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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

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
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
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!”
getting started identify your population
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
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
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
this type of data reporting isn t reliable
“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!
summary
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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