Measurement: the why and the what

1. Measurement: the why and the what Susanne Salem-Schatz, Sc.D Project Director Massachusetts Coalition for the Prevention of Medical Errors

2. Why measure? • For you • Track progress towards key improvement goals • “How do we know a change is an improvement?” • What gets measured gets done • For us • Your experience and progress are a key component of how we evaluate our efforts (surveys, lessons shared on monthly reports, measures over time) • For the CDC (our funder) • National recognition • Continued funding and opportunity to support change in the community

3. What to measure • Limited set of core metrics • Differences by type of facility, when appropriate • Good enough • Balance value and effort • Don’t let the perfect be the enemy of the good

4. Overview of measures: Long term care • Percent of treated UTIs that meet the “Protocol criteria” (ABCs) • Rates* over time of: • new UTI cases • laboratory orders for urine culture • healthcare acquired C. difficile (HA-CDI) * All rates calculated per 10,000 resident days

5. Overview of measures: Emergency Department • Percent of treated UTIs with specific signs or symptoms of UTI • Percent of treated UTIs with non-specific signs or symptoms • Percent of treated UTIs with no signs or symptoms (default) • Rate of urine tests sent to laboratory per ED visitors > 70 years old

6. Measuring Progress Nora McElroy, MPH General Epidemiologist Massachusetts Department of Public Health Bureau of Infectious Disease Prevention, Response and Services, Epidemiology Program

7. Measuring Improvement • Establish baseline UTI rates and chart attributes • Record which LTC patients have been treated for UTIs and whether they fit the protocol definition in long term care facilities • Record the number and attributes of diagnosed UTIs • Assess certain attributes of ED patients diagnosed with UTIs through chart review

8. Provide Feedback • Caculate and illustrate monthly long term care UTI rates on an ongoing basis • Communicate how closely patients treated for UTIs at long term care facilities fit the protocol criteria • Report the attributes of ED patients diagnosed with a UTI • Document UTI testing in the ED

9. Data Collection Tools and Forms • For long term care: • Chart review form • An aide for applying the definition of a UTI in LTC • Chart review spreadsheet • Documentation of monthly chart reviews to be submitted each month • Measuring facility urinary tract and C difficile infection rates • Documentation of events and denominator data

10. Data Collection Tools and Forms • For Emergency Departments • Chart review form • Assists in determining the attributes of patients diagnosed with UTIs in the ED • Chart review spreadsheet • Submission of monthly chart review documentation • Measuring urine testing and ED visits

11. Chart Review Data Collection Form • Chart reviews will examine the characteristics of patients that are being treated for UTIs • Include patients >= 70 years of age • In long term care: • Include only patients with new onset, not recurrent, UTIs • In the Emergency Department: • Have a diagnosis code for urinary tract infection during the period under review and • Urine testing was initiated or done by an emergency department clinician.

12. Chart Review Data Collection Form for Long Term Care

13. Chart Review Data Collection Form for the Emergency Department

14. Notes about the chart review • Review 20 charts a month or five charts a week • Selecting charts to review: • If the name of the month starts with A-F review the first 20 patients with UTIs • If the name of the month starts with J-S review the last 20 patients with UTIs • Use the chart review form to guide your completion of the Excel spreadsheet but only the spreadsheet need to be submitted

15. Chart Review Spreadsheet • Document the answers to the questions on the chart review form and use them to complete the Data Submission Excel Spreadsheet • Answer Yes or No to each of the questions • After completing the chart reviews for each month email the spreadsheet to nora.mcelroy@state.ma.us

16. Completing the Chart Review Spreadsheet for Long Term Care

17. Completing the Chart Review Spreadsheet for the Emergency Department

18. Cases and Figures for Long Term Care • Track new onset Clostridium difficile and urinary tract infections monthly for patients >= 70 years of age in LTC • Determine number of urine cultures performed each month • Enter the monthly census, or resident days, for patients >=70 years of age • Submit monthly with the chart review spreadsheet

19. Calculating a Rate • The C difficile and UTI rates are calculated by: (UTIs/Resident-days)*10,000 • The spreadsheet will automatically calculate C difficile and UTI rates monthly

20. Cases and Figures Spreadsheet for Long Term Care

21. Cases and Figures for the Emergency Department

22. Spreadsheet Demonstration

23. Summary • There are three tools to assist the collection of collaborative data • Chart Review Data Collection Form • Chart Review Spreadsheet • Cases and Figures Spreadsheet • Submit the Chart Review and Cases and Figures Spreadsheets monthly • Please forward any questions to Nora McElroy and nora.mcelroy@state.ma.us or (617) 983-6873

24. Thank you! • Any Questions? • Special thanks to all of the collaborators who provided valuable assistance and advice in the completion of the tools for this project.