Dashboard Overview Webinar

Transcription

1 Regional Information for Shared Excellence (RISE) Initiative Dashboard Overview Webinar Jerry Lassa, MS Statistics May 15 & May 17, 2012

2 Do You Ever Spend a lot of time reviewing data trying to make sense out of it? Wonder how you did last month, last quarter or last year as a reference point? Wonder how well you re doing compared to your colleagues, competitors, the state or the country? See a change in data from one month to the next and wonder whether you should take action or not? Make a decision based on gut instinct or prior experience because you don t have data to support the decision? See a relationship between clinical care and operational functioning of your clinic but can t quantify it? Feel knowledgeable about performance data in your organization but others don t? Wonder whether the priorities you have set should really be priorities?

3 Agenda RISE Background Baldrige Performance Excellence Framework Dashboard Reporting & Use: Best Practices Data Validation Basics Beginner Dashboard Design

4 Big Changes in the Industry Change EHR Implement - Vendor selection - Workflow redesign - Hardware/software - Network - Training - Implementation - Data-driven culture - Performance measures - Link to EHR fields - Optimization - System use, data integrity - Reports, dashboards - Training - Optimization Data Management & Analytics Time 4

5 Then and Now Then: Now: Physician DOS Patient ID Avg A1c BP LDL Foot Exam Smith 4/12/ YES YES YES Smith 4/12/ YES YES NO Smith 4/10/ YES YES YES Smith 4/12/ NO NO YES Smith 4/12/ YES YES NO Smith 4/13/ YES YES NO Smith 4/13/ YES YES NO Smith 4/13/ YES YES YES Smith 4/10/ YES NO NO Smith 4/10/ YES YES YES Jackson 4/13/ YES YES YES Jackson 4/13/ YES YES YES Jackson 4/13/ YES YES NO Jackson 4/12/ YES YES YES Jackson 4/12/ YES NO YES Jackson 4/12/ YES YES NO Jackson 4/13/ YES YES YES Jackson 4/13/ YES YES NO Jackson 4/10/ YES NO NO Jackson 4/10/ YES YES YES 5

6 Is Your Organization Ready for the Tsunami of Data?

7 Background RISE Initiative Over the past decade, clinics have worked to enhance quality improvement efforts, transform culture, information systems, and care delivery Significant work in tracking and reporting key performance measures to assess the quality of patient care Several statewide projects have supported this work AQICC, Tools for Quality, other regional efforts Results: definition of standardized clinical and operational measures, enhancement of quality improvement processes and implementation of HIT, including registries, to collect and report on quality data RISE Initiative: Runs October 2011 to December 2012 Continued data collection, reporting and use work with a focus on Data Sharing Communities and accelerating improvement of clinical and operational performance by supporting data-driven management Added emphasis on enhancing the patient experience

8 Project Description Data Sharing Communities (DSCs): RISE Initiative Super Region North Data Sharing Communities North Coast Clinic Network (Super Region Lead) Alliance for Rural Community Health Health Alliance of Northern California Bay Area Redwood Community Health Coalition (Super Region Lead) Community Health Center Network Community Health Partnership San Francisco Community Clinic Consortium Central Valley South Central Valley Health Network (Super Region Lead) DSCs organized by measure Community Clinics Health Network (Super Region Lead) Coalition of Orange County Community Clinics Community Clinic Association of Los Angeles County

9 Project Description cont. 1. Regional Learning Communities RISE Initiative Data analytics, including data validation, analysis, reporting and sharing data with providers through the use of dashboards Enhancing the patient experience Team approaches to care delivery Patient panel management Staff engagement/culture change Patient self-management support Health coaching Operational changes to increase access 2. Data Analytics The collection, review, and reporting of key metrics across project participants. Quarterly sharing of data and using it to improve patient care with reporting to CHCF every six months Measures sets contain three to six measures with at least one measure in each of the clinical, operational and patient experience measure domains

10 Project Description cont. 3. Dashboard Use RISE Initiative Each DSC will use a standardized dashboard in various forums to display data, and facilitate discussions A standardized dashboard template is available but each DSC and Super Region has the flexibility to customize the dashboard to suit their needs (e.g., different measure sets, display of blinded and unblinded data, variety of audiences) Need to ensure the dashboard is populated appropriately and accurately, and disseminated to various audiences in an effective and meaningful way 4. Plan for Improved Outcomes Each community or region has committed to improvement on at least one measure in the first year, and at least two measures in the second year of the grant

