Data Analy)cs: The DNP’s Powerful Tool in the Quest for Innova)on in Prac)ce

MarthaSylvia,PhD,MBA,RN2017Na7onalDNPConference

Objec)ves • Attheendofthispresenta7on,theDNPwillbeableto:

•  Describeanaly7csinthecontextofthecurrenthealthcareclimate•  Describetheevolu7onofanaly7capplica7onsinDNPprac7cesincetheincep7onoftheDNP

•  Applyanaly7csolu7onstounderstandtheimpactofhealthdispari7esonhealthcareoutcomes

•  Ar7culatethemul7plewaysinwhichdataandanaly7cscanbeusedtoadvanceDNPinnova7ons

hGps://www2.deloiGe.com/us/en/pages/life-sciences-and-health-care/ar7cles/macra.html

Healthcare Analy)cs Adop)on Model

Dale Sanders Copyright © 2013 Health Catalyst. https://www.healthcatalyst.com/white-paper/healthcare-analytics-adoption-model

Precision Health Precisionhealthincludesgenomicsandotherphysiological,psychological,environmental,andethicalfactorsthatarecentraltothedevelopmentandtes7ngofindividualizedtreatmentsforpersons,families,andcommuni7esandisoneofthemostexci7ngareasofscience.Nursesshouldbeattheforefrontofprecisionhealtheffortsandcertainlyintegraltointerdisciplinaryteamsexploringhowtobesttailordiagnos7csandinterven7onstoindividualizedpa7entfactors.Courtesyof:DebraE.Lyon,RN,PhD,FAAN,ThomasM.andIreneB.KirboEndowedChair,Execu7veAssociateDean,UniversityofFloridaCollegeofNursing

Devonet.al."SeVngnursingsciencepriori7estomeetcontemporaryhealthcareneeds."NursingOutlook64(4):399-401

ShaEering a Paradigm!

“Precisionhealthoffersthepromiseoftailoringtreatmenttoindividualsbasedontheirgene7cs,lifestyle,andenvironment”

Courtesyof:DebraE.Lyon,RN,PhD,FAAN,ThomasM.andIreneB.KirboEndowedChair,Execu7veAssociateDean,UniversityofFloridaCollegeofNursingP.A.(2017)."AdvancingScience,ImprovingLives:NINR'sNewStrategicPlanandtheFutureofNursingScience."JournalofNursingScholarship49(3):247-248

Which emerging technologies are you planning to invest in in 2017?

http://www.healthcareitnews.com/slideshow/survey-results-look-ahead-healthcare-it-2017?page=1

Ques)on

“Thefocusfor(DNP)facultyandstudentsshouldbeonthetransla7onofevidencetoimprovethe

qualityofcareandpa7entoutcomes”

“Prac7ce-focused(DNP)graduatesarepreparedtogeneratenewknowledgethroughinnova7onofprac7cechange,thetransla7onofevidence,andtheimplementa7onofqualityimprovementprocesses…toimprovehealthorhealthoutcomes.

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AmericanAssocia7onofCollegesofNursing.(2006).Theessen'alsofdoctoraleduca'onforadvancednursingprac'ce.AmericanAssocia7onofCollegesofNursing.(2015).Thedoctorofnursingprac'ce:Currentissuesandclarifyingrecommenda'ons.

Demonstra7ng“improvement”impliesanunderstandingof:

• Howtodefineimprovement• Howtomeasureimprovement• Howtoanalyzedataforimprovement• Howtodemonstrateimprovement

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Sylvia,M.,TerhaarM.(2014).AnApproachtoClinicalDataManagementfortheDNPCurriculum.JournalofProfessionalNursing.30(1).56-62.

The DNP Need for Data Management Knowledge and Skills

Clinical Data Management (CDM)

“Theprocessofplanning,designing,collec7ng,cleansing,manipula7ng,

analyzing,andrepor7ngdatageneratedintheassessment,development,delivery,andevalua7onofhealth-relatedinterven7ons,products,and

services.”

15

Sylvia,M.,TerhaarM.(2014).AnApproachtoClinicalDataManagementfortheDNPCurriculum.JournalofProfessionalNursing.30(1).56-62.

16

Sylvia,M.,TerhaarM.(2014).AnApproachtoClinicalDataManagementfortheDNPCurriculum.JournalofProfessionalNursing.30(1).56-62.

