KPIs (Key Performance

Indicator) in Cardiovascular

and Thoracic Patients.”

Duangkamol Wattradul

APN, D.N.S.

Introduction

KPIs play an important role in the performance measurement process by assisting to categorize and properly measure levels of service performance.

The National Standards for National Quality Assurance recognize the use of KPIs as a part of the process to analytically monitor, evaluate and constantly improve the quality of care.

The Benefit of KPIs

Quality KPIs are determined to detect suboptimal

care either in structure, process or outcome, and

can be used as a tool to guide the process of

quality improvement in health care.

Improving KPIs of care requires performance measurement and feedback.

What are Quality indicators?

An instrument that is used to assess MEASURABLE ASPECT of Patient care as a guide to assessing

Performance of the health care organization or

individual practitioners within organization.

JCI AHO

How to use KPIs

Using key performance indicators at a local

level assists organizations to develop an insight

into safe and effective care processes.

KPIs are used for improvements in quality and safety at organizational level, facilitating

improvements in local service delivery, using as

a tool to evaluate providers at a national, system level.

Development of KPIs

1. Define the audience and use for measurement

The audience refers to the person or group for whom the

KPIs will aid decision-making and can be the service-

user, the clinician, the public, the facility or the

healthcare system.

For example

a patient waiting for surgery will be more interested in the

average waiting time for that surgery, rather than the number of people on the waiting list.

average waiting time for heart surgery

Development of KPIs

2. Consult with stakeholders and advisory group

The advisory group membership should include

the relevant health professionals and stakeholders

for the area being measured.

Clinician membership should be multidisciplinary

with members recognized as experts in their respective professions.

Consult with stakeholders and advisory group

Institute for Clinical Evaluative Sciences

International environmental scan - heart failure

indicators •15 indicator sets

•50 unique indicators

•Most common indicators

–ACEI/ARB in LVSD in eligible (15/15)

–Beta-blocker in LVSD in eligible (12/15)

–Evaluation of LV systolic function (10/15)

–Anticoagulants in AF in eligible (8/15)

–Assessment of patient weight (7/15)

–Patient education/discharge instructions (8/15)

–Appropriate initial laboratory tests/assessments in newly diagnosed (4/15)

–Assessment of clinical signs and/or symptoms of volume overload (4/15)

–Laboratory tests for patients on ACEI/diuretics/digoxin (4/15)

Abrahamyan et al. CJC 2012

Canadian Cardiovascular Society (CCS)

Heart Failure QI’s (2013)

•Daily assessment of blood chemistry: Electrolytes,

BUN, creatinine

•Chest x-ray completed as part of initial evaluation

•In hospital use of ACE or ARB

•Assessment of left ventricular function

•Documentation of 30 day readmission rate

•Patient education re heart failure management 10

http://ddqi.ccs.ca

Development of KPIs

3. Choose the area to measure Service-user safety KPIs can be generic, measuring standardized mortality rates and adverse events or they can be more specific, measuring healthcare.

infection, preventable surgical complications

medication safety

Other service-user safety KPIs monitor adverse events such as falls and bedsores.

Some KPIs of Heart failure were collected

manually using a discharge checklist

Choose the area to measure

Some KPIs of Heart failure were collected manually

using a discharge checklist

Prescription of ACE inhibitor/ARB and beta blockers

at discharge

Evaluation of left ventricular function (Ejection

fraction)

Completion of patient teaching.

Development of KPIs

4. Achieve a balance in measurement

the “balanced scorecard” which was originally developed by Kaplan and Norton and suggests four perspectives of a performance indicator set to provide a comprehensive view of the performance of an organization:

service user perspective measures how an organization meets the assessed needs and expectations of the service user

internal management perspective measures the key business processes that

have been identified as necessary for a high quality and effective service

continuous improvement perspective measures the ability of the organization's systems and people to learn and improve

financial perspective measures the efficient use of resources to achieve the organizations objectives.

The “Three Es” framework

economy which measures the acquisition of

human and material resources of the

appropriate quality and quantity at the

lowest cost

efficiency which measures the capacity to

provide effective healthcare using minimum

resources

effectiveness which measures the degree to

which the organization attains established goals.

In the United Kingdom, the

performance assessment framework

measures performance in six main

areas:

health improvement

fair access

effective delivery of appropriate care

efficiency

service-user/carer experience

health outcomes.

Development of KPIs

5. Determine selection criteria

Validity Does the KPI measure what it is supposed

to measure?

Reliability Does the KPI provide a consistent

measure?

explicit evidence base Is the KPI supported by

scientific evidence or the consensus of

experts? KPIs should be based on scientific

evidence

Development of KPIs

5. Determine selection criteria

Specificity Does the KPI actually capture changes that

occur in the service for which the measure is intended?

Relevance What useful decisions can be made from

the KPI?

Balance Do we have a set of KPIs that measure

different aspects of the service?

Tested Have national and international KPIs been

considered?

Development of KPIs

5. Determine selection criteria

Safe Will an undue focus on the KPI lead to potential

adverse effects on other aspects of quality and

safety?

Avoid duplication Has consideration been given to

other projects or initiatives?

Timeliness Is the information available within an

acceptable period of time to inform decision-makers?

Development of KPIs

6 Define the indicator

6.1 Identify the target population

6.2 Define the target to be achieved

6.3 Threshold for action

6.4 Action

Conclusion

The KPIs should be selected with consensus of interdisciplinary team and associated with quality of care, risk adjustment, and preventable death. The set of consensus quality KPIs of cardiovascular and thoracic patients can be use in standard list and should be monitor by health care team in order to evaluate and improve their competency of care continuously.

QUESTION?