Coach Medical Home Strategies tools to support patientcentered

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Coach Medical Home Strategies & tools to support patient-centered medical home transformation MODULE 4:

Coach Medical Home Strategies & tools to support patient-centered medical home transformation MODULE 4: Measurement

Learning objectives for this module 2 After completing this module, you will know how

Learning objectives for this module 2 After completing this module, you will know how to: Describe measurement for improvement and why it is critical to PCMH transformation. Help leaders, clinicians, managers, staff, and patients develop a measurement and reporting strategy to support PCMH transformation. Coach Medical Home: Module 4

Overview of contents 3 1. 2. 3. Why measurement for improvement is critical to

Overview of contents 3 1. 2. 3. Why measurement for improvement is critical to PCMH transformation Build an improvement-focused measurement strategy Make measurement part of daily work through reporting Coach Medical Home: Module 4

SECTION 1 Why measurement for improvement is critical to PCMH transformation Coach Medical Home:

SECTION 1 Why measurement for improvement is critical to PCMH transformation Coach Medical Home: Module 4

Using measurement to drive PCMH transformation 5 Reporting on measures will help a practice:

Using measurement to drive PCMH transformation 5 Reporting on measures will help a practice: See the need for transformation Demonstrate quality to staff, patients, & others Find ways to continue improving Achieve PCMH recognition Take advantage of new funding Coach Medical Home: Module 4

Different measures are meaningful for different audiences: Diabetes example 6 Board members & Leaders

Different measures are meaningful for different audiences: Diabetes example 6 Board members & Leaders • Diabetes dashboards Combined measures provide an overall view of quality of care. Providers & Care Teams • Hb. A 1 c testing and control • Foot exams • Eye exams Patients & Families • % patients who are satisfied with their care Specific measures show opportunities for improvement. Coach Medical Home: Module 4

Focusing on improvement helps achieve practice goals 7 External measurement • For accountability •

Focusing on improvement helps achieve practice goals 7 External measurement • For accountability • Based on national standards • Usually reported quarterly or less Formal internal measurement • For monitoring overall performance • Used and shared across the practice Informal internal measurement • For learning and QI • Specific measures gathered during PDSA • Identifies changes that result in improvement Improvement Coach Medical Home: Module 4

SECTION 2 Build an improvement-focused measurement strategy Coach Medical Home: Module 4

SECTION 2 Build an improvement-focused measurement strategy Coach Medical Home: Module 4

Why develop a measurement strategy? 9 Helps everyone understand data sources & calculations Clarifies

Why develop a measurement strategy? 9 Helps everyone understand data sources & calculations Clarifies what is being measured & why Establishes SOPs to support efficiency & consistency A detailed description of a site’s approach to measurement and reporting that supports PCMH transformation or other QI activities. Coach Medical Home: Module 4

A measurement strategy’s components 10 Name Benchmark Source Strategy Goals Method Notes Frequency Coach

A measurement strategy’s components 10 Name Benchmark Source Strategy Goals Method Notes Frequency Coach Medical Home: Module 4

How leaders create a data-driven culture 11 11 Practice leaders should: Ask for data

How leaders create a data-driven culture 11 11 Practice leaders should: Ask for data Make it transparent Display it visually Provide training Datadriven culture Quality improvement PCMH transformation Ask staff for ideas Coach Medical Home: Module 4

Building a measurement strategy: Five ways to maximize value & efficiency 12 1. Link

Building a measurement strategy: Five ways to maximize value & efficiency 12 1. Link • to strategic goals and daily work 2. Look • at measurement activities already taking place & staff in suggesting measures and provide 3. Engage • clinicians training to build capacity 4. Select • measures that show the big picture and will help the practice reach its goals 5. Sustain • momentum by monitoring progress, making adjustments, and acknowledging improvement Coach Medical Home: Module 4

Leadership’s role in building the measurement and reporting strategy 13 The measurement strategy… Leader

Leadership’s role in building the measurement and reporting strategy 13 The measurement strategy… Leader appoints team or point person • Commit resources Strategic plan Daily work • Provide training • Develop reporting strategy 13 Coach Medical Home: Module 4

Engage clinicians & staff in deciding what to measure 14 Strategic plan Data Daily

Engage clinicians & staff in deciding what to measure 14 Strategic plan Data Daily work Possible performance measures Other ideas 14 Coach Medical Home: Module 4

Aim for a balanced set of measures to reveal the big picture 15 Clinical

Aim for a balanced set of measures to reveal the big picture 15 Clinical quality Cost & efficiency Staff satisfaction Balanced set of measures Practice transformation Patient experience & engagement 15 Coach Medical Home: Module 4

Start with nationally endorsed measures 16 Which national measures are tied to the practice’s

Start with nationally endorsed measures 16 Which national measures are tied to the practice’s goals? • MU • HEDIS • NQF • AMA-PCPI • NCQA or PCMH An efficient approach that also allows the practice to compare to national benchmarks Coach Medical Home: Module 4

Customize measures for the practice 17 Add measures of value Consider fit with workflow

Customize measures for the practice 17 Add measures of value Consider fit with workflow Add practicespecific goals • To support QI efforts • Tie to strategic goals • Do they support clinical decisions? • Can they come from a registry? • Do they motivate the team? • How do they compare to national benchmarks? Coach Medical Home: Module 4

Finding value in measures that overlap 18 Internal External Measurement for improvement Measurement for

Finding value in measures that overlap 18 Internal External Measurement for improvement Measurement for required reporting Efficient data collection Coach Medical Home: Module 4

Refine based on available data sources 19 EHR or Registry Practice Mgmt. System Example:

Refine based on available data sources 19 EHR or Registry Practice Mgmt. System Example: Panel lists Administrative Example: Claims data Surveys Examples: Patient, staff, and clinician satisfaction Payer Reports Examples: Claims data, Gaps-in-Care reports, hospital & ED utilization • Strengths: Best way to learn and use data for patient care • Limitations: Takes work if not yet in place • Strengths: Real time, reliable, engages staff • Limitations: Must invest in a panel manager • Strengths: No investment needed • Limitations: Not real time, clinician assignments may be inconsistent • Strengths: Reveals important perspectives • Limitations: Low response, language & literacy barriers, must invest in management & analytics • Strengths: No investment needed • Limitations: Not real time, clinician assignments may be inconsistent, not provided very often Coach Medical Home: Module 4

Use EHRs and registries for measurement as much as possible 20 It may take

Use EHRs and registries for measurement as much as possible 20 It may take time for practices to get started, but it’s worth it: Efficient • Part of care, not a separate task data • Workflows support reliable data collection & high-quality data Timely data • Data reporting shows care provided and needed • Patients & staff are engaged Better workflow and better care • With data integrated into daily workflow, QI opportunities are readily apparent • Patients get the right care at the right time • Practice may qualify for Meaningful Use incentives Coach Medical Home: Module 4

Balance cost vs. value 21 Potential cost Value gained Better care Staff resources IT

Balance cost vs. value 21 Potential cost Value gained Better care Staff resources IT resources Financial incentives PCMH recognition Coach Medical Home: Module 4

SECTION 3 Make measurement part of daily work through reporting Coach Medical Home: Module

SECTION 3 Make measurement part of daily work through reporting Coach Medical Home: Module 4

Engage clinicians and staff through training 23 Develop a training program Explain how &

Engage clinicians and staff through training 23 Develop a training program Explain how & why data are collected Show to interpret measures and reports Ask staff & clinicians what changes they think will result in improvement Builds trust and the capacity to use data to support PCMH transformation. 23 Coach Medical Home: Module 4

Displaying data helps spread engagement 24 Post it where people notice Make it easy

Displaying data helps spread engagement 24 Post it where people notice Make it easy to understand Set visible goals Have fun! 24 Coach Medical Home: Module 4

Minimum standard for monthly reporting: Annotated run chart © Institute for Healthcare Improvement

Minimum standard for monthly reporting: Annotated run chart © Institute for Healthcare Improvement

Why run charts work so well 26 Run charts motivate teams to find ways

Why run charts work so well 26 Run charts motivate teams to find ways to meet goals. Show real improvements Distinguish causes of variation Highlight “lag time” Identify lingering challenges Display trends 26 Coach Medical Home: Module 4

Questions to consider when reviewing run charts 27 Accuracy • How confident are we

Questions to consider when reviewing run charts 27 Accuracy • How confident are we that the data accurately reflect care? • Are results all over the map? Check the denominator size. Results • What do the measures tell us? What do they mean to staff? • If there’s a steady increase, what did we do that worked? • If there’s a decrease, what changed? Goals • What is our target? • When will we feel good about the care we are delivering? • Do we care about this measure? If so, why? Display • Is the way we’re displaying data helpful? • How can we make it better? 27 Coach Medical Home: Module 4

A family of measures refines understanding © Institute for Healthcare Improvement

A family of measures refines understanding © Institute for Healthcare Improvement

A dashboard provides a broader view

A dashboard provides a broader view

Example data wall for staff and patients 30 Measurement Wall at Community Health Partners,

Example data wall for staff and patients 30 Measurement Wall at Community Health Partners, Inc. , Livingston, Montana National PCMH Curriculum: Module #

Coaching tips summary 31 As a coach, you can help a practice: Make connections

Coaching tips summary 31 As a coach, you can help a practice: Make connections between reporting requirements Tie measures to their strategic plan, especially patient improvement Understand the need for resources & training Suggest additional measures Check and adjust for accuracy Remember to involve staff, leaders, patients and families in improvement efforts Coach Medical Home: Module 4