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Change Starts Here . The One with the Trend Graphs: Introduction to the IC-4 Measure ICPC National Coordinating Center.

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change starts here

Change Starts Here.

The One with the Trend Graphs: Introduction to the IC-4 Measure

ICPC National Coordinating Center

This material was prepared by CFMC (PM-4010-080 CO 2011), the Medicare Quality Improvement Organization for Colorado under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.

ic 4 measure definition j 10
IC-4: measure definition (J-10)

“Percentage of communities that can demonstrate four time series graphs showing positive trending data by intervention over four quarters.”

  • Numerator: Number of communities demonstrating improvement over a 4-quarter period
  • Denominator: Number of communities participating in the statewide Learning and Action Network
  • Polarity: Higher is better.
evaluation and data source
Evaluation and data source
  • Evaluation Targets
    • No baseline target
    • 18-month target: 25% of Track 2 communities
    • 27-month target: 75% of Track 2 communities

Demonstrate 4-quarters of improvement on ≥4 outcomes across all Track 2 communities.

  • Data Source
    • Collected and reported by QIOs
    • Deliverable #51 (Community Intervention Plans)
    • Template to be provided by NCC
what to measure
What to measure
  • Intervention implementation
    • Process
    • Reach/dosage of an intervention

Counts; percentage of eligible population

  • Outcomes over time
    • Effect on root cause
    • Success of the intervention

Rates; scores; rating scales

Longitudinal data

Best-fit line or other signal indicating improvement

early considerations 10th sow
Early considerations (10th SOW)
  • Root cause analysis
  • Map out the logic model
    • What is expected to change at the point of intervention?
    • Develop an operational definition of improvement and select the corresponding indicator.

Existing outcomes already reported

Expectations from root cause analysis

How is the problem observed on site?

  • Develop a procedure for tracking implementation and outcome.
    • Logistics, standardization and enforcement
  • Plan to measure frequently to better demonstrate change.
    • Monthly interval yields 12 data points over given 4-quarter period (i.e., 1 year)
selecting an outcome to measure
Selecting an outcome to measure

Consider the following ideals:

  • Measureable – Can it be operationalized and clearly measured?
  • Plausible – Is it reasonably tied to the root cause?
  • Moveable – Is it likely to change in a clinically meaningful way?
  • Compelling – Will an observed change tell the story of improvement?
  • Practical – Are time series data readily collected or available?
  • Future presentations/discussion
    • Details and strategies for IC-4
  • Toolkit
    • Outcome measurement (9th SOW Care Transitions)

  • ICPC NCC contact: Tom Ventura



The ICPC National Coordinating Center –

Change Starts Here.