11 RISE Measures Clinical Measure Hypertension: BP Measurement Meaningful use CORE UDS North Super Region Bay Area Super Region Central Valley SR ARCH HANC NCCN CHCN CHP RCHC SFCCC T7 (control of HTN) Tobacco Use Assess & Tobacco Cessation Interv. CORE Table 6B Adult Weight Screening & CORE Table 6B Follow Up Childhood Immunization Alternate Table 6B Status CORE Diabetes: Hemoglobin A1c Additional Table 7 Poor Control Set Diabetes: Low Density Additional Table 7 Lipoprotein (LDL) Set Management and Control Controlling High Blood Pressure Cervical Cancer Screening Percent of patients without a PCP visit in last 12 months Additional Set Additional Set Health Out/ South SR Disparity Table 6B + Operational: Third Next Available Appointment (TNAA), % No-Show Rate + Patient Experience: TBD (RISE year two focus)

12 Purpose: RISE Linked with BSCF CCAP Initiative (Blue Shield California Foundation California Comparative Analytics Project) Support adaptation of i2i's PoplQ software to serve the data collection and analytic needs of community clinics and other safety net providers who use BSCF s self-assessment tool The adapted software will help community clinics and other safety net providers collect, compare, and share data related to clinical quality, financial, operational, and patient experience performance indicators generated by the tool. Finance measure focus: Operating margin or net margin, Days cash on hand, Current ratio, Revenue mix, Average cost of clinic visit, Average cost of clinic visit by payer, Net revenue or loss by payer or Net operating margin by payer, Collections ratio, by payer, Benefits as % of total salary or wages, Claims quality

13 Importance of Smart Data Display Goo d 51% (Commercial National Best) 44% (Medicaid National Best) 35% (Medicaid National Average) What s the measure? Time period? Which direction is good? Benchmark? Goal? Is performance level a priority? If so, what do we do? Who s responsible? What resources are allocated? Who and how to hold accountable for improvement?

14 Importance of Balanced Measures Measures from multiple domains (e.g., clinical, operational, financial) tell a much richer story than a single measure and better inform decisions.

15 All Clinical Measures: So many more measures to manage need to have efficient reporting 1. HTN blood pressure 2. Tobacco use, cessation 3. Weight screening 4. Flu vax for older adult 5. Diabetes: HbA1c poor control 6. Diabetes: LDL mgmt and control 7. Diabetes: BP mgmt 8. HF: ACE/ARB for LVSD 9. CAD: beta-blocker for prior MI 10. Pneumo vax for older adult 11. Breast cancer screening 12. Colorectal cancer screening 13. CAD: oral antiplatelet therapy 14. HF: beta-blocker for LVSD 15. Anti-depressant med mgmt 16. POAG: optic nerve eval 17. Diabetic Retinopathy: docum of macular edema 18. Diabetic Retinopathy: communication with physician managing diabetic care 19. Asthma pharmacologic therapy 20. Asthma assessment 21. Appropriate testing for children with pharyngitis 24. Oncology breast cancer: hormone therapy 25. Oncology colon cancer: chemo for stage III 26. Prostate cancer: avoidance of overuse of bone scan 27. Smoking and tobacco cessation, medical assistance 28. Diabetes: eye exam 29. Diabetes: urine screening 30. Diabetes: foot exam 31. CAD: drug therapy for lowering LDL 32. HF: warfarin therapy for atrial fib 33. IVD: BP mgmt 34. IVD: use of aspirin or other antithrombotic 35. Initiation and engagement of alcohol and other drug dependence tx 36. Prenatal care: screening for HIV 37. Prenatal care: anti-d immune globulin 38. Controlling high BP 39. Cervical cancer screening 40. Chlamydia screening for women 41. Use of appropriate meds for asthma 42. Low back pain: use of imaging studies 43. IVD: complete lipid id panel and LDL control 44. Diabetes: HbA1c control (<8.0%) + Operational Measures + Finance Measures

16 So Are You Ready?

17 Baldrige Can Help

18 Baldrige National Quality Program President Reagan called for a national study on productivity in October 1982 in response to declining US productivity This resulted in a National Quality Award signed into law in 1987 Baldrige Program promotes excellence in organizational performance, recognizes the quality and performance achievements and publicizes successful performance strategies i th lit d f Malcolm Baldrige

19 Baldrige National Quality Framework How your senior How your key strategic objectives address your strategic challenges. How you ensure strategic and operational plans are achievable and adequately scoped. How you develop and deploy action plans throughout the organization to achieve objectives. How you foster an leaders employee culture communicate conducive to high with and engage performance. How the entire you manage and workforce and encourage frank, two-way communication throughout the organization How you Listen and Learn from your key stakeholders including Customers, Community, Partners, and Payers. How you turn data into information in your organization. How you use that information to improve performance. develop your staff to utilize their full potential. Measurable results you achieved. How you manage and improve your organizations key processes.

