Causal / Barrier Analysis Florida EQR Quarterly Meeting Breakout Session #1 Florida EQR Quarterly Meeting January 16, 2008 Presented by: Cheryl Neel, RN, MPH, CPHQ Manager, Performance Improvement Projects Assisted by: Wendy Talbot, MPH, CHCA Project Leader

Presentation Outline Overview of causal/barrier analysis MCO-type group activity Report activity results to the group Questions and answers

Where are you now with your PIP? Study topic chosen (Activity 1) Study question(s) developed (Activity 2) Study indicator(s) developed with eligible population defined (Activities 3 and 4) Use sound sampling techniques (optional) (Activity 5) Baseline data results completed (Activity 6) What are the next steps?

Now what? Once you know how you are doing at baseline, what interventions will produce meaningful improvement in the target population?

Next steps Data analysis Causal/barrier analysis R1, R2 ,R3 Develop and implement interventions

Data analysis–what does it mean? What did the analysis of baseline results show? How do results compare to national benchmarks, if available? If no national benchmarks, are there internal results available to compare the baseline results? What do the results mean? Are there problems with the data? Do providers need to be educated? Are members not compliant with guidelines?

How do you assess improvement strategies? Activity 7: Assess Improvement Strategies: Real, sustained improvements in care result from a continuous cycle of measuring and analyzing performance, and developing and implementing systemwide improvements in care. Interventions are designed to change behavior at an institutional practitioner or member level. Evaluation element number 1: Related to causes/barriers identified through data analysis and quality improvement (QI) processes.

What is a Causal/barrier Analysis? A causal/barrier analysis is: A systematic process for identifying the problem. A method for determining what causes the barriers. A way to identify what improvement opportunities are available. Causal/barrier analysis has also been called: Root cause analysis

Developing improvement strategies Identify barriers to reaching improvement Opportunities for improvement? Determine intervention(s)

How do I perform a causal/barrier analysis? Determine why an event or condition occurs. What is the problem? - Define the problem and explain why it’s a concern. Determine the significance of the problem. - Look at the data and see how the problem impacts your consumers and/or health plan.

How do I perform a causal/barrier analysis? (cont.) 3. Identify the causes/barriers. - Conduct analysis of chart review data, surveys, focus groups. - Brainstorming at quality improvement committee meetings. - Literature review. 4. Develop/implement interventions based on identified barriers.

Causal/barrier methods and tools Quality improvement committees Develop an internal task force Focus groups Consensus expert panels Tools: Fishbone Control chart Flow chart (process mapping) Barrier/intervention table

Quality improvement tools Example: Fishbone diagram

quality improvement tools Example: Control chart

Quality improvement tools Example: Flow chart

Quality improvement tools Example: Barrier/intervention table Interventions taken for improvement as a result of analysis. List chronologically the interventions that have had the most impact on improving the measure. Describe only the interventions and provide quantitative details whenever possible (e.g., “hired 4 customer service reps” as opposed to “hired customer service reps”). Do not include intervention planning activities. Date Implemented Check if ongoing Interventions Barriers that Interventions Address 9/1/04 X Education to mental health providers on the importance of coordination of care. No documentation of mental health services in PCP medical record.

How was the intervention chosen? By reviewing the literature Evidence-based Pros and Cons Benefits and Costs Develop list of potential interventions – what is most effective?

Interventions checklist Analyze barriers (root causes) Choose and understand target audience Select interventions based on cost/benefit Implement interventions Track intermediate results (optional) Remeasure Modify interventions as needed You can use this guide when you are onsite at the M+CO to give advice THINK OF AN EXERCISE WHERE THE GROUP GETS UP AND USES THEIR MUSCLES -- ?PUT UP 3 CHART PAD PAGES WITH AN INTERVENTION(S) ON EACH. HAVE THEM WALK AND READ EACH AND THEN PUT A STAR ON THE ONE THAT THEY THINK IS MOST EFFECTVE. Meanwhile be changing to next file.

Breakout session Using MCO-type group process Using your collaborative PIP Identify a facilitator and a scribe for each group Apply your current collaborative PIP experience Report out to the group

Questions and answers

HSAG contacts Cheryl Neel, RN, MPH, CPHQ cneel@hsag.com 602.745.6201 Denise Driscoll ddriscoll@hsag.com 602.745.6260