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Data JamIntroduction to the QI Toolkit
National Council for Behavioral HealthMontefiore Medical Center
Northwell HealthNew York State Office of Mental Health
Netsmart Technologies
Today’s Presenters
Samantha Holcombe, MPHDirector, Practice Improvement
National Council for Behavioral Health
Trish Perazzelli, MPHPractice Transformation Specialist
National Council for Behavioral Health
CTN Quality Improvement (QI) Toolkit can help you…
Establish a culture of QI within your organization
Identify and implement QI projects using prompts and tools
• Cannot go it alone• Secure leadership buy-in• Establish a multifaceted team• Communicate early and often
QI Toolkit ResourcesIntro to QI slide deckGuidance on QI team
Communication Plan Template
Establish a Culture of QI
Implementing QI within your organization
Step 1: Identify Improvement Opportunities
QI Toolkit ResourcesImprovement Area WorksheetRoot Cause Analysis Worksheet
Where does your practice need to improve patient care?• Potential sources: EHRs, registries, clinical quality data,
claims data, performance against state/national standards
Where is your practice less efficient than it should be?• Potential sources: Staff discussions or surveys, assessment
tools
What about the day is most frustrating for your team and/or patients?• Potential sources: Staff discussions or surveys, patient
surveys or advisory boards
Step 2: Define Your Project
What are we trying to accomplish?
• GOAL/AIM. Determine what specific outcomes you are trying to change.
How will we know that a change is an improvement?• MEASURES. Identify appropriate measures to track your
success.
What change can we make that will result in an improvement?• ACTIVITIES. Identify key changes that you will test.
QI Toolkit Resource: Logical Framework
Narrative Summary Indicators Data Sources Assumptions
Goal
Objectives/Outcomes
Outputs
Activities
Logical Framework ExampleNarrative Summary Indicators Data Sources Risks/Assumptions
GoalReduce readmissions by 25% for high risk patients in the next year
1. Readmissions rates Medicaid data
Objectives/Outcomes1. 100% of high risk clients are receiving care according to established care pathways2. 75% of high risk clients remain engaged in care
1. Percent of high risk clients attending weekly appts2. Percent of high risk clients receiving monthly medication appts/labs**
EHR Established care pathways include the interventions that address drivers of relapse and readmission
Outputs1. Clinic conducts weekly reviews and assignment of clients to relevant risk levels2. Treatment plans for all high risk clients are aligned to established care pathway
1. Percent of clients assigned to risk levels2. Percent of high risk clients with treatment plans aligned with care pathways
EHR Treatment plans and care pathways will be adhered to
Activities1. Review data and identify high risk patient populations2. Design and implement relevant care pathways
1. Indicators selected2. Care pathway developed3. Staff implementing
workflows
Organization protocolsMonthly staff meetings
Staff are given the tools and resources to effectively implement this approach
**Indicators should align with care pathway interventions
Plan
DoStudy
ActRapid Cycle Change
Step 3: Implement Your Project
Plan
Identify your team
Varied perspectives and knowledge base
Develop your plan
What activities be completed?
What staff will be involved?
What resources (money, people, technology) are
needed?
What are the anticipated barriers?
What is our approach for data collection?
Where do responsibilities lie?
