Transcript Presentation Title

Interactive Data Review
Joseph J. Abularrage, MD, MPH, M.Phil, FAAP, President, NYS AAP - Chapter 2
Jennifer Powell, MPH, MBA, Quality Improvement Consultant
COMMERCIAL INTERESTS DISCLOSURE
Joseph J. Abularrage, MD, MPH, M.Phil, FAAP
Jennifer Powell, MPH, MBA
I have no relevant financial relationships with the
manufacturer(s) of any commercial product(s) and/or provider of
commercial services discussed in this CME activity.
I do not intend to discuss an unapproved or investigative use of a
commercial product/device in my presentation.
LEARNING OBJECTIVE
• Review data and identify trends and variation
in quality improvement data
SESSION APPROACH
• All teach, all learn.
• Be a detective! Develop theories about what
the information is telling you.
• Develop ideas for your QI team.
• Facilitator assigned to each table.
SESSION OUTLINE
1. Review our network’s aim
2. Review the data “toolbox” and how the tools
tie to our key drivers
3. Group Exercises:
– Two group exercises to assess the data and develop theories about
what is happening in our network
4. Report out by group
Aim
Toolbox
Group
Exercise
Report
Out
CQN ADHD AIM
• To build a sustainable quality improvement
infrastructure within our practice to achieve
measureable improvements in ADHD care
processes.
THE MODEL FOR IMPROVEMENT
Aim
Toolbox
Group
Exercise
Report
Out
WHAT’S IN OUR TOOLBOX?
1. Monthly dashboard displaying measures
2. Action period 2 narrative report
– Will help us determine what’s happening to build
reliable systems and a sustainable infrastructure
3. Our analysis of the data and our theories
about what’s driving these results
TOOL 1: CQN DATA DASHBOARD
PRACTICE KEY DRIVER DIAGRAM
1. Improved diagnostic
accuracy using evidencebased guidelines
2. Titration of medications
and monitoring of side
effects based on parent and
teacher feedback
3. Effective follow-up
and surveillance for comorbidities
4. Partnerships with
parents and teachers for
effective behavior
management
5. Use of population
health strategies to
manage children with
ADHD and associated comorbidities
6. Active participation in a
peer-to-peer learning
network (or learning
collaborative) with
transparent data
RUN CHARTS AND TRENDS
• A run chart is a simple visual tool used to
identify trends in the data
• Trend: 3 or more monthly data points going in
a consistent direction
• Caution: trends are not an excuse to “let off
the gas” in your improvement efforts!
COMMON CAUSE VARIATION
• Occurs when the system of causes is relatively
consistent and variation is being produced by
chance causes, by random variation
Common Cause Variation (Random Variation in
a stable system)
100%
86%
80%
81%
80%
86%
87%
85%
60%
40%
20%
Goal
Year 1
Year 2
Year 3
0%
1
2
3
4
5
6
7
8
9
10
11
12
SPECIAL CAUSE VARIATION
• When the system of causes experiences a new
or special or assignable cause that enters
system for either a short or extended time
EXAMPLE OF SPECIAL CAUSE VARIATION
EXAMPLE OF SPECIAL CAUSE VARIATION
CQN Optimal Asthma Care
% of encounters that met optimal
asthma care criteria
100%
90%
85%
82%
81%
80%
70%
72%
60%
48%
50%
40%44%
30%
40%
35%
20%
10%
Goal
Pilot, 2010
Wave 2, 2012
Wave 3, 2013
Wave 4, 2015
0%
1
2
3
4
5
6
7
Months of Participation
8
9
10
11
12
TOOL 2: AP2 NARRATIVE REPORT
• Narrative report by question:
–
–
–
–
–
–
–
Q4: # meetings and/or huddles per month
Q5-6: Reviewing data: % of staff and processes
Q7: % of practice involved in PDSA cycles
Q8: Tests and stage of implementation
Q9: Documentation of PDSAs
Q10-11: Vanderbilt return
Q12-15: New tools, processes, tests; learning points; barriers (openended)
PRACTICE KEY DRIVER DIAGRAM
1. Improved diagnostic
accuracy using evidencebased guidelines
2. Titration of medications
and monitoring of side
effects based on parent and
teacher feedback
3. Effective follow-up
and surveillance for comorbidities
4. Partnerships with
parents and teachers for
effective behavior
management
5. Use of population
health strategies to
manage children with
ADHD and associated comorbidities
6. Active participation in a
peer-to-peer learning
network (or learning
collaborative) with
transparent data
TOOL 3: YOUR HUNCHES &
THEORIES
• In this session, we want to develop our
hunches and theories about what we think is
going on based on the data and narratives
from the practices.
