1. Measurement: the why and the what
Susanne Salem-Schatz, Sc.D
Project Director
Massachusetts Coalition for the Prevention of Medical Errors

2. Why measure? For you For us For the CDC (our funder)
Track progress towards key improvement goals
“How do we know a change is an improvement?”
What gets measured gets done
For us
Your experience and progress are a key component of how we evaluate our efforts (surveys, lessons shared on monthly reports, measures over time)
For the CDC (our funder)
National recognition
Continued funding and opportunity to support change in the community

3. What to measure Limited set of core metrics
Differences by type of facility, when appropriate
Good enough
Balance value and effort
Don’t let the perfect be the enemy of the good

4. Overview of measures: Long term care
Percent of treated UTIs that meet the “Protocol criteria” (ABCs)
Rates* over time of:
new UTI cases
laboratory orders for urine culture
healthcare acquired C. difficile (HA-CDI)
* All rates calculated per 10,000 resident days

5. Overview of measures: Emergency Department
Percent of treated UTIs with specific signs or symptoms of UTI
Percent of treated UTIs with non-specific signs or symptoms
Percent of treated UTIs with no signs or symptoms (default)
Rate of urine tests sent to laboratory per ED visitors > 70 years old

6. Measuring Progress Nora McElroy, MPH General Epidemiologist
Massachusetts Department of Public Health
Bureau of Infectious Disease Prevention, Response and Services,
Epidemiology Program

7. Measuring Improvement
Establish baseline UTI rates and chart attributes
Record which LTC patients have been treated for UTIs and whether they fit the protocol definition in long term care facilities
Record the number and attributes of diagnosed UTIs
Assess certain attributes of ED patients diagnosed with UTIs through chart review
Also working in a numerical ED measure

8. Provide Feedback
Caculate and illustrate monthly long term care UTI rates on an ongoing basis
Communicate how closely patients treated for UTIs at long term care facilities fit the protocol criteria
Report the attributes of ED patients diagnosed with a UTI
Document UTI testing in the ED

9. Data Collection Tools and Forms
For long term care:
Chart review form
An aide for applying the definition of a UTI in LTC
Chart review spreadsheet
Documentation of monthly chart reviews to be submitted each month
Measuring facility urinary tract and C difficile infection rates
Documentation of events and denominator data

10. Data Collection Tools and Forms
For Emergency Departments
Chart review form
Assists in determining the attributes of patients diagnosed with UTIs in the ED
Chart review spreadsheet
Submission of monthly chart review documentation
Measuring urine testing and ED visits

11. Chart Review Data Collection Form
Chart reviews will examine the characteristics of patients that are being treated for UTIs
Include patients >= 70 years of age
In long term care:
Include only patients with new onset, not recurrent, UTIs
In the Emergency Department:
Have a diagnosis code for urinary tract infection during the period under review and
Urine testing was initiated or done by an emergency department clinician.

12. Chart Review Data Collection Form for Long Term Care

13. Chart Review Data Collection Form for the Emergency Department

14. Notes about the chart review
Review 20 charts a month or five charts a week
Selecting charts to review:
If the name of the month starts with A-F review the first 20 patients with UTIs
If the name of the month starts with J-S review the last 20 patients with UTIs
Use the chart review form to guide your completion of the Excel spreadsheet but only the spreadsheet need to be submitted

15. Chart Review Spreadsheet
Document the answers to the questions on the chart review form and use them to complete the Data Submission Excel Spreadsheet
Answer Yes or No to each of the questions
After completing the chart reviews for each month the spreadsheet to

16. Completing the Chart Review Spreadsheet for Long Term Care

17. Completing the Chart Review Spreadsheet for the Emergency Department

18. Cases and Figures for Long Term Care
Track new onset Clostridium difficile and urinary tract infections monthly for patients >= 70 years of age in LTC
Determine number of urine cultures performed each month
Enter the monthly census, or resident days, for patients >=70 years of age
Submit monthly with the chart review spreadsheet

19. (UTIs/Resident-days)*10,000
Calculating a Rate
The C difficile and UTI rates are calculated by:
(UTIs/Resident-days)*10,000
The spreadsheet will automatically calculate C difficile and UTI rates monthly

20. Cases and Figures Spreadsheet for Long Term Care

21. Cases and Figures for the Emergency Department

22. Spreadsheet Demonstration

23. Summary
There are three tools to assist the collection of collaborative data
Chart Review Data Collection Form
Chart Review Spreadsheet
Cases and Figures Spreadsheet
Submit the Chart Review and Cases and Figures Spreadsheets monthly
Please forward any questions to Nora McElroy and or (617)

24. Thank you! Any Questions?
Special thanks to all of the collaborators who provided valuable assistance and advice in the completion of the tools for this project.