Comparative data has become a powerful force in health care performance improvement. In this book you'll learn how to incorporate comparative measurement data into your organization's quality and patient safety improvement strategies. You'll discover how to select credible data sources to determine if your performance measures up to that reported by other organizations. Plus you'll find out how to gain cooperation from practitioners and dig deeper to find the causes of variation. The book includes examples of comparative data from many sources and sites of patient care and a discussion of regulatory and accreditation requirements. You'll learn how to meet these requirements to facilitate positive performance improvements in your health care organization.

Table of Contents

Chapter 1: Comparative Data are Here to Stay

Report Card or Performance Report – What’s the Difference?

How this Book Will Help

Chapter 2: Exploration

Selecting Comparative Data Sources

External Requirements

Clinical Importance

Strategic Performance Management Priorities

Available Resources

Reporting Techniques and Analytic Tools

Results reported individually

Results compared to average performance

Actual versus expected performance

Results compared to a benchmark or goal

Results reported in control charts

Results reported according to a ranking system

Choosing Comparative Measurement Opportunities

Select Measurement Systems

Special Purpose Comparative Data

Chapter 3: Assessment

Data Analysis in Three Steps

Step 1: Verify the Accuracy of Your Data

Step 2: Acquaint Yourself with the Comparison Group

Step 3: Uncover the Story in the Data

Difference between your rate and the comparison group

Amount and type of variation in trends reports

Gap between your performance rate and internal expectations

Chapter 4: Intervention

Be Prepared with Answers

Anticipate Reactions and Prepare Accordingly

Dig Deeper to Find Improvement Opportunities

FADE Case Study

From Analysis to Intervention

Gather Additional Information

Discover “Best Practices”

Select the Best Interventions

Change Can Create Resistance

Test Proposed Changes

Chapter 5: Monitor and Maintain

Select Measures

Monitor Performance

How Long Should Monitoring Continue?

Next Steps

Transfer Knowledge

In Closing

Facilitate Positive Change

LIST OF FIGURES AND TABLES

Figures

Steps involved in using comparative data to improve health care performance

Measurement data presented individually

Example of comparative report

A Quality Indicator Project® comparison chart with facility rate, group’s weighted mean, and range of expected performance

Incidence of increase in pressure ulcers on discharge from home health

Comparative report using percentile rankings

Sample case mix report for home health agency based on OASIS data submitted to the Medicare Program

Comparison of Virginia cardiology mortality versus the national norms

PsychSentinel report showing length of stay versus outcomes

OR Benchmarks report of surgical supply cost comparisons

X-bar control chart of surgical wound infection rates

Control chart selection guide

Matrix for rating the value of performance measures

Urinary catheter-associated urinary tract infection rate for patients in ICU

Steps of data analysis

P-Chart for 1996 VBAC rates at southwest Michigan hospitals, all levels

P-Chart for 1996 VBAC rates at southwest Michigan hospitals, stratified

Example of a Quality Indicator Project® custom report

Comparison of functional outcomes during inpatient episode of care

Distribution of anesthesia costs per case for total knee replacements

Mean pain ratings reported by patients four hours after surgery

Theoretical normal distribution

Theoretical normal distribution with standard deviations

Comparison chart showing confidence intervals, comparison group means, and facility means

Comparison chart of medication error rates

c chart of patient falls in an inpatient rehabilitation facility

Nosocomial infection rates at a skilled nursing facility compared to peer group

p chart of skilled nursing facility nosocomial infection rates

Performance goal: reduce variation

X-bar control chart of mean times for laboratory test processing

Run chart showing a disturbing upward trend

Nosocomial infection rates at a skilled nursing facility compared to peer group

Quality manager’s comparative data presentation preparation worksheet

Histogram showing death rate by attending obstetrician

Histogram showing death rate by attending pediatrician

Flowchart of steps in ordering and administering corticosteroids

Rate of steroid use by physician

Action planning decision tool

Cause-and-effect diagram

Flow chart: Factors affecting surgical wound infections

Illustration of spreadsheet showing patient-level data from the Quality Indicator Project

Common barriers to clinical process improvement: knowledge, attitudes and behavior

Questions to consider during pilot testing of proposed actions

Control chart showing the impact of actions designed to reduce wait times in the emergency department

Steps in using comparative data to improve health care performance

Tables

Examples of AHRQ inpatient quality indicators for surgery services

Examples of Medicare skilled nursing facility performance measures

Common comparative performance projects affecting health care providers

Estimated cost of data collection using different survey techniques

Breakdown of neonatal death rates by mode of delivery

Comparison of lethal congenital anomaly rates

Comparison of fetal distress rates

Comparison of chorioamnionitis rates

Comparison of neonatal death rate causes

Relationship between surfactant use and neonatal deaths

Administration of corticosteroids

Timing of corticosteroid administration

Incidence of suboptimal doses of steroids

Performance data following implementation of action plans

Results of the Guidelines Applied in Practice Initiative (2002)