Aim
Toolbox
Group
Exercise
Report
Out
EXERCISE 1
• Describe any trends you see in the dashboard
data
– First focus on the dashboard at the national level
and your chapter level
– Then, discuss what’s going on at the practice level
that informs the chapter level dashboard
EXERCISE 2
• Review the narrative report, concentrating on
sections that ask questions regarding rapid
cycle testing (Q4, Q7-9)
EXERCISE 1:
DISCUSSION & REFLECTION
• Please share your three main highlights from
your discussions.
EXERCISE 2:
DISCUSSION & REFLECTION
• How adept would you say practices in your chapter
are in testing and implementing changes?
• What do you predict will happen around testing in
action period 3? What might be barriers to testing?
BUILD A PDSA RAMP
Changes That
Result in
Improvement
AIM:
Measure for PDSA Ramp:
AP
SD
Implement
Change:
Wide-Scale Tests of Change:
Hunches
Theories
Ideas
A P
S D
Follow-up Tests:
Very Small Scale Test:
Multiple PDSA Cycles – Sequential Building of
Knowledge – include a wide range of
conditions in the sequence of tests before
implementing the change
LEVEL 1 (90%) RELIABILITY
•
•
•
•
•
•
Start with the end in mind; designed with a global and specific aim
Collaborative participation to accelerate learning and networking
Monthly measurement review and continuous rapid cycle testing
Team meeting regularly to create theories and tests
Understanding the system (workflow and role clarification)
Standardize decision-making and processes
Practical Tips for Improving
Your Performance
THREE AREAS OF FOCUS
• Improving performance on measure 2 (parent
conversation and booklet)
• Improving performance on measure 3
(prescribing behavior therapy)
• Improving return of teacher Vanderbilts
POSSIBLE REASONS FOR LOW
PERCENTAGES ON MEASURE 2
Parent conversation and booklet distributed (assessment patients)
1. Handing out booklet not part of ADHD
patient flow
2. Booklet is being handed out but not being
recorded in mehealth portal
POSSIBLE REASONS FOR LOW
PERCENTAGES ON MEASURE 3
Prescribing behavior therapy to patients ages 4-12 (where available)
1. Not recommending behavioral treatment
2. Recommending behavioral treatment but not
being recorded in mehealth portal
3. No behavioral treatment is available in your
region
IMPROVING RETURN RATE OF TEACHER VANDERBILTS
mehealth sends a reminder to teachers after 3 days and one to parents after 7 days!
POSSIBLE REASONS FOR LOW
TEACHER VANDERBILT RETURN RATES
1. Parents not activating account
2. Teachers not receiving email invite
3. Teachers not completing form
POSSIBLE REASONS FOR LOW
TEACHER VANDERBILT RETURN RATES
1. Parents not activating account
– Solution #1: Parents activate accounts at practice
– Solution #2: Require both parent and teacher
ratings before diagnostic visit
POSSIBLE REASONS FOR LOW
TEACHER VANDERBILT RETURN RATES
2. Teachers not receiving email invite
– Solution #1: Parents email AND print out invite
and hand to teachers
– Solution #2: Have teachers check junk mail – have
school IT whitelist mehealth emails
POSSIBLE REASONS FOR LOW
TEACHER VANDERBILT RETURN RATES
2. Teachers not receiving email invite
– Solution #1: Parents email AND print out invite
and hand to teachers
– Solution #2: Have teachers check junk mail – have
school IT whitelist mehealth emails
POSSIBLE REASONS FOR LOW
TEACHER VANDERBILT RETURN RATES
3. Teacher not completing form
– Solution #1: Contact parents to get them to
remind teacher
PORTAL SPRING CLEANING
• Parent reminders:
– One more VB assessment
– Teacher communication (this year and next)
• Teacher messages:
– Can send message and “insert” VB that day
– Thank them for input
• Clean up patient list (meds, patients)
Questions?