change starts here n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Change Starts Here . PowerPoint Presentation
Download Presentation
Change Starts Here .

Loading in 2 Seconds...

play fullscreen
1 / 14

Change Starts Here . - PowerPoint PPT Presentation


  • 125 Views
  • Uploaded on

Change Starts Here . The One about Outcomes and Indicators ICPC National Coordinating Center.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Change Starts Here .' - seth


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
change starts here

Change Starts Here.

The One about Outcomes and Indicators

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.

recap measurement for ic 4
Recap: measurement for IC-4
  • Time series outcomes
    • Effect on root cause/driver
    • Success of the intervention
      • Rates; scores; rating scales
      • Best-fit line or other signal indicating improvement
      • What to do about outcomes not well portrayed as time-series
  • Intervention implementation
    • Reach/dosage of an intervention
    • Who was affected?
      • Counts
      • Rates among eligible population (offered, refused, completed)
recap suggested approach
Recap: suggested approach
  • Map out a detailed, community-level logic model of the intervention strategy.
  • Select and operationalizeoutcomes and processes from the logic model.
  • Develop and enforce the system for tracking implementation and outcome.
  • Effectively report time series data.
who should participate in outcomes selection and measurement
Who should participate in outcomes selection and measurement?
  • Considerations
    • Who will implement the interventions?
    • Who will be collecting data?
    • Community stakeholders
      • To whom will the observed changes will be meaningful?
  • Resources brought by the QIO
    • Building capacity for outcome measurement
      • Logic models
      • Data collection
    • Technical assistance; analytic support
      • Data management and reporting
      • Detecting improvement (tests of trend, run/control charts)
recap logic model outcomes
Recap: logic model outcomes

Expected short-, medium-, and long-term changes and improvements

  • Short-term
    • Specific improvements in the targeted driver or root cause
  • Medium-term
    • Related outcomes along the causal path
  • Long-term
    • Improved care transitions
    • Avoided readmission
    • Improved health care utilization
  • Implications of potential negative changes or non-changes

Short-/medium-term outcomes are measured for IC-4.

recap outcomes selection
Recap: outcomes selection

SMART objectives guide outcome selection.

Specific

Concrete; represents what, or who, is expected to change

Measureable

Can be seen, heard, counted, etc.

Attainable

Is likely to be achieved

Results-oriented

Generates meaningful, valued results

Timed

Has an acceptable target date

SMART

going further attainability moveabilty
Going further: attainability, moveabilty

Short-term outcomes are more likely to show movement…

…but consider downstream (medium-term) outcomes if short-term outcomes are not feasibly measured.

Outputs Short-term outcomes --------------- Long-term outcomes

indicators
Indicators

What does the outcome look like? How would we know it improved?

  • Create operational definitions.
    • Specifics of how the outcome is measured
  • Make it a number. Quantitative data can be plotted over time or compared across groups.
    • Rate, percentage
      • Numerator and denominator
    • Score (continuous)
      • e.g., 0 to 100 points
    • Rating scale (ordinal)
      • e.g., [0 - ‘never’] -- [1 - ‘sometimes’] -- [2 - ‘always’]

Simple counts are not very informative on their own. Find a way to use them as the numerator of a rate or percentage.

timing and duration
Timing and duration

When will improvement be detected?

  • Considerations
    • How long should it take to observe an effect?
    • What should the effect look like?
      • Abrupt, sustained improvement
      • Rises and falls, with gradual trend towards improvement
  • IC-4: ≥4 quarters of data within 18 months of community engagement
    • Ensure that the measurement period includes pre-intervention baseline data.
  • Measure frequently
    • The more data points, the better. Monthly indicators lend themselves to run/control charts.
level of analysis
Level of analysis

Where will improvement be seen?

  • Provider-/initiative-level
    • A change occurs across several events, people, or organizations.
      • Process improvements (re: standardization; information transfer)
        • e.g., inpatient satisfaction with discharge information
      • Utilization outcomes
        • e.g, 7-day readmission rates; 30-day primary care follow-up rates
  • Patient-level
    • Something happens to an individual person related to his/her patient experience.
      • Patient activation (e,g., change in PAM score)
      • Utilization(e.g. , prevented readmission)
  • Patient-level data should be aggregated to provider-/initiative-level for reporting.
collecting data
Collecting data
  • Considerations
    • What method?
      • Sampling
      • Survey, case review, etc.
    • Who collects the data? Who analyzes it?
    • How will data quality be ensured?
  • Make it explicit.
    • Standardization, data specifications
    • Accountability
  • Don’t forget to track implementation (process) measures, as well.
    • Counts, rates among eligible population (offered, refused, completed)
more to come
More to come
  • Detecting and reporting improvement
  • Context and reasons for success/failure
resources
Resources
  • Toolkit – measurement

http://www.cfmc.org/caretransitions/toolkit_measure.htm

  • Measuring Program Outcomes: A Practical Approach

http://www.unitedwaystore.com/product/measuring_program_outcomes_a_practical_approach/program_film

Excerpts: http://www.unitedwayslo.org/ComImpacFund/10/Excerpts_Outcomes.pdf

  • ICPCA NCC contact: Tom Ventura

tventura@coqio.sdps.org

303-784-5766

questions
Questions?

CO-ICPCTechnical@coqio.sdps.org

The ICPC National Coordinating Center – www.cfmc.org/caretransitions

Change Starts Here.