Phase 2. Assess Data & Set Priorities for Improvement
Key Change 2.1. Use Data to Set Priorities
Most medical practices would like to improve aspects of their clinical and business processes
and outcomes. Whether you want to decrease your patients' cardiovascular risk or increase
staff satisfaction, you'll need data. Baseline data help you assess the current state of care
and provide a picture of where you are succeeding and where improvement is needed. In
other words, the baseline data help to inform the priorities for improvement. Ongoing data
collection helps you see if the improvements you are implementing make a difference.
In reality, data may not be readily available for the issues that you care most about. If
you believe a particular clinical goal is important to tackle—such as improving diabetes
processes and outcomes—it might be worth asking your information support team
to conduct a special data run or a chart audit to gather baseline data. A sample of about
25 charts should be enough to get you started. For more information on what clinical data
might be interesting to collect and measure, the National Quality Forum Starter Kit can
help (go to the tool in key change 2.2 below).
To support improvement in clinical measures, practices often need to understand their business infrastructure and capabilities. Below are tools that can help your team collect
data about the five areas teams are most often interested in:
- Patient satisfaction & activation.
- Staff satisfaction.
- Office processes & efficiency.
- Financial system function.
- Available resources in the community.
One advantage to incorporating both clinical and non-clinical goals in your improvement
efforts is that it enables creative thinking when implementing strategies for change.
Sites can often brainstorm ways to improve multiple measures at once. Keep in mind that
collecting this information is not an end in and of itself; it is only useful in guiding decisions
|Patient Satisfaction & Activation
Assess your patients' experiences with chronic care.
|Patient Assessment of Chronic
Illness Care (survey)12
Patient Assessment of Chronic
Illness Care Scoring Guide13
|Assess overall patient satisfaction.
||CAHPS® Adult Primary
Assess staff satisfaction.
|Primary Care Staff
|Office Process & Efficiency
Assess your system's chronic care capability.
|Assessment of Chronic
Illness Care (survey)16
Assessment of Chronic
Illness Care Scoring Guide17
|Assess your office processes.
||Primary Care Practice Know
Your Processes (survey)18
|Financial System Function
Assess your financial systems.
|Available Resources in the Community
Assess what community resources are available for patients.
- The Patient Cycle Tool, available at http://www.clinicalmicrosystem.org, will be helpful
for those who have gone through a collaborative, or want to focus on access
and efficiency as a way to improve chronic care. This is one of a variety of tools
that help to quantify cycle time from the patient's perspective.
- First, Break All the Rules by Marcus Buckingham. This book includes a staff
satisfaction survey recommended by many safety net providers.
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Key Change 2.2. Select performance measures based on your needs assessment
Now that you know something about your team and your business infrastructure, it is time
for your team to select specific clinical system changes that will be the focus of your
improvement effort. The key changes should be evidence-based and supported by a useful
You'll want to identify a reasonable number of performance measures tied to the evidence based
system changes you intend to make. Think broadly, and identify a few performance
measures that represent the major clinical, business, satisfaction, and operations goals
you identified in key change 2.1 above. Many practices find using a "dashboard" of measures
a helpful and concise way to monitor multiple measures. Be careful to balance the
comprehensive number and variety of your data measures with the time and resource burden
of collecting and tracking those data. Improvement efforts will be greatly facilitated if each
measure is simple and has a clear operational definition.
It is important to track your measures throughout the process of implementing improvements
so that the team can monitor its progress. Seeing improvements in the numbers can be
incredibly motivating for the team. Using the measurement process as a mechanism to inform
the clinic or organization about the improvement effort is one of the best ways
to generate interest in and commitment to the aim and improvement priorities.
The tools below provide a wide variety of guidelines, models, and measures. You're likely
to find something that fits your needs.
|Procure and adapt specific guidelines.
|Choose clinical performance measures.
for Ambulatory Care
|Establish system-level performance aims.
Be sure to include a measure of self-management support.
|Redesign and Finance
% of patients with self-management
in the registry
- Promote the transparency of data. This is one of the best ways to generate interest in
and support for improvement. One great book that talks about creative and interesting
ways to display data is The Elements of Graphing Data by W.S. Cleveland.
- Utilizing a dashboard of measures is one way that organizations can get a handle on
multiple metrics including patient satisfaction, finances, clinical measures, and
market share. One example of a dashboard is located on the JENY Web site, an online
community for quality improvement professionals.
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Key Change 2.3. Build performance measurement capacity
A data collection system is the backbone of performance improvement efforts. Without data
about your patients, you can't proactively plan care or demonstrate improvements in process
or outcomes. That said, data collection for performance measurement can be expensive, time
consuming, and misleading if not done well. To maximize data measurement efforts:
- Leverage information technology (IT) to harvest data that are already in the system.
- Avoid developing new IT capacity to start on data collection; you may be waiting a
- For those data not readily available, create the easiest process to secure them with an
eye toward building future IT capacity. Double data entry or manual chart extraction
requirements invariably stymie efforts to sustain and spread the improvement.
- Begin using your measurement system to create efficient clinical and business
processes, and document the successes.
- Engage the rest of your system in the need for improved performance measurement
capability, demonstrating the return on investment associated with your efforts.
One way to maximize both clinical quality and efficiency is to use a patient-centered data
registry rather than one focused on a specific disease. In fact, there is nothing inherently
disease specific about a registry at all. It is just a spreadsheet used to collect patient data.
You can always add columns. For example, Chronic Disease Electronic Management System
(CDEMS) is a publicly available database tool that can be used even without electronic
medical records and enables a practice to get a holistic sense of its patients needs.
It is likely that your ability to identify and track data will influence the performance measures
you chose to focus on, so you can think of key changes 2.1, 2.2, and 2.3 as iterative.
- Use the guidelines and dashboard to inform the process for data collection
- Start thinking at the beginning of ways to eliminate waste by considering the
use of technology to monitor both clinical and business components.
- To the extent to which strategy, resources, and priorities for improvement
are aligned, transformation is more sustainable.
|Build database and implement reminder system.
||Chronic Disease Registries:
A Product Review (online)24
CDEMS Registry (online)25
|Focus leadership attention on improvement by building
business and clinical improvement capability.
||Executive Review of
|Use monthly reports to track progress toward goals.
||Quantitative Diabetes Monthly
Report Template (worksheet)27
Narrative Monthly Report
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