Standards for public agencies

2020 Edition

Performance and Quality Improvement (PA-PQI) 4: Case Review

The agency maintains case review processes for each of its services that inform performance and quality improvement activities by evaluating: 
  1. the impact of service delivery on each program's service population;
  2. the quality and effectiveness of service delivery practices; and
  3. the quality of documentation and data entry.
2020 Edition




 An agency-wide performance and quality improvement system effectively engages staff, persons served, and other stakeholders in advancing the agency’s mission and achieving strategic goals through continuous, integrated, data-driven efforts to improve service delivery and administrative practice. 
Note: The case review processes addressed in this standard produce aggregate qualitative and quantitative data from across each service area that can be used to evaluate the impact of the agency’s service delivery practices on the outcomes of its service populations. These reviews are distinct from the case-level, supervisory review that is conducted for individual cases on a quarterly or more frequent basis to assess service plan implementation and the individual’s progress towards meeting his or her service goals and desired outcomes.
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed administration and management infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
County/Municipality Administered Agency, State Administered Agency (Central Office), or other Public Entity
  • Procedures for: 
    1. Qualitative case reviews 
    2. Case record reviews 
  • Qualitative case review scoring tool(s) 
  • Quantitative Case record review scoring tool  
  • Sampling methodologies
  • Aggregate reports from the most recent case review processes 
State Administered Agency (Regional Office)
  • Aggregate reports from the most recent case review processes
All Agencies
  • Results of external case record audits, if applicable
All Agencies
  • Interviews may include:
    1. PQI staff 
    2. Relevant staff

PA-PQI 4.01

At least annually, qualitative case reviews within each service area evaluate the impact of service delivery on the outcomes of individuals and families served by examining:
  1. the quality and effectiveness of services provided; and 
  2. outcomes for individuals and families served.


For child and family services agencies, implementation of this standard should include an examination of relevant systemic factors assessed by the Child and Family Services Reviews (CFSRs). 
Examples: Qualitative case reviews monitor the quality and effectiveness of services provided by evaluating the following, as appropriate to the program: 
  1. safety, well-being, and/or progress of the individual or family;
  2. timeliness and comprehensiveness of the completed assessment;
  3. appropriateness of the service plan and related service decisions for the individual or family;
  4. family engagement; 
  5. collaboration with external service provider(s);
  6. achievement of service goals; and
  7. level to which service implementation and results are being monitored, evaluated, and modified.
Examples: Qualitative data obtained from case reviews can provide greater insight into the underlying practices causing a change in the quantitative data (PA-PQI 4.03). Conversely, the quantitative data can be used to determine the scope or breadth of a practice concern (e.g. system wide, regional, worker, etc.). As such, both qualitative and quantitative data have a critical role to play in any effective PQI system.

PA-PQI 4.02

Annual, qualitative case reviews include case-specific interviews with persons served, workers, and other stakeholders involved with the case.

PA-PQI 4.03

Quarterly reviews of case records are conducted to:
  1. evaluate the presence, timeliness, clarity, quality, continuity, and completeness of required documents;
  2. monitor compliance with regulatory, funding, and accreditation requirements; and
  3. minimize risk associated with case record completeness and documentation.

PA-PQI 4.04

Case review processes include:
  1. staff at all levels of the agency including frontline staff;
  2. a stratified, random sample of both open and closed cases; 
  3. uniform scoring tools to ensure consistency and permit comparison of information; 
  4. measures to minimize conflict of interest such as ensuring that reviewers do not review cases in which they have been directly involved as a provider, supervisor, or consultant;
  5. measures to maintain process integrity such as third party quality assurance checks; and 
  6. mechanisms to address safety concerns identified in cases under review. 



Sampling: The chosen sample must reflect all of an agency's regions and/or sites, each of its programs and service areas, and the various types of record reviews the agency conducts. Agencies should choose a sampling method that satisfies any applicable regulatory requirements and is appropriate to their size and agency structure. 

Closed cases: COA does not define the percentage of closed cases that must be included in the sample. The majority of cases the agency reviews should be open, but the agency must include a sample of closed cases to evaluate documentation related to discharge planning, case closing, and aftercare.