A qualitative study examining the implementation of outcomes management systems in child and adolescent out-of-home placement settings

Introduction. Though Outcomes Management Systems (OMS) have the potential to guide decision-making within organizations and provide accountability for payers, little is known about how these systems are implemented and used by staff across organizational levels. The regulatory and political context surrounding state-wide implementation of OMS remains largely unexamined. This study assessed the statewide- and organizational-level implementation of outcomes systems within out-of-home placement settings for children and youth.; Method. A multiple case study was conducted to examine a subset of child out-of-home care programs in Maryland that collaborated to develop an OMS in 1995. A single case study with embedded units was used to examine the formulation and implementation of HB1146, legislation passed in 2004 that called for several state child-serving agencies to plan for a state-level outcomes management system. Multiple sources of data were collected: 51 semi-structured interviews with staff from four out-of-home placement programs, legislators, staff from a provider advocacy organization, and personnel from child-serving agencies; observations of treatment team and quality management meetings; and documents related to OMS use and to the enactment and response to legislation. Case study and grounded theory methodology guided analyses.; Results. Data from the outcomes management system were largely unused because staff across programs struggled to "generate meaning" from the data. They experienced difficulty understanding and applying the data to their work. Problems with implementation that limited the utility of the data related to organizational context, the features of the OMS, the quality and quantity of feedback provided and difficulties "translating" the data. However, staff did routinely use other types of systematically collected information to make decisions. Policymakers envisioned using a statewide OMS for improving the quality of services provided and pay-for-performance, however, a number of political and institutional barriers were identified.; Significance. The need to generate comparable data across child and behavioral health settings must be balanced with the need to ensure the outcomes system produces information that is useful across a number of different stakeholders and contexts. State agencies' resistance to outcomes system legislation illustrates how institutional and political barriers must be overcome in order to foster innovations.