Evalua)ng Quality of DNP Scholarly Work •  BasedontheUncertainty,Pace,ComplexityModel•  ComplexityandRela7onshiptoQualityTargets

•  Innova7on•  Design•  Sta7s7cs•  Transla7onFramework

•  OutcomesofProject•  Innova7onNovelty,Complexity,Pace•  TechnologicUncertainty•  BusinessGoal•  Customer•  StrategicGoals

Evalua)ng Quality of DNP Scholarly Work • QualityRela7vetoCohort• QualityRela7vetoTarget•  FinancialImpact•  SystemImpact

Terhaar, M.F., Sylvia M., (2016). Scholarly work products of the doctor of nursing practice: One approach to evaluating scholarship, rigor, quality, and impact. Journal of Clinical Nursing. 25.163-74

Source:DowlingJ.,HernandezC.,Miles,H.(2017).TheDNPProject:Quandriesfornursingscholars.NursingOutlook.65(1),84-93.

Ques)on

Increased Rigor of Capstone Projects

•  Studentsdemonstratetheabilityto:√ Createandimplementanevalua7onplan√ Applyconceptsofsamplesizedetermina7onusingpoweranalysis√ Describetechniquesfordatacleansingandmanipula7on√ Useexploratorydataanalysistechniquestounderstandpopula7onaGributesandsamplingbias√ Appropriatelyapplysta7s7caltechniquestoadjustforbias√ Presentprojectresultsinameaningfulway

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Health Dispari)es vs. Health Inequi)es

•  “…simpledifferencesinhealtharenecessarybutnotsufficient.”(Adler,2006)

•  “unnecessaryandavoidable;…unfairandunjust.

•  EquityinhealthimpliesthateveryoneshouldhaveafairopportunitytoaGaintheirfullhealthpoten7aland…thatnooneshouldbedisadvantagedfromachievingthispoten7al…”(Whitehead,1992)

Healthy People 2020 •  1of4OverarchingGoals:

•  Achievehealthequity,eliminatedispari7es,andimprovethehealthofallgroups.

•  HealthyPeople2020definesahealthdisparityas“apar7culartypeofhealthdifferencethatiscloselylinkedwithsocial,economic,and/orenvironmentaldisadvantage.Healthdispari7esadverselyaffectgroupsofpeoplewhohavesystema7callyexperiencedgreaterobstaclestohealthbasedontheirracialorethnicgroup;religion;socioeconomicstatus;gender;age;mentalhealth;cogni7ve,sensory,orphysicaldisability;sexualorienta7onorgenderiden7ty;geographicloca7on;orothercharacteris7cshistoricallylinkedtodiscrimina7onorexclusion.”

http://www.healthypeople.gov/

Ques)on

Source: University of Wisconsin Population Health Institute. County Health Rankings 2013. Accessible at www.CountyHealthRankings.org

Life Expectancy at birth, by Hispanic origin, race, and sex, US, 2010

NCHS Data Brief, No 99, July 2012, found at http://www.cdc.gov/nchs/data/databriefs/db99.htm

by Place

Life Expectancy by Poverty

The DNP Skill Set and Analy)cs: Tackling Health Dispari)es •  LeadershipinHealthCareOrganiza7onsforAdvancedAnaly7csandInforma7csInfrastructure

• Understanding,Priori7zing,andImplemen7ngDataInfrastructurestoPromoteDataAvailabilityforMeasuringDispari7es

• Designingevidence-basedtransla7onworktoaccountforhealthdispari7es

• Usinganaly7ctechniquestoaccountforhealthdispari7es• Recognizinganaly7cresultsthatintroducebiasandhaveunintendedconsequencesforthosewithhealthdispari7es

•  Thesetypesofanaly7cresultsleadtopolicieswhichcanleadtosystema7cdiscrimina7oninhealthcaredelivery

Ques)on

Source: University of Wisconsin Population Health Institute. County Health Rankings 2013. Accessible at www.CountyHealthRankings.org

Infrastructure MaEers

Source: Hadi Kharrazi, Center for Population Health IT Johns Hopkins Bloomberg School of Public Health

