Data Driven Decision Making

Pat Teske, MHA, RNCynosure Health

Why do we want to

measure?

Poll answers:

A. Because we have to.B. To understand how we are performing.C. To let us know where we need to improve.D. All of the above.E. B & C.

Do you operate like this?

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This is NOT the answer?

Use data to work strategically

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Use both big and little data

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On Death, Dying & Data

DENIAL

ANGER

BARGAINING

DEPRESSION

ACCEPTANCE

Poll

QUESTION:• In what state is your

organization most often when you are sharing data?

ANSWERS:A. DenialB. AngerC. BargainingD. DepressionE. Acceptance

Units of Measurement

• Ratios• Rates• Percentages• Median• Mean• Counts

Choosing appropriate statistics

• Useful to adjust for natural impacts e.g. volumeRates

• Useful when denominator is large and numerator is smallCount

• You have 5 readmissions/month and 15 discharges

• Your readmission rate is 30%• To reduce your rate by 20% you need to

get your rate down to 24%• Or…you need to avoid ONE readmsission

Numerators are concrete

Percentage or Percentile?

• Suppose your score on the GRE was reported to be the 80th percentile

• Does this mean you scored 80% of the questions correctly?

Mean• Mean (average)

• Measures the center, or middle, of a numerical data set

• The sum of all the numbers divided by the total number of numbers

• May not be a fair representation of the data

• Easily influenced by outliers

Median

• Median• Also measures the center of a numerical

data set• Much like the median of an interstate

highway• The point at which there are an equal

number of data points whose values lie above and below the median value

• Is truly the middle of the data set• Better measure when there are outlying

values in the data set

Median v Mean

• 10 people are on the bus

• The mean income of the riders is $50,000/yr

• The median income of the riders is $50,000/yr

• What does this tell us?????

Joe Blow gets off Bill Gates gets on

Mean v. Median

Please chat in. What would change? The mean or the median?

Let’s give it a try

What are the mean and median of the following numbers?

111

1221

Poll

What are the mean andmedian of the followingnumbers?

111

1221

ANSWERS:A. Mean = 3, Median = 12B. Mean = 3, Median = 1C. Mean = 1, Median = 3

Bell Curve

Where are you?

What if you’re hospital A?, H?, D?

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C A G B H F E D

Median ED Arrival to Departutre Time

Median ED A to D Median

Poll

QUESTION:• What would you do if

you were hospital A?A. Since our

performance is below the median I would not focus on improvement for this measure.

B. I would try to improve so I could be better than hospital C.

Poll

QUESTION:• What would you do if you

were hospital H?A. Since our performance

is slightly above the median I would not focus on improvement for this measure.

B. I would try to improve so I could be better than the median.

C. I would look at all of my other data to see where I need to make the most improvement.

Poll

QUESTION:• What would you do if you

were hospital D?A. Since our performance

is way above the median I would prioritize improvement for this measure.

B. I would try to improve on a different measure where I am not so far away from the median.

Use big data to target effectively

• What groups come back more frequently?

• What is the discharge disposition?

• How soon are your patients returning?

• Who are your highest utilizers?

• What are the top DRGs?

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30-Day Potentially Preventable Readmission (PPR) Rates by Race and

Ethnicity

Poll

QUESTION:• How do the Medicare

patients differ?A. Less than 10% go

home with home health services

B. More than 25% are discharged to a SNF.

It’s about learning

not doing

• Why, why, why….– An interview might reveal that a

patient did not take her medication, which then contributed to her rehospitalization.

• Why did she not take her medication?

– She did not take it because she did not have it. Why?

– She did not go to pick it up from the pharmacy. Why…?

Listen for themes

Leaving the hospital unprepared, or inadequately informed, without specific instructions on what to do

A lack of coordination - Challenges in accessing services: appointments, transportation, medications, equipment

Changing circumstances after discharge

PCP instructions to return to the ED

Readmissions are O.K., expected, or very frustrating

Aggregate and prioritizeReason Pt. A Pt. B Pt. C Pt. D Pt. E Pt. F Pt. G Pt. H Pt. I Pt. J Pt. K Pt. L Pt. M Pt. N Pt. O Pt. P Pt. Q Pt. R Pt. S Pt. T TotalMedication Management Y Y Y Y Y 5Discharge Instructions not clear Y Y Y Y Y Y Y Y Y Y Y 11Palliative care/hospice Y Y Y Y Y Y Y Y 8Care coordination Y Y Y Y 4MD f/u or instructed to return Y Y Y Y 4Psychosocial/family dynamics Y Y 2Transportation Y Y 2Other Y Y 2

Poll

QUESTION:• Based on their patient

interview findings, this hospital should work to improve:

A. TransportationB. MD instructed them to

returnC. Discharge instructions

Key questions?• Do you have a data

informed targeting strategy?

• Do you know the reasons why your patients are being readmitted?

• Do you monitor your key processes?

• Have you modified your approach?

Please chat in

• How do you analyze your MBQIP data?

• If you see an improvement opportunity, how do you go about improving?

• What have you tried so far?

Data Display and Analysis

• How do you want to tell your story?

• Who are you going to tell your story to?

Plot The Dots• Visual display of data

enhances analysis

• We want to know if we are decreasing or increasing as a result of our efforts

Chart1

week 1week 1week 1

week 2week 2week 2

week 3week 3week 3

week 4week 4week 4

Series 1

Series 2

Series 3

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Sheet1

Series 1Series 2Series 3

week 12.42

week 24.42

week 31.83

week 42.85

To resize chart data range, drag lower right corner of range.

Shock Program O/E Mortality

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1.0

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Control Yr 1 Yr 2 Yr 3 Yr 4 Yr 5

O/E RatioShock Program

pushback Continued feedback to entire Medical Staff

Continued adoption of new best practice &

increased acceptance

Engage change agents & established standard of

care by Medical Staff

Courtesy of Martha Leighton; Eliot Hospital, Manchester, NH

It’s not a rate: it’s a human being

We did it!

Please chat in

• How do you display your data?

• What have you tried so far?

• What advise do you have for others?

46

Pat Teske, RN, MHAImplementation OfficerCynosure Healthpteske@cynosurehealth.orgALL IN

mailto:pteske@cynosurehealth.orghttps://www.amazon.com/All-Using-Healthcare-Collaboratives-Improve/dp/0996792708?ie=UTF8&keywords=all%20in%20using%20healthcare%20collaboratives&qid=1453739079&ref_=sr_1_1&sr=8-1

Data Driven Decision MakingWhy do we want to measure?Poll answers:Do you operate like this?This is NOT the answer?Use data to work strategicallyUse both big and little dataOn Death, Dying & DataPollUnits of MeasurementChoosing appropriate statisticsNumerators are concretePercentage or Percentile?MeanMedianMedian v MeanMean v. MedianLet’s give it a tryPollBell CurveWhere are you?What if you’re hospital A?, H?, D?PollPollPollUse big data to target effectively30-Day Potentially Preventable Readmission (PPR) Rates by Race and EthnicitySlide Number 28PollIt’s about learning not doingListen for themesAggregate and prioritizePollKey questions?Slide Number 35Slide Number 36Please chat inData Display and AnalysisPlot The DotsShock Program O/E MortalityIt’s not a rate: it’s a human beingWe did it!Please chat inSlide Number 44Slide Number 45Slide Number 46Slide Number 47Pat Teske, RN, MHA