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Quality Reporting and Improvement Using Technology

Quality Reporting and Improvement Using Technology. Mike Hindmarsh Hindsight Healthcare Strategies Cincinnati, OH June 18, 2010. How Do We Know That a Change is an Improvement?.

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Quality Reporting and Improvement Using Technology

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  1. Quality Reporting and Improvement Using Technology Mike Hindmarsh Hindsight Healthcare Strategies Cincinnati, OH June 18, 2010

  2. How Do We Know That a Change is an Improvement? “When you can measure what you are speaking about and express it in numbers, you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind.” Lord Kelvin, May 3, 1883

  3. Measuring Performance for Improvement • We cannot improve what we cannot measure • IT is a critical success factor in gather improvement data • Understanding how to get data out of your EMR is essential • Garbage in, Garbage out • “Why bother, I’m doing okay in practice!”

  4. Sometimes gathering data can bring new and surprising knowledge!

  5. Different Purposes for Measurement

  6. Getting Started:Identify your population • Create a query that identifies the population (e.g., ICD-9 codes) • Be sure to code populations the same way. • Don’t “over-worry” about the accuracy of case finding: you can clean it up as you go. • Get baseline data in the easiest, fastest fashion possible…..if it’s hard to program, leave it for later! • Don’t obsess about baseline data accuracy! • Select measures that you can impact and have clinical relevance

  7. For Each Measure • Use measures from evidence-based guidelines • Create concrete operational definitions to capture data from you IT in a reliable, consistent manner • Use the reporting template to display your measures as quickly as possible. • Set goals based on evidence or best pratice • Gather data monthly (quarterly at a minimum!)

  8. Example of Improvement Measures: Diabetes • % with A1c<7 • % with BP<130/80 • % on ACE1 or ARB • % with LDL<2.0 nmol/l • % screened for microalbumen • % with eye screen in last 24 months • % with foot exam in last 12 months • % with A1c in last six months • % with documented self-mgmt goals in medical record

  9. Annotated Time Series

  10. “This type of data reporting isn’t reliable!!” • Yes it is….for quality improvement purposes! • Trending is what you are looking for…not statistical reliability. • Your “goal” is to improve population outcomes over your usual care by changing care for every patient: the annotated time series (run chart) will tell you if you are succeeding!

  11. Improvement in Glycemic Control Percent of (Patients with HbA1c >9 in Clinic A)

  12. Improvement in Glycemic Control (% of Population with HbA1C >9 in Clinic A)

  13. Improvement in Glycemic Control (% of Population with HbA1C >9 Clinics B and C)

  14. Improvement in Glycemic Control (% of Population with HbA1C >9 in Clinic B)

  15. Improvement in Glycemic Control (% of Population with HbA1C >9 in Clinic C)

  16. Run Charts of Monthly Measures - Diabetes Population

  17. Summary • Define your population with carefully thought out queries • Obtain baseline data on relevant measures through structured queries • Produce regular reports for improvement activities • Set targets/goals for imporvement based on best practice • Be ambitious!

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