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Data Collection and Measurement
Diane Abatemarco, PhD, MSWRuth S. Gubernick, MPH
Practicing Safety Learning SessionMay 30, 2009
Disclosures
Diane Abatemarco : I have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this CME activity. I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.
Ruth Gubernick: I have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this CME activity. I do not intend to discuss an unapproved/investigative use of a commercial product/device in mypresentation.
Measurement, Data Collection & Evidence of Change
Importance of measurement – Why? How will we know that a change is an improvement?
Clarify and be directly linked to goals Seek usefulness over perfection Be integrated into daily work whenever possible Be graphically and visibly displayed For PDSA cycles, be simple and feasible enough to accomplish in close time proximity to tests of change
How will we know that a change is an improvement?
Plan
DoStudy
Act
What are we trying to accomplish?
What changes can we make that will result in improvement?
The Improvement ModelThe Improvement ModelThe Improvement ModelThe Improvement Model
The Improvement GuideAssociates in Process Improvement
Measurement for Quality Improvement
You can’t improve what you can’t (or don’t) measure
A good aim statement provides clear direction. Measures tell a team if the changes they make
are making a difference Measurement tells you where you are and
where you are going
Measures
Need to define Target population Numerator Denominator
Practicing Safety: Example
Target Population: All 2 month old infants seen in a participating practice for
well care visit
Numerator: # of infants with documentation in chart that
parent/caregiver received assessment/screening regarding coping with crying at or by the 2 month well visit
Denominator: All 2 month old infants seen in participating practice for
well care visit whose charts are reviewed
Effective Measurement
Seek usefulness, not perfection
Keep measurement simple, think big, but start small
Effective Measurement: Outcomes
Outcome measures: represents the voice of the customer or patient
Average hemoglobin A1c Hospitalizations or ED visits due to asthma Patient satisfaction with time to getting an
appointment
Effective Measurement: Processes
Process measures: represents the workings of the system Percent of charts with documentation indicating
use of 1 or more tools for maternal depression at or by the 2 month well visit.
Percent of parents/caregivers receiving assessment/screening regarding discipline at or by the 18 month well visit.
Effective Measurement
Build measurement into daily work routine Data should be easy to obtain and timely Small samples over time
Use quantitative and qualitative data Qualitative data is highly informative Qualitative data is easy to obtain
Why Plot Data Over Time
You develop a process to screen mothers for maternal depression using the Edinburgh Postnatal Depression Scale. The 6 months before implementing the process the average % screened using this tool is 10%. Six months after the process is implemented, the average % of mothers screened is 90%.
How will you answer the question: was this change an improvement?
0102030405060708090
100
April
May
June Ju
ly
Augus
tSep
tOct
Nov
Change
Run Charts
0
10
20
30
40
50
60
70
April
May
June Ju
ly
Augus
tSep
tOct
Nov
Change
Chart Documentation Form and Instructions
Include in charts; not used as retrospective chart review form
Use in charts of specified visits (2 month; 18 month; or other as determined by your team)
Leave form in chart to document follow-up
Insert practice ID numbers on Charts Documentation Forms before making copies for charts
Submit on 30th of month to Ruth
Note: Binders include 1 form for each age group per month (totaling 12 forms)
Chart Documentation Form and Instructions
Team Planning Identify which of your infant and toddler patients will be seen for
well care during each month Use Chart Documentation Form included as part of their pre-visit
planning/preparation This might change over the six (6) month period, as your team
conducts PDSA cycles to test the process and the Toolkit Your team will also decide how you will determine which 10
Infant Chart Documentation Forms and 10 Toddler Chart Documentation Forms will be submitted to the Practicing Safety Project team for review. For example:
Your protocol may be to submit copies of the Chart Documentation Forms for those infant and toddler patients seen for a well-child visit one day each week (i.e., each Monday or Friday) that month
Or those infant and toddler patients seen for well-care during the last week of that month, for a total of 10 forms of each cohort.
Example Run Charts from Chart Documentation Form
% Receiving Assessment/ScreeningRe: Maternal Depression and Attachment/Bonding
0%
50%
100%
Apr-09
May June July Aug Sept Oct Nov
Month
% A
chie
ved Mat Depression
Attach/Bonding
Goal
% Receiving Assessment/Screening Re: Discipline
0%
50%
100%
Apr-09 May June July Aug Sept Oct Nov
Month
% A
chie
ved
Monthly Progress
Provides information about Tests of change completed each month Assessment of team progress Other qualitative measures
Each month, staff will email the Monthly Progress Report so it can be completed electronically
Instructions Insert your practice’s Aim statement. Indicate the Practicing Safety bundles you have implemented.
Describe specific changes and tools you have tested. Rate your team’s progress using the scale. Report your team’s
learning. Complete Index. E-mail your monthly progress report to Jill Healy at
Example Chart from Monthly Progress Report Index
Practice-based Systems Index by Month
012345
6789
10
Apr-0
9M
ayJu
ne July
AugSep
tOct Nov
To
tal
Nu
mb
er o
f B
oxe
s C
hec
ked
Project Workspace
All data and run charts will be available for review on the Project Workspace Web site http://www.aap.org/qualityimprovement/quiin/workspaces/PracticingSafety/PS_Home.html Username: pracsafety Password: r3f5y7
Compare your team’s data to other teams and to the aggregate