LOYOLA

UNIVERSITY

HEALTH SYSTEM

Loyola University Chicago

CHARTrunnerShort Course Notes

Center for Clinical Effectiveness

Confidential Material to be Used for Quality Improvement Only

Acute Myocardial Infarction Inpatient Mortality

0%

5%

10%

15%

20%

25%

Jul-02 Aug-02 Sep-02 Oct-02 Nov-02 Dec-02 Jan-03 Feb-03 Mar-03 Apr-03 May-03 Jun-03 Jul-03 Aug-03

Mean = 7%

3 sigma(Each colored section represents one sigma from the mean)

UCL = Upper Control Limit

LCL = Lower Control Limit

Parts of a Control Chart

Input your data into Excel in a specific format• The first row always contains column

headings• Data should start with row 2 (do not

leave any rows blank between the column headings and the data)

• You need two columns of data for the identifier: one that CHARTrunner uses to sort your data and the other that it uses for labels on the x-axis

– Identifier in ‘integer’ format (integers 1, 2, 3, etc) or ‘date’ format (Nov-03, Dec-03, etc)

– Identifier in ‘text’ format (Jul-02, Aug-02, Sep-02, etc)

• Measurement data (88%, 100%, 95%, etc) may be one column, but may also be two columns (i.e. if you have a numerator and denominator that you want CHARTrunner to calculate and graph for you).

Once the Excel spreadsheet is constructed, updated data can periodically be added to the spreadsheet, and the file re-saved.

Formatting Cells in Excel

Highlight the column, click on ‘Format’, then ‘Cells’. Choose ‘Text’.

Open CHARTrunner

From the START button, choose CHARTrunner from the list of programs OR click on the CHARTrunner icon that was placed on the desktop when the program was installed.

When the program is first opened, you will see a list of sample charts that you can review to see how they are constructed.

When you create a chart that uses your Excel data, you are creating a ‘chart definition’. CHARTrunner stores chart definitions in working folders. You should set your working folder to one that is on a drive that is backed up (use a system drive, NOT your hard drive).

In class, we will use the SampleCharts folder installed with CHARTrunner. Right-click on the current working folder and select “set working folder” from the pop-up menu. Or, open the Setup Menu and select Set working folder.

In the ‘Browse for Folder’ form, select CHARTrunner/ SampleCharts and click ‘OK’.

Using Working Folders

Chart Definition Form – Chart Name/TypeEach tab in the Chart Definition form has a different function. You will complete these tabs working from LEFT TO RIGHT. The first is the “Chart name/Type” tab. Here, you will choose a name for your chart definition, and the type of chart.

Choose the type of data, which will most likely be Microsoft Excel.

Under “Database or File Name”, click on the Browse button to locate your Excel file. Once you locate the file, double-click on the file name in the browse window OR click ‘OK’.

Chart Definition Form – Data Source

Under ‘Table’ select the worksheet that has your data. ‘Source for Data’ should be set to ‘Table’.

After you selected your table/worksheet, the grid at the bottom of the form will list information from that Excel worksheet. Assign the spreadsheet fields so that CHARTrunner knows how to handle the data in each column. You may use two ‘identifiers’ if you want to sort by one and have CHARTrunner display the other.

Chart Definition Form – Data Definition

NOTE: If you later return to the data definition screen and find that the columns ‘not assigned’ are missing, click on the ‘Refresh Columns’ button. This usually happens after you’ve defined and created the chart.

Select ‘Use temporary limits computed from data in the chart’.

Although you are able to select the control limits to be used on your charts, it is strongly recommended that you do not do anything with these fields. This allows CHARTrunner to calculate the limits for you. These calculations are made based on the data, and, along with the test rules, they are what the program uses to mark the “special cause variation”.

Later, when you view the completed graph, you may assign “phases” to your graph. When you do this on your graph, CHARTrunner will calculate the ‘Saved control limits’ and fill in the form on the “Limits” tab automatically.

Chart Definition Form – Limits

Process stable in both phases (no special cause variation).Amount of variation is decreased in second phase.

Mea

sure

men

t S

cale

CONTROL CHART WITH PHASESIndividuals

Jan

03

Feb 0

3

Mar

03

Apr 0

3

May

03

Jun

03

Jul 0

3

Aug 0

3

Sep 0

3

Oct 0

3

Nov 0

3

Dec 0

3

Jan

04

Feb 0

4

Mar

04

Apr 0

4

0

50

100

150

200

250

300

350

400

Mean = 174.8

Mean = 64.5

Baseline

Implementationor change in

processoccurred here

Set the chart options as shown on the illustration below. If you choose “Color 1,2,3….” the default colors in CHARTrunner will be used. For continuity of control charts throughout the organization, please leave the colors as they are in the CHARTrunner default (lime, lemon, raspberry). If you are sharing a computer, please do not change default settings as they will remain the way you set them for everyone who uses that computer.

Chart Definition Form – Control Chart

The ‘X-axis Y-axis’ tab is most often overlooked because it is hiding behind the ‘chart options’ tab. This area allows you to define your x- and y-axes. Label the X-axis with the unique identifier that is most likely the column you formatted as ‘text’ in the Excel file. CHARTrunner will know that the other ‘identifier’ is the one it will sort by.

Chart Definition Form – Control Chart (X-axis, Y-axis tab)

It is a good idea to let the software automatically scale your y-axis. Most often, this is fine for the user’s needs. Sometimes, however, you may want to go back and click on “user scale” to define the maximum, minimum, and increments for the y-axis (i.e. if you want more white space above and below the three sigma area).

You may also type in a label and a number which will insert a horizontal line in your graph (i.e. if you have a target for your data).

