Quality reporting and improvement using technology
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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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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?

“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


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!”


Sometimes gathering data can bring new and surprising knowledge!


Different Purposes for Measurement


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


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!)


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


Annotated Time Series


“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!


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


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


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


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


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


Run Charts of Monthly Measures - Diabetes Population


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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