1. Measurement: the why, the what, and the how Paula Griswold, MPH Executive Director Massachusetts Coalition for the Prevention of Medical Errors Nora McElroy, MPH General Epidemiologist, Massachusetts Department of Public Health Bureau of Infectious Disease Prevention, Response and Services, Epidemiology Program Laurie Herndon, GNP Massachusetts Senior Care Foundation

2. Why measure? 1. For you  Track progress towards key improvement goals “How do we know a change is an improvement?”  What gets measured gets done 2. 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) 3. For the CDC (our funder)  National recognition  Continued funding and opportunity to support change in the community

3. How to choose measures? Looking at processes or outcomes that demonstrate the changes in practice we are encouraging Good enough measures  Balance value and effort  Don’t let the perfect be the enemy of the good We’ll give you core measures  And tools for reporting and and sharing Future review of antibiograms

4. What we measure & hope to see How we know a change is an improvement Measure Percent of treated UTIs that meet the “Protocol criteria” (ABCs) Rates/10,000 resident days  new UTI diagnoses  laboratory orders for urine culture  healthcare acquired C. difficile (HA-CDI) We hope to see Increase in UTIs meeting criteria Decreases in events due to less mis-identification of asymptomatic bacteriuria

5. Measurement for real time learning Review and share progress monthly  How you did: excel file with measures  What you did: monthly report is in your packet you will receive email reminders. Teach your staff about the value of measurement in quality improvement Be on the lookout for unintended consequences

6. Don’t Forget The Law Of Unintended Consequences UTI diagnosis missed UTI treatment delayed Clinical decompensation Hospital transfer

7. One Approach For Monitoring For Unintended Consequences

8. Watching for trends…

9. Monthly Measurement & Reporting How it works

10. Data Collection Tools and Forms  Data collection & reporting instructions  Chart review form An optional tool for applying the definition of a UTI in LTC  Excel workbook Documentation of monthly chart reviews and summary statistics to be submitted monthly

11. What we are going to measure Rates* over time of:  new UTI cases  laboratory orders for urine culture  healthcare acquired C. difficile (HA-CDI) Percent of treated UTIs that meet the ABCs criteria * All rates calculated per 10,000 resident days

12. Collaborative Results 2012-2013 (N=17) 12

13.  2 types of measures: Summary statistics to track rates Chart review for evaluating whether ABCs criteria are met Overview of Measures

14. Calculating a Rate The rates are calculated as in the following example: (UTIs/Resident-days)*10,000

15. Calculating Resident-days  What are Resident-days? The denominator used to calculate infection rates Calculate resident days by adding up the daily census for an entire month  Day 1 census + Day 2 census + ……..… + Day 31 census If a facility has 100 beds and 90 were in use every day in October the resident days for October would be 2,790 (90*31) Include only residents aged 70+ in this calculated

16. Selecting Residents for Data Collection  Include residents 70 years of age or older  A UTI case is any new, not recurrent, diagnosis and treatment. Include patients that are treated, not just those that meet the ABCs  For C difficile cases, include patients with symptoms beginning on the fourth day after admission to your facility or later

17. Summary data spreadsheet

18. Summary Data Tutorial July 2013: 1 C diff case, 5 UTIs, 50 urine cultures,3621 resident days Aug 2013: 0 C diff cases, 4 UTIs, 45 urine cultures, 3599 resident days Sep 13: 0 C diff cases, 2 UTIs, 43 urine cultures, 2597 resident days

19. Sample summary data worksheet

20.  2 types of measures: Summary statistics for rates Chart review for evaluating whether ABCs criteria are met Overview of Measures

21. Chart Review Data Collection Form  Chart reviews will examine the characteristics of all patients treated for UTIs and whether they met the ABCs criteria  Review up to 20 charts a month If you have more than 20 UTIs in a month, review the first 20 infections, otherwise review all infections  Use the optional chart review form to guide your completion of the Excel spreadsheet but only the spreadsheet will be submitted

22. Measurement: Practical Application Case 1 October 15, 2013 Shangri La Nursing Home

23. Chart review data collection form

24. Chart review data spreadsheet

25. Completing a Chart Review with the Data Collection Form 1 October X XXXX X X X October 3, 2013 X

26. Chart Review Spreadsheet  Document chart review form answers and transcribe them onto the Data Submission Excel Spreadsheet  Answer Yes or No to each of the questions  After completing the chart reviews each month, email the spreadsheet to EBiocchi@macoalition.org

27. Completing the Chart Review Spreadsheet

28. Case Study 1

29. Case Study Walkthrough Read through the remaining two case studies and fill in the sample worksheet and data submission form

30. Case Study Summary

31. Summary There are three tools to assist the collection of collaborative data  Chart Review Data Collection Form (paper)  Chart Review Spreadsheet in the Excel file  Summary Data Spreadsheet in the Excel File Submit the Excel file by the 7 th of each month to:  Ebiocchi@macoalition.org Ebiocchi@macoalition.org

32. Thank you! Any Questions? Nora: nora.mcelroy@state.ma.us Susanne: sss@hcqi.comsss@hcqi.com Laurie Herndon, GNP: lherndon@maseniorcare.org