This area allows you to enter titles onto the graph. You may enter titles or other information at the top (left, middle or right) or bottom (left, middle, right). The bottom areas are ideal for a confidentiality statement, which should be displayed on all material that is not public information.

Chart Definition Form – Titles

You may also enter the label for your x-axis under ‘left title’. ‘Right title’ is an option also if you choose to enter information that will be displayed at the right side of the graph. You may also choose to add other information in your title. Feel free to try out these options and choose what works best for you.

Set “How to label lines” to “label lines with name and value. This will put the value of your mean on your chart.

This area defines how you want the chart to be generated. It is recommended that you check “EMF (Enhanced Meta File)” because this file type, when inserted into PowerPoint, will allow you to make minor formatting changes. JPG format is a picture, much like a photograph, which cannot be changed later.

Browse to where you want to place the chart image and give it a name. You may give it the same name as the chart definition so that you will later know that these are related to each other. They will have different file extensions, which will make it easier to distinguish later.

Check “Landscape”

Check “Close data source after drawing chart”. This allows you to move back and forth from CHARTrunner to Excel without a problem, should you need to make changes in the spreadsheet. If it is not checked, CHARTrunner will stay connected to the Excel file after you view your graph, and that file will then be “in use” until both applications are closed.

Click on OK to save the chart definition.

Chart Definition Form – Misc.

The Chart Definition is done….now what?

Now that you’ve created a “chart definition”, your chart definition will be displayed in the list of charts that are saved in your CHARTrunner “working folder”.

Single-left-click on the name of your chart definition to highlight it. Right-click and you will be given a number of options:

Display chart – This displays the graph in a browser on your computer.Print chart – Send the graph directly to your computer. However, it defaults to a vertical graph in portrait, and doesn’t appear to be as pleasing as inserting it into PowerPoint.Generate chart image file – This tells CHARTrunner to generate the graph and send it to the image file you specified under the “Misc” tab in the “Chart Definition Form”.Modify chart – This takes you back to the “Chart Definition” for that chart.Delete chart – Deletes the chart definition.Create new chart – Opens up a new “Chart Definition” form. Copy – Creates a “Copy of…” the highlighted “Chart Definition”. This is especially useful if you have multiple columns of data you want to graph from the same workbook and worksheet. Create clipCHART – Don’t worry about this.

Separating data over time into PhasesWhen an change has occurred in a process, you may want to separate your data into phases. This allows for the mean and control limits to be recalculated based on the data in that phase. When viewing the chart in CHARTrunner:Click on the right side of the data point (1) that should be included and drag to the right until you have highlighted all the data points in the first phase (1-2). Right-click in the gray area and choose “Compute Limits”. Do the same for the next phase(s) (2-3). Make sure to include all data points in the graph in at least one phase.

What appeared to be an “out of control process” is now a changed process that is “in control”.

1

2

3

Save the chart image by: 1) selecting “Save Chart Image” from the chart’s ‘File’ drop-down menu (see below), or 2) choosing “Generate Chart Image File” from the list of chart definitions (as described previously).

Saving a Chart as a Picture

Name the file. Under the “Save as type” dropdown list, choose “Windows Enhanced Metafile”.

Saving a Chart as a Picture

Open a new PowerPoint presentation. Select: Insert/ Picture/ From File

Locate and select your *.emf picture file in the directory where you saved it

Inserting your *.emf Picture Fileinto PowerPoint

Formatting the PictureTo format the picture, right-click on the picture and select “grouping”, then “ungroup”.

This allows you to adjust fonts, change decimals to percents, adjust the layout of text, adjust the picture in any other way you wish. This DOES NOT in any way change your CHARTrunner files.

Caution: When you ungroup the picture, all parts can then be changed. Be careful not to move something you don’t want moved. When all changes are made, select all the parts of the graph and select “grouping”, then “group”.

The CCE is currently supporting 2 options of submitting Control Charts for CCE Quality Reports

Option 1:

Submit the Control Chart(s) in one separate PowerPoint File

Option 2:

Send the PowerPoint File into the Word Document (below)

This allows you to resize and move the slide similar to Excel graphs

Chartrunner can be downloaded from the Center for Clinical Effectiveness (CCE) webpage. Instructions for downloading the software and running the test rules file are also included as a link on the website.

Accessing CHARTrunner

www.lumc.edu/cce

Problems and Questions

Many Loyola employees will be trained in the next few months. In order to address problems and questions regarding the downloading of CHARTrunner, using the program, working with your data, and interpreting your control charts, we have arranged for brown-bag lunch sessions.

Please bring your CHARTrunner files AND the Excel files to these help sessions.

These sessions will be on Tuesdays and Thursdays and will run through the end of May. Starting in June, they will be held weekly on Tuesdays. Check the CCE website for more training sessions and brown bag lunches.

http://www.luhs.org/depts/cce/tools/variation.htm

The Center for Clinical Effectiveness will provide you with a CHARTrunner certification letter once you complete the assignment below. This may be done back at your office. ASSIGNMENT: Within 7 days of completing the CHARTrunner class•Create a graph in CHARTrunner that has a minimum number of 12 data points.•Appropriately label x- & y-axes, and necessary titles.•Insert this graph into a PowerPoint slide.•Add a text box on the slide, or add an additional slide explaining your experience.

•Is the data real?•Did you have difficulty with anything?•Would you like CCE to follow-up with you?

•Save it, and email it to:Michael Wall, mwall@lumc.edu

Please include your name that will allow us to print CHARTrunner certificate.

We request that you attend a brown-bag session to receive your certificate and work on further graph refinements. Please bring your CHARTrunner file AND Excel file. Please register for brown-bag sessions via email.This certification can be included with your annual performance review.

Obtaining a Certificate of Course Completion