1. 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

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

3. 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?

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

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

6. 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?

7. 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.

8. 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

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

10. 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.

11. 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.

12. 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

13. Quality improvement tools
Example: Fishbone diagram

14. quality improvement tools
Example: Control chart

15. Quality improvement tools
Example: Flow chart

16. 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.

17. 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?

18. 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.

19. 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

20. Questions and answers

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