1. Change Starts Here. The One with the Trend Graphs: Introduction to the IC-4 Measure ICPC National Coordinating Center This material was prepared by CFMC (PM-4010-080 CO 2011), the Medicare Quality Improvement Organization for Colorado under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.

2. IC-4: measure definition (J-10) Percentage of communities that can demonstrate four time series graphs showing positive trending data by intervention over four quarters. Numerator: Number of communities demonstrating improvement over a 4-quarter period Denominator: Number of communities participating in the statewide Learning and Action Network Polarity: Higher is better.

3. Evaluation and data source Evaluation Targets – No baseline target – 18-month target: 25% of Track 2 communities – 27-month target: 75% of Track 2 communities Demonstrate 4-quarters of improvement on 4 outcomes across all Track 2 communities. Data Source – Collected and reported by QIOs – Deliverable #51 (Community Intervention Plans) – Template to be provided by NCC

4. What to measure 1.Intervention implementation – Process – Reach/dosage of an intervention Counts; percentage of eligible population 2.Outcomes over time – Effect on root cause – Success of the intervention Rates; scores; rating scales Longitudinal data Best-fit line or other signal indicating improvement

5. Early considerations (10th SOW) Root cause analysis Map out the logic model – What is expected to change at the point of intervention? – Develop an operational definition of improvement and select the corresponding indicator. Existing outcomes already reported Expectations from root cause analysis How is the problem observed on site? Develop a procedure for tracking implementation and outcome. – Logistics, standardization and enforcement Plan to measure frequently to better demonstrate change. – Monthly interval yields 12 data points over given 4-quarter period (i.e., 1 year)

6. Selecting an outcome to measure Consider the following ideals: Measureable – Can it be operationalized and clearly measured? Plausible – Is it reasonably tied to the root cause? Moveable – Is it likely to change in a clinically meaningful way? Compelling – Will an observed change tell the story of improvement? Practical – Are time series data readily collected or available?

7. Resources Future presentations/discussion – Details and strategies for IC-4 Toolkit – Outcome measurement (9th SOW Care Transitions) http://www.cfmc.org/caretransitions/toolkit_measure.htm ICPC NCC contact: Tom Ventura tventura@coqio.sdps.org 303-784-5766

8. Questions? CO-ICPCTechnical@coqio.sdps.org The ICPC National Coordinating Center – www.cfmc.org/integratingcarewww.cfmc.org/integratingcare Change Starts Here.