Identify a performance measure you use in your daily practice

Identify a performance measure you use in your daily practice and discuss the following:

1. Identify what is being measured and offer an operational definition.

2. How is the measure calculated? ex. for percentages or rates, identify the numerator and denominator

3. How is the measure reported - ie to managers only through printouts; dashboards for the staff, etc.

4. Describe the usefulness of the measure for your role and practice setting. (use references to support your position)

Module 3: Readings, Lecture, and Assignments
Quality Measurement
Big Data in Healthcare
It’s no surprise that since the widespread adoption of electronic health records, data collection has become much simpler; but knowing what to do with that data requires a completely new framework for analysis, interpretation and visualization. Read the following article on “big data” and healthcare:

The_big_data_revolution_in_healthcare.pdfPreview the document

The challenge with quality measurement and improvement at this stage in the game isn’t measuring the data; it’s making it actionable. Having data for data’s sake is great job security for your IT team, but for quality improvement- data is practically useless unless the receiver can draw insight from the message you are trying to send. Read this article on the “missing link” between data and value:

"Missing Link" (Links to an external site.)

Often times when we think about value, we immediately relate that to cost (i.e. your Module 1 discussion). And although cost is important, evidence of the direct association between cost and quality is inconsistent at best. One of the main reasons for this is regional variation in the costs of providing care- think the cost of staffing 1 nurse in New York City vs. the cost of staffing 1 nurse in Kentucky; think about the cost of robotic surgical equipment; think about access to preventative care in rural Appalachia. It’s easy to see how these heterogeneous populations have difficulty linking cost directly to quality given all the extraneous psychosocial and geographic factors at play; to name a few. Please read the following systematic review outlining the challenges of directly linking cost to quality:

Association between Cost and Quality: A Systematic Review (Links to an external site.)

Besides psychosocial and geographic differences- what other challenges did Hussey et al. identify in their study? Think about the importance of data integrity (Links to an external site.) in the world of “big data”- what role do you think this plays in providing validity and reliability to quality measurement?

Review the following resources on data integrity and shared measure definitions:

Data Quality Management Model (Links to an external site.)

Here are several links to valuable resources for quality measurement. Many also have open-access datasets that users can self-service- [HINT: These may be helpful in Module 5 as we work on defining problem statements]

Leapfrog (Links to an external site.)

PressGaney (Links to an external site.)

CDC (Links to an external site.)

Joint Commission (Links to an external site.)

Health IT (Links to an external site.)

Nursing Home Compare (Links to an external site.)

HEDIS- Ambulatory (Links to an external site.)

OASIS- Home Care (Links to an external site.)

Shared Savings and ACO Measures (CMS) (Links to an external site.)

I want you to think about your DNP Project, because proving value is a big part of “making your case” to the executive leaders at your clinical sites. By now, you have completed you organizational assessment and should have a fairly thorough understanding about what drives your organization’s “True North”. You should also have a sense of their capacity to measure and interpret their outcomes. Insight into measurement and interpretation of outcomes can lead you inferences about the direction and priorities of your organization. Try to put all those puzzle pieces together as you look toward pitching your project to senior leaders.

Please review a few of the most common ways that organizations measure value:

Reduced Nosocomial Events
Any time a patient experience a hazard of hospitalization (i.e. infections, falls, etc.) there is an associated cost associated to that event that could have been avoided. These types of avoidable costs are typically linked to the quality of care a patient receives while hospitalized.


Cost of HAIs (Links to an external site.)

Suppose your project was to reduce central line-associated bloodstream infections (CLABSI) by implementing the CDC CLABSI checklist (Links to an external site.) in the ICU. How would you measure the impact of reducing CLABSI rate from 5.3 per 1,000 catheter days to a rate of 4.9 per 1,000 catheter days? Suppose by reducing CLABSI rate, your average length of stay in the ICU went down as well because less patients were having to stay hospitalized for antibiotics- how would you measure that? (we will get to that as well in more detail).

Here is a great resource for student’s thinking about infection reduction projects

APIC HAI Cost Calculator (Links to an external site.) (click on “Download the Excel file”)

The same methodology above can be used for falls reduction projects as well.

Readmissions Reduction
You have already read in module 1 about the impact of the Affordable Care Act and other government-sponsored programs to improve quality and reduce cost. Please read this more in-depth article on the history of the hospital readmissions reduction program:

Readmission Reduction Program (Links to an external site.)

Hospital Readmission Reduction Program (HRRP) (Links to an external site.)

If your interest for your DNP involves reducing unnecessary hospitalizations or impacting quality outcomes for a cohort of patients with a certain disease (i.e. heart failure, COPD, pneumonia); consider using one the following evidence-based tool kits that can provide a framework for your intervention:

Project RED (Links to an external site.)

QIO Readmissions Resources (Links to an external site.)

Operational Efficiency and LEAN
Many of you may be familiar with the principles of LEAN in healthcare. The basic foundation of LEAN is to reduce operational inefficiencies to improve work outputs and eliminate waste. Originally intended to improve efficiency in manufacturing, the principles can also apply to healthcare.

8 Wastes of LEAN

8 wastes

The IHI endorses LEAN principles and their applicability to healthcare. Please read the following article to gain a better understanding of LEAN in healthcare.

GoingLeaninHealthCareWhitePaper.pdfPreview the document

Linking a direct cost to creating an operational efficiency can be easier said than done; but remember we are measuring value, which is not necessarily cost.

Depending on your audience, value can mean different things to different stakeholders.

What Matters to Patients (Links to an external site.)

Imagine you are implementing a quality improvement project around implementing an infection prevention bundle for patients undergoing total joint replacement. Pretend you are about to “pitch” your project to gain buy-in from stakeholders you need involved to make the project successful. You always want to lead with your value proposition. How would you change your value message, based on the following audiences:

The CEO?
The Vice President of Finance?
The Chief Nurse?
The patient?
The surgeon?
The nursing staff on the med-surg unit?
The infection prevention team?

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