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Data Quality Tools of the Trade

Data Quality Tools of the Trade. 9.22.2014. OBJECTIVES. Review Public Policy Organizations that regulates Solid Organ Transplant Show how OTTR can assist in obtaining quality data using Workflow Review QAPI Tools of the Trade in OTTR. Defining Quality.

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Data Quality Tools of the Trade

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  1. Data Quality Tools of the Trade 9.22.2014

  2. OBJECTIVES Review Public Policy Organizations that regulates Solid Organ Transplant Show how OTTR can assist in obtaining quality data using Workflow Review QAPI Tools of the Trade in OTTR

  3. Defining Quality • Quality in general is the attribute or identified characteristic that provides a product or a system with a status of distinctive excellence(1).

  4. QAPI • Gathers Data from multiple sources such as patient’s surveys, EMRs and transplant charts. • Organize and Presents this data to appropriate committees • Departmental level • Organizational level • Develop process improvements consistent with the organization’s directions • Communicates and educates regarding changes in workflow or policies that are consistent with the results of the process improvement to achieve desire quality outcomes.

  5. Organizational Structure http://www.livingdonor101.com/public_policy_organizations.shtml

  6. SRTR and OPTN • Scientific Registry of Transplant Recipients (SRTR) was founded in 1987 to analyze the data from multiple sources including UNOS data and reach conclusions regarding transplantation • United Network for Organ Sharing (UNOS) was awarded the first federal management contract by the OPTN in 1986 • Unos gathers data regarding transplantation

  7. CMS and OPTN • CMS and the OPTN has created a compliance document to help solid organ transplant centers adhere to policies and procedures. • Evaluation Plan • http://optn.transplant.hrsa.gov/ContentDocuments/Evaluation_Plan.pdf (Updated 9.1.14) • http://optn.transplant.hrsa.gov/content/policiesAndBylaws/evaluation plan.asp • CMS-OPTN Crosswalk • http://optn.transplant.hrsa.gov/ContentDocuments/CMS-OPTN_Crosswalk.xls (Updated 7.1.14) • http://optn.transplant.hrsa.gov/content/policiesAndBylaws/evaluation plan.asp

  8. CMS/OPTN Crosswalk • Divided into 4 major groups • Administrative Requirements • CMS survey quarterly 95% submission of required forms to OPTN • Removal of Candidates from the waiting lists within1 day (CMS) 24hrs (OPTN) • Clinical • ABO verification: Two separate typing from 2 different draws (OPTN) while CMS will ascertain that the blood types are documented in the medical record before activation in UNet. • Psychosocial Evaluation before placing candidate in the waiting list. • Human Resources • Members of the Multidisciplinary team: • Independent Living donor Advocate • QAPI • Components of the program • Performance improvement Actions • Adverse Events and Analysis

  9. CMS/OPTN Crosswalk http://optn.transplant.hrsa.gov/ContentDocuments/CMS-OPTN_Crosswalk.xls

  10. Focus – QAPI Evaluation

  11. FQAPI • The focus on Process and Quality evaluates the QAPI program at transplant centers with emphasis in: • Structure within the organization, adequate resources with leadership involvement, communication within the transplant department and the hospital organization • Effective Data Systems to ensure ongoing data collection, tracking and analysis related to all quality indicators and adverse events • Systematic and ongoing Analysis of collected data and actions to improve quality of care and reduce risks to patients • Performance improvement Processes that implements and evaluates interventions and projects • http://optn.transplant.hrsa.gov/ContentDocuments/Evaluation_Plan.pdf

  12. Example • Patient satisfaction survey: “Are you satisfied of the process of evaluation?”: • Answer: It took too long (3 dissatisfaction level) • below benchmark of 75% • Current Process: • 6 Transplant Evaluations weekly • Average time to get a patient to see a consult 90 days. • Average time to schedule a patient for MRI 30 days. • Goal: Improvement of Patient satisfaction • Action: Initiate evaluation within 3 weeks of referral • Action Implementation • Workflow process education • Re-evaluation within a time frame

  13. QAPI TOOLS in OTTRTM • Build in Standard functionality are tools that will support your QAPI staff : • Dedicated QAPI Lists • Workflow is appropriately completed • Quickly spot the holes in reportable data • Reports to display the data entered thru the workflow • Present to appropriate committee meetings

  14. QAPI TOOLS in OTTRTM

  15. Field Identification throughout the phases • Identified fields within the application that tells the user the importance of the data. (Starred and dotted)

  16. Order Sets • Order sets that contain workflow for your center • Referral Plan

  17. Order Sets for communication • On call procedures

  18. Order Sets for Efficiency • Improving efficiency and compliance with policies, procedures and physician orders

  19. Quality Data in OTTR thru Workflow • Gathering Data in the patient’s OTTR chart

  20. Compliance with Regulatory Policies.

  21. Listing Phase - NO • UNOS approved Primary Listing Diagnoses

  22. Gather Information in One single Screen • Report to UNOS: Post Transplant Information

  23. Documentation • Documenting discussions and complying with Regulations

  24. A Multidisciplinary Approach

  25. PDF Attachments and sources of Truth - NO

  26. Alerts throughout the record • Alerts throughout the record • Closure of phases and actions

  27. Help!!!

  28. Help! • Specific Organ Labs

  29. UNOS and CMS Compliance: TCR forms with Organ Details • Tighten it all together: Rewards if previously documented

  30. Following with Results • Data Interfaces to avoid data entry errors

  31. Lists • Follow Lists to manage patients and find incomplete data

  32. Open Evaluations • Management of Evaluation Workflow

  33. Analyzing and Reporting Data

  34. Management of Listed Patients • Example of a List Columns

  35. Analyzing the Data • Analyzing the MELD score at Listing Time

  36. OPTN/CMS Crosswalk 1. Policy Metrics Common to All Transplant Centers derives from OPTN/CMS Policies ie: 2 ABO verification. removal of pt in 24 hrs Listing letters to patients within 10 days 2. Process Improvement metrics are Center Specific Evaluation of Errors Patient Surveys

  37. Data Quality and Administrative List

  38. Purpose of the Sub Sections • Data Quality • Lists used for Data Quality and Compliance Groups, Management, including HIPAA Audits • Role: Data Quality Lists (New Role) • Notifications • Commonly called Alert List, generally used by clinical and administrative staff • Minor/Sever Notifications: Yes • Role: All Users • Statistics • List commonly used for Site and Program Level Stats, including program level survival • Role: All Users • Software Support • List commonly used by the OTTR Admin or site Administrator • Role: Sys Admin Software Support List • Support • List commonly used by Administrative or Clerical Support • Role: All Users

  39. A few NEW lists • Intra Transplant -> Lung • Pre-Transplant -> Eval Letters • Pre-Transplant -> Listing Letters • Pre-Transplant -> Listing- Lung • Pre-Transplant -> Listings - Liver • Post Transplant -> Patients w/ BK Virus • Post Transplant -> Patients w/ Pos CMV and PCR • Post Transplant -> Patients w/ Pos EBV or PCR • Post Transplant -> Transplant - Kidney • Post Transplant -> Transplant - Kidney/Pancreas • Post Transplant -> Transplant - Liver • Post Transplant -> Transplant – Lung • Patient Phase Details

  40. Intra Transplant -> Lung List displays information about the Lung Transplant. Including Surgical Technique, ischemic times and admit days.

  41. Pre-Transplant -> Listing Letters List of all candidate listings and the date the listing letters were created. Patients that to not have a letter generated will be highlighted. This list can by easily modified to include the letters for any site.

  42. Pre-Transplant -> Listings - Liver Chronological listings with the listing diagnosis, current(or last) listing code, HCVab labs and HVC RNA Post Transplant w/ Date of Death. This list can be modified for different labs or even additional data point.

  43. Post Transplant -> Transplant - Liver List of all Liver Transplant. With the MELD at time of Transplants, date of Liver Biopsy, Date of ERCP, Graft Failure w/ Reason and graft failure w/I 365 days. This information is repeated for up to 2 re-transplants.

  44. Patient Phase Details List displays each patient by phase, from referral through transplant. Patients that have been re-referred or re-transplanted will have multiple rows in the data. List can be Graphed Entering a date range will limit the data.

  45. Patient Phase Details: Graphing 1. Select your Pivot 2. The section below will show you the break down of your data. 3. Click the Graph Tab.

  46. Patient Phase Details: Graphing

  47. Lists and Graphing

  48. Lists and Graphing

  49. Lists and Graphing: Tips • Write the list for the raw data points. • Allow the list to determine the years and months from the date • Use formatting in your column headers • Make sure you can limit your list • All Columns in your SQL have a unique column header • Do not use an alias in your order by

  50. Lists and Graphing: Tips

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