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Measurement: the why, the what, and the howPaula Griswold, MPH
Executive DirectorMassachusetts Coalition for the Prevention of Medical Errors
Nora McElroy, MPHGeneral Epidemiologist, Massachusetts Department of Public HealthBureau of Infectious Disease Prevention, Response and Services, Epidemiology Program
Laurie Herndon, GNP Massachusetts Senior Care Foundation
Why measure?1. For you
Track progress towards key improvement goals “How do we know a change is an improvement?”
What gets measured gets done
2. For us Your experience and progress are a key component
of how we evaluate our efforts (surveys, lessons shared on monthly reports, measures over time)
3. For the CDC (our funder) National recognition Continued funding and opportunity to support change
in the community
How to choose measures? Looking at processes or outcomes that
demonstrate the changes in practice we are encouraging
Good enough measures Balance value and effort Don’t let the perfect be the enemy of the good
We’ll give you core measures And tools for reporting and and sharing
Future review of antibiograms
What we measure & hope to seeHow we know a change is an improvementMeasure Percent of treated UTIs that
meet the “Protocol criteria” (ABCs)
Rates/10,000 resident days new UTI diagnoses laboratory orders for urine
culture healthcare acquired C.
difficile (HA-CDI)
We hope to see Increase in UTIs meeting
criteria
Decreases in events due to less mis-identification of asymptomatic bacteriuria
Measurement for real time learning Review and share progress monthly
How you did: excel file with measures What you did: monthly report is in your packet you
will receive email reminders. Teach your staff about the value of
measurement in quality improvement Be on the lookout for unintended
consequences
Don’t Forget The Law Of Unintended Consequences
UTI diagnosis missed UTI treatment
delayed Clinical
decompensation Hospital transfer
One Approach For Monitoring For Unintended Consequences
Watching for trends…
Monthly Measurement & Reporting
How it works
Data Collection Tools and Forms Data collection & reporting instructions
Chart review form An optional tool for applying the definition of a UTI in
LTC
Excel workbook Documentation of monthly chart reviews and summary
statistics to be submitted monthly
What we are going to measure
Rates* over time of: new UTI cases laboratory orders for urine culture healthcare acquired C. difficile (HA-CDI)
Percent of treated UTIs that meet the ABCs
criteria
* All rates calculated per 10,000 resident days
Collaborative Results 2012-2013(N=17)
12
2 types of measures:
Summary statistics to track rates
Chart review for evaluating whether ABCs criteria are met
Overview of Measures
Calculating a Rate The rates are calculated as in the following
example:
(UTIs/Resident-days)*10,000
Calculating Resident-days What are Resident-days?
The denominator used to calculate infection rates
Calculate resident days by adding up the daily census for an entire month Day 1 census + Day 2 census + ……..… + Day 31 census
If a facility has 100 beds and 90 were in use every day in October the resident days for October would be 2,790
(90*31)
Include only residents aged 70+ in this calculated
Selecting Residents for Data Collection
Include residents 70 years of age or older
A UTI case is any new, not recurrent, diagnosis and treatment. Include patients that are treated, not just those that meet
the ABCs
For C difficile cases, include patients with symptoms beginning on the fourth day after admission to your facility or later
Summary data spreadsheet
Summary Data Tutorial
July 2013: 1 C diff case, 5 UTIs, 50 urine cultures,3621 resident days
Aug 2013: 0 C diff cases, 4 UTIs, 45 urine cultures, 3599 resident days
Sep 13: 0 C diff cases, 2 UTIs, 43 urine cultures, 2597 resident days
Sample summary data worksheet
2 types of measures:
Summary statistics for rates
Chart review for evaluating whether ABCs criteria are met
Overview of Measures
Chart Review Data Collection Form Chart reviews will examine the characteristics of all
patients treated for UTIs and whether they met the ABCs criteria
Review up to 20 charts a month If you have more than 20 UTIs in a month, review
the first 20 infections, otherwise review all infections
Use the optional chart review form to guide your completion of the Excel spreadsheet but only the spreadsheet will be submitted
Measurement: Practical Application
Case 1
October 15, 2013
Shangri La Nursing Home
Chart review data collection form
Chart review data spreadsheet
Completing a Chart Review with the Data Collection Form
1 October X
XX
X
X
X
October 3, 2013
X
Chart Review Spreadsheet
Document chart review form answers and transcribe them onto the Data Submission Excel Spreadsheet
Answer Yes or No to each of the questions
After completing the chart reviews each month, email the spreadsheet to
Completing the Chart Review Spreadsheet
Case Study 1
Case Study Walkthrough
Read through the remaining two case studies and fill in the sample worksheet and data submission form
Case Study Summary
Summary There are three tools to assist the collection of
collaborative data
Chart Review Data Collection Form (paper) Chart Review Spreadsheet in the Excel file Summary Data Spreadsheet in the Excel File
Submit the Excel file by the 7th of each month to: [email protected]