20 Random Organizational Activity

21 Activity vs. Organizational Direction

22 Improving Random Activity

23 Aligned Organizational Activity & Direction

24 How It All Fits Together ASQ, 2004

25 Example Plan Strategy Objective Measurable Pillars Statements Indicators

26 Create a strategy that fits your organization Don t piece one together Accountable Care Organization Meaningful Use Patient Centered Medical Home

27 Baldrige as a Guide for Dashboard Design Provides balanced model for organization performance Used heavily in health sector Since 2005, > 50% of Baldrige award applicants are health care Provides context for data management Measures should align with the industry e.g., NQF or P4P at local, state, national Dashboard measures should align with organization strategy t Dashboard measures should be balanced e.g., g, clinical, operational, financial,,patient experience measures

28 Best Practices Dashboard Formats Dashboard Reporting Trend/time charts with internal goals and external benchmarks or norms Stoplights (red, yellow, green coloring to indicate measure status) Dashboard Deployment Use to track strategy and annual plan execution Use same dashboard format Horizontal Across sites, divisions, departments/specialties p Use similar measures as relevant (e.g., TNAA applies to all clinical departments) Vertical BOD, senior leadership, management, staff Measures should roll up with selected core strategic measures at ttop

29 Basic Dashboard Format

30 Stoplight Dashboard for Individual Provider

31 Review of Dashboards in Meetings Best Practices Review dashboard results Recognize improvements Scan trends across all measures, look for potential issues Discuss and prioritize opportunities Develop a plan to address; establish goals for improvement Assign responsibility Allocate appropriate resources to achieve goal

32 Accountability for Results A measurable Strategic and Operating Plan is the main reference point for accountability in outcomes achievement Need alignment of goals between governance, leadership, management, and staff Assign responsibility for specific strategy objectives and goals to appropriate governance and management committees (e.g., clinical quality, finance, IT) Incorporate performance goals and incentives into board, leadership, and staff performance management plans and reviews; incorporate goals into provider contracts

33 Public Accountability and Transparency The good will earned by accountable and transparent nonprofits is one of, if not the most important, of its assets. --National Council of Non-Profits Health reform, through Accountable Care Organizations, will make accountability and transparency a business imperative for community health centers

34 Data Validation Basics Understand the measures (you and everyone else) Numerator, denominator, exclusion criteria Historical data requirements for selected measures Sample (paper charts) vs. Population data (EHR) Sample data requirements Ensure representative and random sampling Ensure appropriate sample size for achieving desired margin of error UDS requirements: n=70 Population data requirements Appropriate use of EHR queries and report writers when selecting data follow inclusion/exclusion criteria in measure definitions Ensure data are accurate and reliable Run frequency tables to cross validate patient totals and system use Identify clinical content, screen flow issues to inform EHR optimization roadmap Ensure reliability of interfaces (e.g., lab, pharmacy) Address leadership/management issues (e.g., compliance with using EHR)

35 Examples of System Use Measures These types of measures help you monitor data validation issues

36 Excel basics Beginner Dashboard Design Worksheet tabs and optimal use of the real estate Appropriate use of columns and rows with data for charts Common commands: formulas, cell formatting Excel graphs Rationale: Visual presentation of data improves user ability to interpret Approach: Various types of charts; use column or line charts with time across x-axis Application: Creating a column chart with a goal lines; formatting title and axis labels, column series color, data labels, y-axis Dashboard report formatting Rationale: Create an efficient layout of graphs for effective use in sharing data in various forums Approach: Alignment with organization strategy, use of internal goals and external benchmarks Application: Arranging multiple graphs on a single page; formatting page setup including margins, header/footer, fitting to one page

37 Be Sexy with Data I keep saying that t the sexy job in the next 10 years will be statisticians, said Hal Varian, chief economist at Google. And I m Im not kidding.

38 Questions? /rise