CARF moving to scorable standards for accreditation next year
CARF moving to scorable standards for accreditation next year
Scoring system to be refined during 1998 surveys
With its 1998 standards manual, CARF...the Rehabilitation Accreditation Commission in Tucson, AZ, will move toward scorable standards and, eventually, a national benchmarking system that will rate rehabilitation providers’ conformance with CARF standards. Called the Standards Conformance Rating System (SCoRSsm), the new system uses a four-point scale to rate how well providers meet each individual standard. Here is the scale: 0 = nonconformance; 1 = minimal conformance with substantial room for improvement; 2 = acceptable level of performance; and 3 = excellent practice.
"Rather than the current system in which providers either conform or don’t conform, this new system allows us to expand the description of the degree of conformance to the standards," says Deborah Wilkerson, MA, director of research and quality improvement. The 1998 standards will be published in January and go into effect July 1. The new system won’t change the character of the standards, nor will it change the cost or the length of the survey, she says. "The difference is that now we assess you yes’ or no.’ With the new system, we will assess on the zero-to-three scale."
All providers who go through the accreditation process under the 1998 standards manual will be rated using SCoRSsm on each of the standards, but the information will not be used in making the accreditation decision. Rather, CARF staff will analyze the data collected, determine whether or how the SCoRSsm ratings can be used to make decisions on accreditation, and refine the process during CARF’s 1999 standards year.
The accreditation commission expects to have the system fully in use by the time CARF’s 2000 standards manual takes effect, she adds.
Whether the numerical score will affect accreditation is a decision that will not be made until the CARF staff has a chance to analyze the data and see how they can work, Wilkerson says. "This is a developmental process. We know that we have to analyze the data, refine them, and decide how they will be used to define excellent practice."
CARF is moving toward scorable standards to give more precision and reliability to the survey process and provide a more accurate way of quantifying a provider’s degree of conformity to the standards, Wilkerson says. However, she is quick to point out that the scorable standards will not supplant "what we consider to be the soul of CARF our consultative approach to the survey process." Surveyors still will interact and consult with the providers.
"This will not be a cut and dried numerical system that will take away the surveyors’ interaction with the providers. We see it as a tool to refine and improve the survey process," Wilkerson says. The accreditation process will still include anecdotal as well as numeric information, she adds.
"We don’t know exactly how we will use the data until we get into it and do some analysis of the best way to use the scoring system. Part of the field testing and conversion year will be gathering feedback from surveyors and organizations to help with the refinement," she says.
The 1998 standards will be written so each standard represents a single concept that can be applied to the rating system, she says. For example, past standards said the organization should have and implement a written safety policy. The new ones will make this item two separate concepts.
"We know you can have a written policy and not do a good job of practicing safety and that you can have a crummy policy and do a very good job," Wilkerson says.
Surveyors will use the survey checklist that normally serves as a worksheet for their on-site review as a tool for scoring the standards.
At present, CARF has not decided whether providers will be given a numerical score based on their ratings on the standards. "We can’t determine that until we have some data and see how it works. However, we do look forward to the SCoRSsm system helping to identify programs with excellent practice," Wilkerson says.
[Editor’s note: For more information, contact CARF at (520) 325-1044 or visit its Internet Web page at www.carf.org.]
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