeholders’ view as most important to measure, socially validate the NQF framework, and drive the development and refinement of measures in this area.


Watch the Phase 1 results webinar

The PPDM importance weighting of NQF domains

Domain# ItemsImpt. Wt.Std. Error
Choice and Control62195.620.53
Person-Centered Planning and Coordination43695.530.57
Service Delivery and Effectiveness54095.370.55
Human and Legal Rights37795.270.54
Community Inclusion97292.470.61
Consumer Leadership in System Development1090.710.77
System Performance and Accountability590.711.01
Holistic Health and Functioning60690.291.03
Caregiver Support22988.931.11

The State of Residence of PPDM Group Stakeholders

StateStakeholder Groups
AlabamaAging Related Disabilities, Cross-Disability
ArizonaTraumatic Brain Injury
CaliforniaIntellectual and Developmental Disabilities, Mental Health Needs
ColoradoCross-Disability, Physical Disabilities, Traumatic Brain Injury
District Of ColumbiaCross-Disability, Intellectual and Developmental Disabilities, Physical Disabilities
FloridaAging Related Disabilities
GeorgiaCross-Disability, Intellectual and Developmental Disabilities
IowaTraumatic Brain Injury
IllinoisCross-Disability, Intellectual and Developmental Disabilities
KansasPhysical Disabilities
MassachusettsIntellectual and Developmental Disabilities, Physical Disabilities
MarylandCross-Disability, Intellectual and Developmental Disabilities
MaineIntellectual and Developmental Disabilities
MinnesotaAging Related Disabilities, Cross-Disability, Intellectual and Developmental Disabilities, Mental Health Needs, Physical Disabilities, Traumatic Brain Injury
MissouriIntellectual and Developmental Disabilities
North CarolinaIntellectual and Developmental Disabilities
New JerseyCross-Disability, Intellectual and Developmental Disabilities
New MexicoPhysical Disabilities, Traumatic Brain Injury
NevadaCross-Disability, Traumatic Brain Injury
New YorkIntellectual and Developmental Disabilities, Mental Health Needs, Physical Disabilities
OhioCross-Disability, Intellectual and Developmental Disabilities, Traumatic Brain Injury
PennsylvaniaCross-Disability, Intellectual and Developmental Disabilities, Mental Health Needs, Physical Disabilities
TennesseeAging Related Disabilities, Intellectual and Developmental Disabilities
TexasPhysical Disabilities
VirginiaCross-Disability, Intellectual and Developmental Disabilities
WisconsinIntellectual and Developmental Disabilities, Traumatic Brain Injury