1. I have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this CME activity. I do not intend to discuss an unapproved/investigative use of a commercial product/device in this presentation. Data Collection and Measurement Paula Duncan, MD Amy E. Pirretti, MS Learning Session January 21-22, 2010

2. Measurement, Data Collection & Evidence of Change  Importance of measurement – Why?  How will we know that a change is an improvement?  Clarify and be directly linked to goals  Seek usefulness over perfection  Be integrated into daily work whenever possible  Be graphically and visibly displayed  For PDSA cycles, be simple and feasible enough to accomplish in close time proximity to tests of change

3. How will we know that a change is an improvement? Plan DoStudy Act What are we trying to accomplish? What changes can we make that will result in improvement? The Improvement Model The Improvement Guide Associates in Process Improvement

4. Measurement for Quality Improvement  You can’t improve what you can’t (or don’t) measure  A good aim statement provides clear direction.  Measures tell a team if the changes they make are making a difference  Measurement tells you where you are and where you are going

5. Measures  Need to define Target population Numerator Denominator

6. Define an Aim  What are we trying to accomplish?  Be specific Goal (90%) Action (BMI percentile ) Population (2-3year olds) When (at WCC visits) Time period (by November 2011)

7. Aim  To improve preventive services for children in our practice by assuring the delivery of evidence-based clinical care.  90% of Well Child Care Visit over the age 2 year old will have a documented BMI Percentile.  80% of Well Child Care Visit with a BMI > 85% will have documentation of an intervention.  By October 2011, 90% WCC visits will have a documented BMI percentile and 80% with a BMI > 85% will have documentation of an intervention.

8. Effective Measurement  Seek usefulness, not perfection  Keep measurement simple, think big, but start small

9. Effective Measurement  Build measurement into daily work routine Data should be easy to obtain and timely Small samples over time  Use quantitative and qualitative data Quantitative data is highly informative Qualitative data is easy to obtain

10. Change Run Charts

11. Chart Review Chart Reviews for 2 Sets of Patients:  At least 10 charts of 9 month health supervision visits. Age range: 8-10 months Retrospective pull of last 10 charts from your practice  At least 10 charts of 24 month old health supervision visits. Age range: 22-28 months Retrospective pull of last 10 charts from your practice  Complete both sets of Survey Monkey Forms monthly by the last day of the month

12. 9 month health supervision visit – 20 total charts

14. 24 month health supervision visit – 20 total charts

17. Data Collection Site: http://www.aap.org/qualityimprovement/quiin/workspaces/P reSIP/DataCollection.html

18. Chart Review Log Sheet Example 1 Log Sheet for Each Age Group (9 month and 24 month)

19. Monthly Progress  Provides information about Any barriers encountered across the month Assessment of practice implementation of maternal depression screening Assessment of team progress Instructions  Insert your practice’s Aim statement.  Rate your team’s progress using the scale. Report your team’s learning.  Complete the information about maternal depression screening.  Submit your Monthly Progress Report by the 30 th of the month for which you are submitting, using the Survey Monkey link (URL) that will be sent each month via the project listserv

20. Project Workspace  All data and run charts will be available for review on the Project Workspace Web site http://www.aap.org/qualityimprovement/quiin/ workspaces/PreSIP/Home.html Username: presip Password: p3r6p8  Compare your team’s data to other teams and to the aggregate data!

21. I have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this CME activity. I do not intend to discuss an unapproved/investigative use of a commercial product/device in this presentation. Team Planning and Sharing Paula Duncan, MD Preventive Services Improvement Project Learning Session January 21-22, 2011

22. Objectives  Plan PDSA cycle for Team members will apply what they have heard today to their own practice Identify priorities for improvement regarding Bright Futures recommendations Plan tests of change  Share the plans

23. Apply the Model for Improvement to your own practice and develop your plan of what to try by next Tuesday...

24. TEAM PLANNING & SHARING INSTRUCTIONS In this session you will…. --As a team, think about how you will begin to make changes in your practice (what topics do you want to start working on?; what age group?; who will be responsible for what?; etc). --You may choose to discuss your ideas for change with the other team assigned to your room or work as an individual practice. Discussing as a larger group may help you to think of other ideas and strategies for using the tools. --Use the Testing Change (PDSA) Worksheet found in your binder to guide your discussions. --Review Team Planning Time Breakout Sheet in binder to find your breakout location. Note: The more well planned your tests are the more likely they’ll be successful

25. TEAM PLANNING & SHARING INSTRUCTIONS Team Report Out 1.Share your plan! 2.Tell us what you think was the most important thing you learned today 3.Pretend a reporter for your local newspaper is coming to do an article on your practice after you have tested changes to improve Bright Futures in your medical home. What would you hope the headline might say? Be Brief! Only 2 mins per team!