Performance Measurement: How Is Data Used in Quality Improvement ? Title I Mental Health Providers Quality Learning Network Quality Learning Network Johanna Buck, Quality Consultant NYS DOH AIDS INSTITUTE November 28 th, 2005

Why data? A quick review…  The basis of the scientific approach is collecting and using data to guide your thinking  A variation of the scientific approach (QI) is a systematic way for individuals and teams to solve problems and improve processes

Value in using data  Data enhances all the other tools used in problem solving – knowledge, experience, insight and intuition  Three ways data helps in problem solving: 1. separates what you thinkis happening from what is really happening 1. separates what you think is happening from what is really happening 2. establishes abaseline 2. establishes a baseline 3. helps avoid putting ineffective solutions in place 3. helps avoid putting ineffective solutions in place

When is data used in the improvement process ?  To establish the baseline  To gather more detailed information on a process to help select a solution  To assess how well an improvement is functioning  To demonstrate to others an improvement action – comparison to baseline  To monitor an improvement to make sure it is not slipping

Performance data and HIV care  Most HIV quality programs use quality of care indicators  Title I indicators are based on specific standards of care derived through formal group decision-making methods  Review organizations, software – IPRO, NYCSHRO, HIVQUAL

Criteria for selecting indicators for measurement  Relevance  Measurability  Improvability  Validity

HIVQUAL Publications Performance Measurement Guide

I have my data. What do I do now?  When data is initially reviewed, ask a series of questions: What are the major findings? What immediate steps must be taken?  Next, develop a plan: for overall improvement; for a project to address specific findings; or to continue monitoring a specific area.

How can data help set quality priorities ?  Goals need to be prioritized in order to conserve resources, gain staff focus and buy-in and direct efforts towards issues that most need it

How can data help set quality priorities ?  Three criteria to consider: 1. Frequency – how many patients did this effect? 1. Frequency – how many patients did this effect? 2. Impact – what is the effect on patient’s health if they did not receive this care? 2. Impact – what is the effect on patient’s health if they did not receive this care? 3. Feasibility – can you realistically do something about the problem? 3. Feasibility – can you realistically do something about the problem?

Using Data in Specific Quality Improvement Projects  Helps determine if improvement is actually taking place. Remember- All improvements require change, but not all changes are improvements !

Tips for Measurement #1  Plot data over time Tracking a few key measures over time is the single most powerful tool a team can use. Tracking a few key measures over time is the single most powerful tool a team can use. % Patients With a Visit in Past Three Months

Tips for Measurement #2 The perfect is the enemy of the good.

Tips for Measurement #3 Sampling

Tips for Measurement #4 Integrate measurement into the daily routine

Tips for Measurement #5 Use both words and numbers

In Conclusion QI without Data?  A “hit or miss” endeavor  An investment of time and energy to improve a service that may not be critical  An improvement/change that may not have an impact comparable to the required inputs

In Conclusion Why Data?  Improved client care  More efficient processes  Greater employee satisfaction  Opportunities to reduce costs  Ability to sustain improved services

Final Thought … If you don’t have time to do it right, when do you have time to do it over?