1 Quality Improvement Series Session 9 Baseline Data Windy Stevenson Cindy Ferrell

2 Today’s Agenda

3 Recap Problem: The DCH ambulatory clinic problem lists are incomplete and inaccurate. Problem: Patients with BMI>85%ile do not have obesity or overweight listed on their problem lists. AIM: >95% of patients >2yo seen by a provider in the gen peds clinic or Westside clinic (including acute care; excluding healthy lifestyles) who have a BMI >85%ile will have “BMI; category” listed on their problem list.

4 Current status  Future state taking shape  Order set request in EPIC queue- ready for PDSA  Obtaining heights on acute care visits- what state?  EPIC requests for populating problem list from an order and driving PCP appointment generation  Exploration of adding prompt to notes template  Baseline data available (next slides!) Pt >2yo checked in and ht/wt recorded EPIC uses ht and wt to generate BMI and flags if >85%ile Provider sees banner under Quality issues and clicks associated smart set Acute care visit- problem added; follow up appt made with PCP Family stops at desk to get appt WCC- provider adds problem; uses smart set to guide care

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6 Baseline Data- The process 1.Residents define inclusion/exclusion criteria 1.Population, setting, timing 2.How to define a YES 2.Windy attempts to accurately describe criteria to non-clinical data guy (Adam) 3.Adam clarifies request, determines he can’t access BMI calculator 4.Adam builds BMI calculator and runs data 5.Windy validates data by doing chart review 6.Windy and Adam redefine search criteria 7.Windy begins data analysis; builds graphs for review 8.Team validates data (DO IT. Take the time.)

7 The baseline data  The pull: patients >2yo and 85%ile, with stratification of those who have any of the identified problems noted on their problem list

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9 The baseline data  37%  37% overall success (457/1220 patients)

10 The Science of Reliability Reliability LevelReliability Expression Reliability RateFailure Rate Level 110‾¹80-90% reliable1-2 failures in 10 opportunities Level 210‾²95% reliable<5 failures in 100 opportunities Level 310‾³99% reliable<5 failures in 1000 opportunities Level 6 (Six Sigma) 10‾6<5 failures in 1,000,000 opportunities

11 Baseline Data, continued

12 Questions to ponder  Should this count?

13 >99% Problem List Baseline Data, continued

14 Questions to ponder  Does age matter (this one is 5yo)?

15 Questions to ponder  What about the first time you meet a 3yo?

16 Age and BMI

17 Questions to ponder  How important is the REMOVAL of the problem from the list?

18 Future State- data  What do we want to know? –Will EPIC (retrospective) reports be sufficient?  When do we want to know it?  Where can we post it?  How can we use it to motivate and maintain?

19 Measurement  What’s the Hawthorne Effect?  What’s a run chart? –What’s it good for?