Jalali,Aet.al.(2012).LeveragingCloudCompu7ngtoAddressHealthDispari7es:AnAnalysisoftheSPHPS.OnlineJournalofPublicHealhInforma7cs.Accessibleatfile:///C:/Users/Martha/Documents/DNP%20Conference/VPC%20Ar7cle.pdf

Ques)on

Analy)c Technique: Risk Adjustment “Accoun7ngforpa7ent-relatedfactorsbeforeexaminingoutcomesof

care”Iezzoni,2013•  Factors

•  Gene7cs•  Demographics•  Clinicalfactors•  Psychosocial,socioeconomic,andenvironmentalfactors•  Health-relatedbehaviorsandac7vi7es•  Qualityoflife,aVtudes,percep7ons

Figure 17.2 - Florence Nightingale visualized causes of death throughout the Crimean War with the

invention of the coxcomb graph

Source: (Nightingale, 1858)

Outcome of Care: BMI “Ameasureofbodyfatbasedonheightandweightthatappliesto

adultmenandwomen”

• NIHBMICalculator•  (WeightinPounds/HeightinInches2)*703• BMICategories:

•  Underweight=<18.5•  Normalweight=18.5–24.9•  Overweight=25–29.9•  Obesity=BMIof30orgreater

History of BMI Development • DevelopedinBelgiuminEarly19thCentury,byQuetelet,amathema7cian

• Developedtheequa7onbycrea7ngaformulathatmatchedthedatacollectedinBelgium

• Developedtounderstandaggregatesofpeopletomeasuretrendsinapopula7on

• Warned“Itisverymisleadingwhenappliedtoindividuals”

Top10ReasonsWhytheBMIisBogus.NPR(2009).hGp://www.npr.org/templates/story/story.php?storyId=106268439

BMI as an Outcome: Not so Simple • Rela7onshipsbetweenBMIandfatnessandBMIandmorbidityvaryacrosspopula7ons

•  SomeChineseandSouthAsianpopula7onsincreasedchronicdiseaseriskoccursatlowerBMI

• BMIdoesnotgiveameasureofintra-abdominal(visceral)vs.lowerbodyfatness

•  Highvisceralfatisindependentlylinkedtochronicillnessriskandcancer•  Highlowerbodyfatrela7vetowaistisassociatedwithlowerchronicillnessrisk

•  AtanyBMIFemaleshaveagreaterpropor7onofbodyweightasfatandagreaterpropor7onoflowerbodyfatthanmales

Ulijaszek,S.,Lofink,H.ObesityinBioculturalPerspec7ve.(2006).AnnualReviewAnthropology.35:337-60.

BMI as an Outcome: Not so Simple

•  Classifica7onofchildhoodobesityusingBMIproblema7c•  Variabilityofgrowthratesofchildrenwithinandbetweenpopula7ons•  BMIchangeswithage•  Manyhealtheffectsofchildhoodobesityexperiencedinadulthood

•  Invertedrela7onshipbetweensocialclassandobesity•  Inaffluentna7onsminoritypopula7onsandruralcommuni7esshowthehighestratesofobesity

•  Thereisgreatdiversityinobesity-relatedgenotypes•  Phenotypedependentonmanyfactors•  Naturalselec7onforthecapacitytosaveandstoreenergyindifferentpopula7ons,geographicareas,anddifferentkindsofenvironmentalpressure

Ulijaszek,S.,Lofink,H.ObesityinBioculturalPerspec7ve.(2006).AnnualReviewAnthropology.35:337-60.

WorkplaceWellnessProgramsCharacteris7csandRequirements.KFFIssueBriefMay2016.hGp://files.kff.org/aGachment/Issue-Brief-Workplace-Wellness-Programs-Characteris7cs-and-Requirements

Summary • Describeanaly7csinthecontextofthecurrenthealthcareclimate• Describetheevolu7onofanaly7capplica7onsinDNPprac7cesincetheincep7onoftheDNP

• Applyanaly7csolu7onstounderstandtheimpactofhealthdispari7esonhealthcareoutcomes

• Ar7culatethemul7plewaysinwhichdataandanaly7cscanbeusedtoadvanceDNPinnova7ons

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MarthaSylvia,PhD,MBA,RN

ForestVueHealthcareSoluVons915FollyRad,#83

Charleston,SC29412(843)375-8300

Martha.Sylvia@forestvue.com