Think
Activities, Resources, Timelines
QI Toolkit Resources
Planning worksheet
Plan
Activity Resources Needed Responsible Party Timeline
Design Care Pathway Evidence Base, current protocol, PH Partnership
Medical Director 1 month
Develop P&P/Workflow for Staff
Current process; feedback from staff
Clinical Director 1 month
Identify patients through data
Up to date EHR, potentially PH info from partners
QI Manager / IT Director 3 weeks
Build in tracking/data registry of care pathway
EHR/data registry, inputs from staff, report capability
QI Manager / IT Director 1 month
Train Staff on P&P/Workflow Updated P&P; Staff Time Clinical Director; Supervisors 2 weeks
Aim: Develop and implement a care pathway for patients with schizophrenia Timeline: 4 months
Do
Consistently track and monitor progress
Workplan and data
Adapt or change when needed
Use root cause analysis to understand challenges
or barriers
Communicate openly and often
QI Toolkit Resources
Workplan templateRoot cause analysis
guidance
DoActivities Responsible Start End Days Status Week 1 Week 2 Week 3 Week 4 Week 5
Team 1 - Clinical, Project ManagementIdentify Best Practices in the evidence base and review current practices Medical Director Jan 1 Jan 15 15 CompleteDraft care pathway for individuals with schizophrenia Medical Director Jan 15 Jan 30 15 CompleteIdentify key external stakeholders Project Manager Jan 1 Jan 30 30 In progressShare care pathway with all stakeholders for review Project Manager Feb 1 Feb 28 28 In progressDevelop P&P/Workflow for Staff Clinical Director Feb 21 Mar 31 35 In progressTrain Staff on P&P/Workflow Clinical Director Apr 1 Apr 30 30 Not started
Team 2 - Quality Improvement and InformaticsSelect variables to identify patients through data QI Manager Jan 1 Jan 30 30 CompleteIdentify likely physical health partners through data HIT Director Jan 15 Jan 30 30 DelayedBuild in tracking/data registry of care pathway HIT Director Jan 1 Feb 28 59 In progress
Study
Complete analysis of data
Include both quantitative (data/metrics) and
qualitative (subjective experience/feedback)
data
Compare results to predictions
Did things turn out as expected?
Why or why not?
Identify areas for improvement/refinement
What went well?
What could be improved?
Is there new information available?
QI Toolkit Resources
Run chart templateAfter action review
Study
43%
81%
0%10%20%30%40%50%60%70%80%90%
Scre
enin
g R
ate
Month
High Risk Clients Attending Weekly Appointments
Percent
Act
Adjust
If you didn’t get the results you expected
Scale
If you’ve identified a replicable model
Communicate
Share successes and failures
QI Toolkit Resources
Communication plan template
Prompt worksheet
ActRoot Cause Analysis At one clinic location the engagement
rates for high risk clients less than 50%
People
High staff turnover at
clinic
Not all staff are trained in care
pathway
Managers feel overwhelmed
Environment
Culture of clinic does not
reinforce QI
Supervisors are not reviewing risk levels with
clinicians weekly
Materials
Care pathway P&P not readily
available to staff
Process
Few clinicians reviewing
documented risk level for scheduling
Lack of clarity around who
does follow up outreach
Equipment
Not all clinicians have
laptops to review CP while
scheduling
Measurement
Risk levels not updated in a
timely manner, may skew
results
Act
Audience Interests Message ApproachPatients & Family Members Access to clinician; Quality of care Our services are being tailored to
meet your unique needs, and our patients have achieved better outcomes as a result
Family Open Houses; Marketing Materials
Staff Reduced administrative burden; resources to aid in clinical decision making; participation in organizational change
We have used your feedback to develop tools and trainings to help you provide the highest quality care to your clients
Supervision; Staff Meetings
Payers Lower costs; reducing readmissions
We have reduced costly hospitalizations for our clients through better managed care
Value Proposition to share when contracting begins
Communication Plan
Questions?
Quality Improvement Office Hours
• Being offered throughout March• Sign-up link will be distributed post-webinar
Upcoming Events
Quality Improvement • Quality Improvement Office Hours – Throughout March
Health Information Technology• New HIT Consulting Package: Introducing NYeC – March 6 from 12-1pm• HIT 101 for Behavioral Health Providers – March 19 from 12-1pm
Reducing Fragmentation Through Coordinated Care• The Behavioral Health Provider Perspective – March 21 from 12-1pm• Individual consultations are available for free with Mindy Klowden
Don’t forget to enter “NATCON200” to get $200 off your registration!
Thank you!www.CareTransitionsNetwork.org
The project described was supported by Funding Opportunity Number CMS-1L1-15-003 from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. Disclaimer: The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.
