Quality improvement is dependent on data. Judy Evans e-health Manager

Transcription

1 Quality improvement is dependent on data Judy Evans e-health Manager

2 Data!

3 Data Healthcare organisations are increasingly involved with and dependent on data. Healthcare decisions are driven by the analysis of data. The importance of data in decision-making is paramount, but it is only recently that the concept of data quality has become important.

4 Quality data fit-for-purpose Data are of high quality if they are fit for their intended uses in operations, decision-making, and planning. Data are fit for use if they are free of defects and posses desired features

5 The quality of patient information in computer based patient records is often found to be poor, with patients incorrectly registered or information incorrectly recorded, or not recorded at all. Quality information supports effective monitoring of patients and forms the basis for all healthcare decisions

6 Question Reflect on your practice and on a scale from 1 5 (1=very poor, 5=excellent) How would you rate the quality of the patient information in your practice clinical system? Can you identify particular types of information that might be deficient, e.g. allergies, past medical history or medication lists?

7 Data The terms data, information and knowledge are frequently used for overlapping concepts The difference is the level of use Data information knowledge Data on its own carries no meaning. Data is considered as raw facts, generally stored as characters, words, symbols, measurements or statistics and requires processing before it becomes information and knowledge

8 Data is the raw material from which information is constructed via processing or interpretation:. This information in turn provides knowledge on which decisions and actions are based Data Blood pressure reading (data element). Information Is the blood pressure reading accurate? Has the measurement been taken with clinical accuracy and recorded correctly? Was the patient sitting or standing? Knowledge Apply critical thinking to the blood pressure (data element) in context of the patients health history, age and health risks. Decision Make a decision based on clinical guidelines in the management of hypertension. Action Prescribe medication and repeat the blood pressure test in 2 months.

9 High quality data is meaningful, accurate, and consistent Poor quality data affects patient safety and quality of care Maintaining consistent data quality is a challenge and requires a solution

10 Data quality is a key element of clinical governance and implies a shared responsibility to follow a systematic approach to maintaining and improving the quality of patient care. Clinical governance applies to all who are involved in the care of patients; this includes clinical and non-clinical staff that is, all members of the practice team.

11 Healthcare professionals play a critical role in capturing clinical information accurately and ensuring the quality of that information. General practice cannot have high quality healthcare information at hand if they have not established high quality data collection procedures and processes

12 The driving force behind good quality data is ultimately to improve the quality of care and improve patient safety through appropriate clinical management based on the best information available higher quality information results in better patient care.

13 RACGP Standard 1.7 Our patient health records contain sufficient information to identify the patient and to document the reasons for a visit, relevant examination, assessment, management, progress and outcomes.

14 Data governance Data governance is a process of monitoring and improving how data is collected, recorded, and used. It is a responsibility for the whole practice team. Data quality is a key element of clinical governance and implies a shared responsibility to follow a systematic approach to maintaining and improving the quality of patient care.

15 Data quality dimensions 1. Institutional environment: where was it collected? 2. Relevance: who is it about? 3. Timeliness: is it current and valuable? 4. Accuracy: is it useful and meaningful? 5. Coherence: it is consistent and comparable? 6. Interpretability: is it understandable? 7. Accessible: can I access it?

16 Data tip Be realistic in your expectations you will not be able to clean up the data in your clinical systems overnight it is an ongoing quality improvement process

17 Computerisation 6% are using entirely paper-based medical records 37% are hybrid a mixture of paper-based and electronic medical records 56% are using entirely electronic medical records

18 Questions Hybrid systems what are the risks?

19 The emergence of a shared electronic records system (Personally Controlled Electronic Health Record) further highlights the need for data to be accurate, computer readable, accessible, and of a quality to share with other care providers. Patient health information is initially collected for use between the patient and the clinician in delivering care, whereas this information now has the potential to be shared across the whole health sector.

20 QI framework 1. What is the question or problem 2. What can we improve? 3. How can we achieve improvement? 4. Have we achieved improvement? 5. Have we sustained improvement?

21 Quality improvement

22 PDSA

23 Clinical audit Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through the systematic review of care against explicit criteria, identification, from the review, of action to improve clinical practice and the implementation of those actions.

24 CAs are not new Florence Nightingale during the Crimean War arrived at the medical barracks hospital in in 1854, Florence was appalled by the unsanitary conditions and high mortality rates among injured or ill soldiers. She and her team of 38 nurses applied strict sanitary routines and standards of hygiene to the hospital and equipment, and applying mathematics and statistics kept meticulous records of the mortality rates among the hospital patients. Following this change the mortality rates fell from 40% to 2%, and were instrumental in overcoming the resistance of the British doctors and officers to Florence's procedures. Her methodical approach, as well as the emphasis on uniformity and comparability of the results of health care, is recognised as one of the earliest programs of outcomes management.

25 Ernest Codman( ). Codman became known as the first true medical auditor following his work in 1912 on monitoring surgical outcomes. Codman's "end result idea" was to follow every patient's case history after surgery to identify individual surgeon s errors on specific patients. Although his work is often neglected in the history of healthcare assessment, Codman's work anticipated contemporary approaches to quality monitoring and assurance, establishing accountability, and allocating and managing resources efficiently.

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28 Rubbish in rubbish out

29 8 essentials for improving data quality Relationship management Leadership and change management Data collection and cleaning Training Communication Patient registers Health planning Feedback

30 Domains of quality

31 Data management can target appropriate use of healthcare services support better use of medicines support best practice patient care changing work practices streamline practice business management improve the management of complex health needs evaluate effectives of clinical processes research

32 E-tools Clinical Audit Tool PrimaryCare Sidebar Canning Tool Doctors Control Panel

33 thank you