Chuck Mercier, MD - Vermont Oxford · • Every list identifies infants by 4 key variables ... Chuck Mercier, MD April 5, 2016 18 Case Studies ... which are controls

Using Nightingale to Inform Your Quality Improvement Work

Chuck Mercier, MD

April 5, 2016 1


NICQ NEXT2 Quality Improvement Collaborative

Jacksonville: April , 2016

Chuck Mercier, MD

Disclosures


Chuck Mercier, MD

April 5, 2016 2

Learning Objectives

Participants will demonstrate they can

1. Navigate Nightingale to select appropriate measures for NICU NEXT2 Quality Collaborative work;

2. Create center‐based project‐specific data tables and graphs;

3. Compare and contrast data need for very small, small, medium and large tests of change or outcome.

Login Page

• https://vtoxford.org

• If you forgot your password, click on Forgot your password?

• If you need access, click on Need a login and password?


Chuck Mercier, MD

April 5, 2016 3

Home Page

• To view reports, click on Nightingale Tables and Charts, choose a category from the drop‐down menu, or click on click here in the green box below the drop‐down menu

Query Navigation

• Category: Choose a group of measure types to view

• Population: All VLBW Infants (default); 501 to 1500g; 22 to 29 weeks; Expanded

• Location: All Infants (default); Inborn; Outborn

• Comparison Group: Network (default); NICU Type*

• Measure: Items within categories

• Group By (Measure pages only): Birth Weight 10‐level (default), Birth Weight 5‐level, Gestational Age Category, Gestational Age Week, Birth Location, Outborn Category, Birth Year

• Year: Default is current calendar year because Nightingale reflects most up‐to‐date data


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Category Page

• Click on a measure to go to a Measure page• Click on the question mark to open the data definition• Click on RA to go to the risk‐adjusted page for that measure

– applies to Key Performance Measures only

Measure Page

• Use the Group By drop‐down menu to change the display

• To see all data for that measure by year, choose Group By: Birth Year


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Infant List

• Click on one of the birth weight categories to get a birth weight specific list

• Click on All to get a list of ALL infants

Infant List

• Infant lists are sorted by Infant ID as a default.

• Every list identifies infants by 4 key variables

• You can click on the word at the top of any column to sort by that attribute.


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I know my measure, but…

• Click on Tools > Data Definitions

I know my measure, but…

• Click on one of the Nightingale Data Definitions categories, OR

• Click on Index


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…where is it?

• Click on your measure

• Find the Definition, Eligibility, Available Date, and Category Location

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Reports Download

• Repository of PDF reports created by Vermont Oxford Network• Click on the name of the report to download• Search for a report by keyword in the box at the top of the File column or filter by

document type, year, or category


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Working from a report…

• Is there an opportunity for improvement here?

Working from a report…

Q3, Q1 Mean = Comparative Network values (caveats!)2007 % = Your Center’s performance

Q3

Q1

Minimum

Maximum

NETWORK

CENTER

MEDIAN

MEAN


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Making Nightingale Work for You

Big Dot

Small Dot

● Chronic Lung Disease

Nasal CPAP

● CPAP B4 ETT

● DR CPAP

Aim: To reduce chronic lung disease for inborn infants 26‐29 weeks GA by 10% from

baseline (averaged over 5 years) by December 2017

Vermont Children’s HospitalSummary of Measures

Homeroom: Minimizing Chronic Lung Disease

Outcome Measures Source Venue Priority (notes)

Chronic Lung Disease Nightingale based Homeroom Aim Primary Outcome

Pneumothorax Nightingale based Site Primary Balance

Any Ventilation Nightingale based Site Secondary (Resource)

Any Surfactant Nightingale based Site Secondary (Resource)

Home O2 Nightingale based Site Secondary (Resource)

Family bundle Center based Site Primary Family

Process Measures Source Venue Priority (notes)

DRCPAP Nightingale based Homeroom Aim Primary Process of care

DRETT Nightingale based Site Secondary (Resource)

DR Surf Nightingale based Site Secondary (Resource / proxy)

CPAP Before ETT Vent Nightingale based Site Secondary (Resource)

Vent After Early CPAP Nightingale based Site Secondary (Resource)

Surf After 2 hours Nightingale based Site Secondary (Resource)

Caffeine use Center based Site Secondary

Care algorithm deviation Center based Site Secondary (Algorithm)


