Key Performance Indicator (KPI) Matrix for Performance Measurement Framework

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1 Color Legend: TB Contact and Investigation and Identification LTBI WRHA Program: Tuberculosis Pillars of Excellence (What we are measuring) Customer Satisfaction Quality and Outcomes Delivery and Utilization Resource Employee Engagement Level 3: Oversight Directors, Medical Directors, VP s ITBS005 ITBS003 ITBS004 ITBS006 Levels of Accountability (Who uses the KPI for making decisions/ recommendations) Level 2: Committee includes Chairs of each of the 4 Committees Level 1: 4 Committees with membership from program delivery ITBS002 ITBS007 ITBS011 ITBS012 ITBS001 ITBS008 ITBS009 ITBS010 ITBS013 1 Definitions/Acronyms: ITBS Integrated TB Services structural name for all organizational entities involved in all things TB related (logical umbrella) LTBI Latent TB Infection tested positive but symptom dormant TB - Tuberculosis PCR Preliminary Chain Reaction DNA technology AFB Acid Fast Bacilli ICD International Classification of Diseases HIM Health Information iphis Population Health Information System Note: views of a KPI may be different where it maps to more than one cell; the KPI can be customized to the audience in each level and/or dimension Levels of accountability notation: for these KPI s a primary level of accountability has been identified with secondary accountability levels shown in square brackets example: Only the primary level of accountability is shown in the above matrix

2 Committees TB Contact investigation and Delivery and Utilization Level 1 [2-3] indication of program delivery ITBS A how well the program is functioning Issue of access and identification (tracking) and continuity of service The proportion of follow-up not complete within a Contact Investigation Number of unique contacts from the list identified in the denominator that as of 3-months later who are not yet completed assessment for infection/disease unique contacts associated with all cases in a 1-month period that received a sputum PCR or diagnosis of respiratory TB in that month MB Health TB Registry iphis TB Contact investigation and Quality and Outcomes Level 1 [2-3] indication of program delivery ITBS A program functioning Safety and efficacy The proportion of newly diagnosed laboratoryconfirmed or clinicalconfirmed TB disease within a Contact Investigation Number of unique contacts from the list identified in the denominator that as of 3-months later are either a laboratoryconfirmed or clinicalconfirmed case of TB disease unique contacts associated with all cases in a 1-month period that received a sputum PCR or diagnosis of respiratory TB in that month 2

3 TB Contact investigation and Resource Level 3 [1, 2] senior leaders are aware of sustainability of program resources ITBS A program functioning Overlaps with Quality & Outcomes (Detection) But is focused on resourcing the population identification (i.e. LTBI reservoir is huge in northern regions) Focus on what needs to happen. The proportion of newly identified latent TB infection within a Contact Investigation Number of unique contacts from the list identified in the denominator that as of 3-months later were newly diagnosed with latent TB unique contacts associated with all cases in a 1-month period that received a sputum PCR or diagnosis of respiratory TB in that month 3 TB Contact investigation and Resource Levels 3 [1, 2] senior leaders are aware of sustainability of program resources ITBS A program functioning The proportion of contacts with no evidence of TB disease or latent TB infection within a Contact Investigation Number of unique contacts from the list identified in the denominator that as of 3-months later were found to have no evidence of TB disease or unique contacts associated with all cases in a 1-month period that received a sputum PCR or diagnosis of respiratory TB in that month

4 Quality & Outcomes Level 3 [2, 1] Closing the loop Levels 1 and 2 are confident that Level 3 is aware of the problem and is discussing it at a senior level crosssector senior leaders aware of inadequate community resources ITBS Provide an estimate of the appropriateness of admission Front line staff [Level 1] (nurses/ physicians) are reporting these patients presenting to acute. Percentage of admitted persons diagnosed with TB disease, admitted to hospital despite being assessed as clinically well enough to receive their TB care as an outpatient (i.e., unable to provide adequate isolation in a community home like setting). Number of admitted persons diagnosed with TB disease, admitted to a Winnipeg Health Region hospital despite being assessed as clinically well enough to receive their TB care as an outpatient (i.e., unable to provide adequate isolation in a community home like setting). persons annually diagnosed with TB disease, who are admitted to a Winnipeg Health Region hospital. MB Health TB Registry Manitoba Health HIM (Health Information ) 4

5 Resource Level 3 [1, 2] crosssector senior leaders aware of inadequate community resources and the pressure it puts on acute care ITBS To estimate the number of bed days utilized from inappropriate admissions Average number of days of hospitalization of persons diagnosed with TB disease who are identified as clinically well enough to receive their TB care as an outpatient (i.e., unable to provide adequate isolation in a community home like setting). Total annual number of days spent in a Winnipeg hospital for all admitted persons diagnosed with TB disease who are admitted to a Winnipeg Health Region hospital and are identified as clinically well enough to receive their TB care as an outpatient at the time of admission. Total annual number of admitted persons diagnosed with TB disease, admitted to a Winnipeg Health Region hospital despite being assessed as clinically well enough to receive their TB care as an outpatient. 5

6 Quality & Outcomes level effectiveness of support of chronic disease ITBS A treatment completion. defined as at least 80% of total doses completed within 9 months for persons prescribed a 6-month course of treatment, and within 12 months for persons prescribed a 9-month course of treatment Proportion of persons diagnosed with TB disease and prescribed treatment by a Winnipeg Health Care Provider who start treatment for TB disease and who complete the prescribed course of TB treatment within 3 months of their targeted treatment completion date Annual number of persons diagnosed with TB disease who have been prescribed treatment by a Winnipeg Health Care Provider and who have started treatment, who complete a full course of treatment within 3 months of their targeted treatment completion date Total annual number of persons diagnosed with TB disease who have been prescribed treatment by a Winnipeg Health Care Provider and who have started treatment. 6

7 Identification Delivery & Utilization timeliness in primary care ITBS To determine if there is a delay in diagnosis of TB and opportunity for health care provider education Start coughing date to 1 st visit date Time from Patient Identified Date of Onset of Cough Until First Visit to Healthcare Provider for Respiratory Reason in all Persons with Culture Confirmed Respiratory TB Total time in days for all patients with respiratory TB measured from the patient identified date of onset of cough until the patient s first visit to a healthcare provider for a respiratory related ICD9 reason code. patients with culture confirmed respiratory TB. iphis Manitoba Health HIM (Health Information ) 7 Identification Delivery & Utilization effectiveness of primary care ITBS To determine if there is a gap in health care knowledge of TB 1 st Visit date to TB test date Time from First Visit to Healthcare Provider for Respiratory Reason Until Collection Date of First Sputum for AFB in all Persons with Culture Confirmed Respiratory TB Total time in days for all patients with respiratory TB measured from the first visit to a healthcare provider for a respiratory related ICD9 reason code until the date of first sputum for AFB. patients with culture confirmed respiratory TB.

8 Identification Delivery & Utilization capacity requirements ITBS To determine delay in diagnosis and opportunity of health care provider education Number of Healthcare Visits for Respiratory Reason Between the First Visit For Respiratory Reason and the Collection Date of First Sputum for AFB in all Persons with Culture Confirmed Respiratory TB healthcare visits for a respiratory related ICD9 reason code for all patients with respiratory TB between the patient s first visit to a healthcare provider for a respiratory related ICD9 reason code and the date of first sputum for AFB. patients with culture confirmed respiratory TB. 8 LTBI Quality & Outcomes capacity requirements ITBS Determine what the baseline percentage is. Benchmark is 80%. Further exploration on reasons why benchmark is not met Proportion of persons diagnosed with LTBI, who ARE identified as contacts of Sputum Culture Confirmed Tuberculosis Cases, who start treatment for LTBI. Number of persons diagnosed with LTBI who start treatment persons annually diagnosed with LTBI, who ARE identified as contacts of Sputum Culture Confirmed Tuberculosis Cases Klinic database

9 LTBI Quality & Outcomes effectiveness of support of prevention and disease ITBS Determine baseline for program and further explore reasons why benchmark is not met (bench mark 80% of total doses) Proportion of persons who start treatment for LTBI, who ARE identified as contacts of Sputum Culture Confirmed Tuberculosis Cases, who complete a full course of treatment for LTBI (defined as at least 80% of total doses) Number of persons with LTBI who have started treatment, who complete a full course of treatment (i.e., at least 80% of total prescribed doses) persons annually diagnosed with LTBI, who ARE identified as contacts of Sputum Culture Confirmed Tuberculosis Cases, who have started treatment for LTBI (i.e., the numerator for Indicator #1) Klinic database 9

10 LTBI Resource Level 1 [2, 3) effectiveness of support of prevention and disease ITBS To determine the relative value of follow up in lower risk groups to better inform resource allocation and recommendations on best practice Are resources wasted on lower risk groups not committed to completing full course of treatment? Proportion of persons who start treatment for LTBI, who ARE NOT identified as contacts of Tuberculosis Cases, who complete a full course of treatment for LTBI (defined as at least 80% of total doses) Number of persons with LTBI who have started treatment (who ARE NOT identified as contacts of Tuberculosis Cases), who complete a full course of treatment (i.e., at least 80% of total prescribed doses) persons annually diagnosed with LTBI, who ARE NOT identified as contacts of Tuberculosis Cases, who have started treatment for LTBI Klinic database 10

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