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Coach Medical HomeStrategies & tools to support patient-centered medical home transformation
MODULE 4: Measurement
Learning objectives for this module
After completing this module, you will know how to: Describe measurement for improvement and why it is
critical to PCMH transformation.
Help leaders, clinicians, managers, staff, and patients develop a measurement and reporting strategy to support PCMH transformation.
Coach Medical Home: Module 4
2
Overview of contents
1. Why measurement for improvement is critical to PCMH transformation
2. Build an improvement-focused measurement strategy
3. Make measurement part of daily work through reporting
Coach Medical Home: Module 4
3
Why measurement for improvement is critical to PCMH transformation
SECTION 1
Coach Medical Home: Module 4
Using measurement to drive PCMH transformation
Coach Medical Home: Module 4
5
Different measures are meaningful for different audiences: Diabetes example
Coach Medical Home: Module 4
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Combined measures provide an overall view of
quality of care.
Specific measures show opportunities for improvement.
Focusing on improvement helps achieve practice goals
Coach Medical Home: Module 4
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Build an improvement-focused measurement strategy
SECTION 2
Coach Medical Home: Module 4
Why develop a measurement strategy?
Coach Medical Home: Module 4
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A measurement strategy’s components
Coach Medical Home: Module 4
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How leaders create a data-driven culture
11
Coach Medical Home: Module 4
PCMH transformation
Quality improvement
Practice leaders should:
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Building a measurement strategy: Five ways to maximize value & efficiency
Coach Medical Home: Module 4
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The measurement strategy…
Leadership’s role in building the measurement and reporting strategy
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Coach Medical Home: Module 4
Leader appoints team or
point person
• Commit resources
• Provide training
• Develop reporting strategy
Engage clinicians & staff in deciding what to measure
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Coach Medical Home: Module 4
Strategic plan
Daily work
Other ideas
Data
Data
Data
Possible performance
measures
Aim for a balanced set of measures to reveal the big picture
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Coach Medical Home: Module 4
Start with nationally endorsed measures
Which national measures are tied to the practice’s goals?
•MU
•HEDIS
•NQF
•AMA-PCPI
•NCQA or PCMH
Coach Medical Home: Module 4
1616
An efficient approach that also allows the practice to compare to national benchmarks
Customize measures for the practice
Coach Medical Home: Module 4
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Finding value in measures that overlap
Coach Medical Home: Module 4
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Measurement for improvement
Measurement for required reporting
Internal External
Efficient data collection
Refine based on available data sources
Coach Medical Home: Module 4
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Use EHRs and registries for measurement as much as possible
It may take time for practices to get started, but it’s worth it:
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Coach Medical Home: Module 4
Balance cost vs. value
Coach Medical Home: Module 4
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Make measurement part of daily work through reporting
SECTION 3
Coach Medical Home: Module 4
Engage clinicians and staff through training
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Coach Medical Home: Module 4
Builds trust and the capacity to use data to support PCMH transformation.Builds trust and the capacity to use data to support PCMH transformation.
Displaying data helps spread engagement
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Coach Medical Home: Module 4
Minimum standard for monthly reporting:Annotated run chart
0
10
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60
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100
Ma
r-9
9
Apr
-99
Ma
y-99
Jun-
99
Jul-9
9
Aug
-99
Sep
-99
Oct
-99
Nov
-99
Dec
-99
Jan-
00
Fe
b-0
0
Ma
r-0
0
Apr
-00
Ma
y-00
Jun-
00
Jul-0
0
Aug
-00
Sep
-00
Per
cen
t of
Pat
ien
ts in
Reg
istr
y
Percent of Patients with Documented Collaborative Goals
Goal = 60% to start.Encourage your teams to step it up once they get close to the goal.
Cycle 1: Dr. Smith/ 3 patients
Cycle 2: Test of Group Visit
Cycle 3: 8 patients self measuring blood glucose
© Institute for Healthcare Improvement
Why run charts work so well
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Coach Medical Home: Module 4
Run charts motivate teams to find ways to meet goals.
Questions to consider when reviewing run charts
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Coach Medical Home: Module 4
Percent of Patients with Structured Diagnostic Assessment in Record
0
20
40
60
80
100
Nov-99 Dec-99 J an-00 Feb-00 Mar-00 Apr-00 May-00 J un-00 J ul-00 Aug-00 Sep-00 Oct-00 Nov-00 Dec-00 J an-01 Feb-01
perc
en
t
Goal
Percent of Patients with Follow-up Structured Assessment at 4-8 Weeks
0
20
40
60
80
100
Nov-99 Dec-99 J an-00 Feb-00 Mar-00 Apr-00 May-00 J un-00 J ul-00 Aug-00 Sep-00 Oct-00 Nov-00 Dec-00 J an-01 Feb-01
perc
en
t
Goal
Average Change in MHI5 for Patients Treated After 12 weeks
0
5
10
15
20
25
Nov-99 Dec-99 J an-00 Feb-00 Mar-00 Apr-00 May-00 J un-00 J ul-00 Aug-00 Sep-00 Oct-00 Nov-00 Dec-00 J an-01 Feb-01
Avg
. ch
ang
e in
MH
I5
Goal
A family of measures refines understanding
© Institute for Healthcare Improvement
A dashboard provides a broader view
National PCMH Curriculum: Module #30
Example data wall for staff and patients
Measurement Wall at Community Health Partners, Inc., Livingston, Montana
Coaching tips summary31
Coach Medical Home: Module 4
As a coach, you can help a practice: