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Part I – Data Collection and Measurement . Ruth S. Gubernick, MPH Quality Improvement Advisor Lori Morawski, MPH CHES Manager, Quality Improvement Programs Florida Pediatric Medical Home Demonstration Project Learning Session I September 23-24, 2011. Disclosure.
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Part I – Data Collection and Measurement Ruth S. Gubernick, MPH Quality Improvement Advisor Lori Morawski, MPH CHES Manager, Quality Improvement Programs Florida Pediatric Medical Home Demonstration Project Learning Session I September 23-24, 2011
Disclosure We have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this CME activity. We do not intend to discuss an unapproved/investigative use of a commercial product/device in their presentation.
Measurement, Data Collection & Evidence of Change Importance of measurement – Why? How will we know that a change is an improvement? Clarify and be directly linked to goals Seek usefulness over perfection Be integrated into daily work whenever possible Be graphically and visibly displayed For PDSA cycles, be simple and feasible enough to accomplish in close time proximity to tests of change
What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in improvement? Act Plan Study Do The Improvement Model The Improvement Guide Associates in Process Improvement
Measurement for Quality Improvement • You can’t improve what you can’t (or don’t) measure • A good aim statement provides clear direction. • Measures tell a team if the changes they make are making a difference • Measurement tells you where you are and where you are going
Measures • Need to define • Target population • Numerator • Denominator
Florida Pediatric Medical Home Demonstration Project: Example • Target Population: • All Medicaid/KidCare infants/children seen by clinicians in participating practice • Numerator: • Total number of patients whose individual and family concerns are elicited at this visit • Denominator: • All Medicaid/KidCare infants/children seen in participating practice whose charts are reviewed during the month of interest.
Effective Measurement • Seek usefulness, not perfection • Keep measurement simple, think big, but start small
Effective Measurement: Outcomes Outcome measures: represents the voice of the customer or patient • Hospitalizations or ED visits due to asthma • Hospital readmissions w/in 30 days due to asthma • Patient satisfaction with time it takes to schedule an appointment
Effective Measurement: Processes • Process measures: represents the workings of the system • Percent of patients with all expressed concerns addressed or with plans made to address them • Percent of patients who have a medical summary or comprehensive care plan created or updated/maintained at this visit
Effective Measurement • Build measurement into daily work routine • Data should be easy to obtain and timely • Small samples over time • Use quantitative and qualitative data • Quantitative data is highly informative • Qualitative data is easy to obtain
Why Plot Data Over Time • You develop a process for patients/families to have a current copy of their medical summary or comprehensive care plan reviewed and offered to them at their visit. The 6 months before implementing the process the average % of patients/families having a current copy of their medical summary or comprehensive care plan reviewed and offered to them is 10%. Six months after the process is implemented, the average % is 90%. • How will you answer the question: was this change an improvement?
Run Charts Change February October Jan. 2012 March Aug. 2011 November September December
Change October Jan. 2012 Aug. 2011 September February November December March
Data Collection Web Site www.aap.org/qualityimprovement/quiin/workspaces/MedHome/DataCollection.html
Requirements of Teams • From October 15, 2011 through March 30, 2012 you will be asked to submit a total of 10 patient chart reviews using the EQIPP. • Data cycles will be open on the 15th of each month. Please do not submit data until the 15th of every month. Data will be due by the 30th of each month. • Your practice will have the ability to close your own data cycle once you have submitted 10 total chart reviews each month. • If you do not have 10 charts to review in a particular month, please contact project staff and they will manually close your data cycle for you. • You will need to complete the on-line chart review survey for each patient chart you review. You have the option of first completing a “hardcopy” survey of each chart reviewed, using the PDF Data Collection Tool, but you must then submit that data using EQIPP.
EQIPP Data User View Each individual user can analyze their own results real time!
Data Reporting • QI Advisor and AAP staff will run monthly reports to share with participating practices: • Project measure reports • Measure Reports (all practices) • Practice Reports (all measures)
Reports • Reports include comprehensive data for all practices – provide more information than EQIPP • Reports will be shared monthly prior to monthly calls • Reports will be posted on project workspace • Monthly calls: • 3rd Wednesday of the month • 2nd Tuesday of the month
Monthly Progress Provides information about • Tests of change completed and tools used each month • Assessment of team progress • Other qualitative measures Instructions • Insert your practice’s Aim statement. • Indicate the change package items you have tested. Describe specific changes (by domain) and tools you have tested. • Rate your team’s progress using the scale. Report your team’s learning. • Complete the Systems Index. • Submit your Monthly Progress Report by the 30th of the month for which you are submitting, using the Survey Monkey link (URL) that will be sent each month via the project listserv
Example Chart from Monthly Progress Report Index Aug. 2011 Jan. 2012 Sept Feb. March Nov. Dec Oct.
Project Workspace All data and run charts will be available for review on the Project Workspace Web site http://www.aap.org/qualityimprovement/quiin/workspaces/ MedHome/Home.html Compare your team’s data to other teams and to the aggregate data!