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Making Nightingale Work for You

Big Dot

Small Dot

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Aim: To improve nutrition and feeding practices for infants 26‐29 weeks GA

by December 2017

Center –Based Collaborative Dashboard(Nightingale‐Based)


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Care Measures – Center ValuesMinimizing Chronic Lung Disease

Vermont Children’s Hospital2010 – 2012

Download Data

• Choose file format to download (most often Excel)


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April 5, 2016 12

Download Data –Web Administrators

• Web Services Administrators can download files of raw, infant‐level data

• Data keys (PDF files) explain the variable names and values

***SIDE BAR ***

Download Data ‐Web Administrators

• Save as an Excel spreadsheet (e.g. VON Raw Data Summary 2015)

• Choose target columns

***SIDE BAR ***


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***SIDE BAR ***

• Field Name = Column Header

• Codes and Ranges = Cell entries

***SIDE BAR ***



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What’s in a Name

• SURFX → Field Name

• Surfactant At Any Time → Measure Name

– Surfactant → Group Measure Name

– Respiratory Care → Category

***SIDE BAR ***

How do I make my own…?

• Determine your “study” group inclusion criteria

– Population; Location; Group by; Mortality (Survival)

– Click <ALL> to view patient level data

– Consider PRE‐Download sorting

• Download (SAVE OPTIONS>Download as Excel)

• Save as an Excel workbook

– Download format is type: Web Page

– Label inclusion criteria

– Consider Post‐Download sorting


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• ALWAYs label (Population; Location; Group by; Year)• Consider ALWAYs keeping Infant ID to your left most column• Sort by measure of primary of interest (your right most column)• If eliminating patients, consider amending label• Example: GA 22‐29 weeks, All Infants, by GA Week, Eliminated Early Deaths, 2014


• Determine your “measures”

– Use identical Population, Location, Group by, Year

– Do not Pre‐Sort

• Download

– copy and past all rows and columns to Baseline Excel spreadsheet

• Reconcile by patient


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• Hide or delete redundant columns• Track patients eliminated from baseline

Allows first pass reconciliation


• Sorted, cleaned• Two discrepancies attributable to infant death after 12 hours

Infants 1611, 1614• One discrepancy attributable to early infant death

Infant 1612• One discrepancy attributable to cranial imaging = NO

Infant 1579? Population (denominator) implication


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The Measure Conundrum

• Define the denominator for every variable

– What is the infant population at risk?

– If each of the cases had NOT acquired the condition (e.g. had the disease), would s/he still be included in the population?

• Define the numerator for every variable

– What is the case definition?

– If each of the non‐cases in the population had acquired the condition, would s/he have been included as a case?

The Measure Conundrum

• Specified morbidities: CLD and/or PVL

– Population of infants at risk: 20

– Infants with CLD alone: 5

– Infants with PVL alone: 5

– Infants with CLD and PVL: 5

• What is the rate of CLD?

• What is the rate of PVL?

• What is the rate of specified morbidities?

• How does this impact your aim statement?


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Case Studies

Population: infants at risk Cases

Case Studies

• Case 1: DRCPAP=Yes, DRETT=Yes

– Interpretation

– Impact on improvement

• Case 2: Surf AT, DR Surf, Surf>2

– Interpretation

– Impact on improvement


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Charts

• What should we be working on?

Charts

• What should we be improving?

• By how much should we aim to improve?


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Charts

• Which patients are cases; which are controls

Charts

• How have we performed over time?


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What is wrong (right) with this picture?



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April 5, 2016 22


Navigation Summary

• Save Options: Save the table or chart that you are viewing. You can add the report to the Workspace on Nightingale or download it to your computer as a PDF or Excel file.

• Reporting: Access the Workspace, Report Download, and Data Download.

• Tools: Data definitions, the help page, the Data Management section of the Member’s Area, and your user profile.

• Log Out: Potentially better Best practice suggests that you Log Out when you are done using Nightingale. The system will automatically log you out after 15 minutes of inactivity.


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Nightingale Internet Reporting System

• Reporting Hub

– Center data within 30 minutes of submission

– Download PDF reports

– Risk‐adjusted results

Documents

Chuck Mercier, MD - Vermont Oxford · • Every list identifies infants by 4 key variables ... Chuck Mercier, MD April 5, 2016 18 Case Studies ... which are controls