Measurement: the why, the what, and the howPaula Griswold, MPH

Executive DirectorMassachusetts Coalition for the Prevention of Medical Errors

Nora McElroy, MPHGeneral Epidemiologist, Massachusetts Department of Public HealthBureau of Infectious Disease Prevention, Response and Services, Epidemiology Program

Laurie Herndon, GNP Massachusetts Senior Care Foundation

Why measure?1. For you

Track progress towards key improvement goals “How do we know a change is an improvement?”

What gets measured gets done

2. For us Your experience and progress are a key component

of how we evaluate our efforts (surveys, lessons shared on monthly reports, measures over time)

3. For the CDC (our funder) National recognition Continued funding and opportunity to support change

in the community

How to choose measures? Looking at processes or outcomes that

demonstrate the changes in practice we are encouraging

Good enough measures Balance value and effort Don’t let the perfect be the enemy of the good

We’ll give you core measures And tools for reporting and and sharing

Future review of antibiograms

What we measure & hope to seeHow we know a change is an improvementMeasure Percent of treated UTIs that

meet the “Protocol criteria” (ABCs)

Rates/10,000 resident days new UTI diagnoses laboratory orders for urine

culture healthcare acquired C.

difficile (HA-CDI)

We hope to see Increase in UTIs meeting

criteria

Decreases in events due to less mis-identification of asymptomatic bacteriuria

Measurement for real time learning Review and share progress monthly

How you did: excel file with measures What you did: monthly report is in your packet you

will receive email reminders. Teach your staff about the value of

measurement in quality improvement Be on the lookout for unintended

consequences

Don’t Forget The Law Of Unintended Consequences

UTI diagnosis missed UTI treatment

delayed Clinical

decompensation Hospital transfer

One Approach For Monitoring For Unintended Consequences

Watching for trends…

Monthly Measurement & Reporting

How it works

Data Collection Tools and Forms Data collection & reporting instructions

Chart review form An optional tool for applying the definition of a UTI in

LTC

Excel workbook Documentation of monthly chart reviews and summary

statistics to be submitted monthly

What we are going to measure

Rates* over time of: new UTI cases laboratory orders for urine culture healthcare acquired C. difficile (HA-CDI)

Percent of treated UTIs that meet the ABCs

criteria

* All rates calculated per 10,000 resident days

Collaborative Results 2012-2013(N=17)

12

2 types of measures:

Summary statistics to track rates

Chart review for evaluating whether ABCs criteria are met

Overview of Measures

Calculating a Rate The rates are calculated as in the following

example:

(UTIs/Resident-days)*10,000

Calculating Resident-days What are Resident-days?

The denominator used to calculate infection rates

Calculate resident days by adding up the daily census for an entire month Day 1 census + Day 2 census + ……..… + Day 31 census

If a facility has 100 beds and 90 were in use every day in October the resident days for October would be 2,790

(90*31)

Include only residents aged 70+ in this calculated

Selecting Residents for Data Collection

Include residents 70 years of age or older

A UTI case is any new, not recurrent, diagnosis and treatment. Include patients that are treated, not just those that meet

the ABCs

For C difficile cases, include patients with symptoms beginning on the fourth day after admission to your facility or later

Summary data spreadsheet

Summary Data Tutorial

July 2013: 1 C diff case, 5 UTIs, 50 urine cultures,3621 resident days

Aug 2013: 0 C diff cases, 4 UTIs, 45 urine cultures, 3599 resident days

Sep 13: 0 C diff cases, 2 UTIs, 43 urine cultures, 2597 resident days

Sample summary data worksheet

2 types of measures:

Summary statistics for rates

Chart review for evaluating whether ABCs criteria are met

Overview of Measures

Chart Review Data Collection Form Chart reviews will examine the characteristics of all

patients treated for UTIs and whether they met the ABCs criteria

Review up to 20 charts a month If you have more than 20 UTIs in a month, review

the first 20 infections, otherwise review all infections

Use the optional chart review form to guide your completion of the Excel spreadsheet but only the spreadsheet will be submitted

Measurement: Practical Application

Case 1

October 15, 2013

Shangri La Nursing Home

Chart review data collection form

Chart review data spreadsheet

Completing a Chart Review with the Data Collection Form

1 October X

XX

X

X

X

October 3, 2013

X

Chart Review Spreadsheet

Document chart review form answers and transcribe them onto the Data Submission Excel Spreadsheet

Answer Yes or No to each of the questions

After completing the chart reviews each month, email the spreadsheet to

EBiocchi@macoalition.org

Completing the Chart Review Spreadsheet

Case Study 1

Case Study Walkthrough

Read through the remaining two case studies and fill in the sample worksheet and data submission form

Case Study Summary

Summary There are three tools to assist the collection of

collaborative data

Chart Review Data Collection Form (paper) Chart Review Spreadsheet in the Excel file Summary Data Spreadsheet in the Excel File

Submit the Excel file by the 7th of each month to: Ebiocchi@macoalition.org

Thank you!

Any Questions?

Nora: nora.mcelroy@state.ma.us Susanne: sss@hcqi.com Laurie Herndon, GNP:

lherndon@maseniorcare.org