Learning to Love Data JEFF CAPOBIANCO, PHD
What we’ll be discussing together! Why the strong focus on “Data” today in the “healthcare marketplace”? What can we do to reframe how we think about and use data? How can we use data to assess services quality and outcomes to drive treatment decisions? How can we use it to inform clinical practice to help our clients achieve their goals?
Most Common Responses to the Talk About Data or Measurement
“Hey Jeff…” What I’ve heard about Data/Measurement “Behavioral Health staff aren’t good at math…after all that’s why I went into Behavioral health…” “What we do and who we work with are too complex to measure…” “You can’t hold me accountable for a consumer achieving a treatment plan metric…” “The demand to use data is just another way to get us to work harder/more…to talk about productivity” “Our EMR is not useful…and I don’t see that changing anytime soon…no really I’m serious.”
Value-Based Purchasing - An Old Term Getting New Life in the “Healthcare Marketplace” "The concept of value-based health care purchasing is that buyers should hold providers of health care accountable for both cost and quality of care. Value-based purchasing brings together information on the quality of health care, including patient outcomes and health status, with data on the dollar outlays going towards health. It focuses on managing the use of the health care system to reduce inappropriate care and to identify and reward the best-performing providers. This strategy can be contrasted with more limited efforts to negotiate price discounts, which reduce costs but do little to ensure that quality of care is improved." Source: Theory & Reality of Value-Based Purchasing: Lessons from the Pioneer. November 1997. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/meyer/index.html
Current & Future Expectations for Providers Today Screening & Length of Care/ Target Level of Level of Service Service Bundle Assessment Engagement Criteria/Cost Time to Tx Parameters Maintenance/ Improved Academic Low Intensity Medication Performance Relapse Low Intensity/$ 0-9 Months Female, 18 yrs old Prevention Substance Cessation On-going Screening or Reduction Substance Addicted (nicotine) Crisis Plan Action PHQ-9 Score <10 Moderate Moderate Intensity Depressed Cog. Beh. Therapy Appt’s Kept Intensity/$$ 9-18 Months Self-harming Preparation Use of Crisis Plan Smoking Cessation Poor Academic No self harm Academic Supports Performance Precontemplation High Intensity No Hosp. & ED Use High Intensity/$$$ & Contemplation 18 -28 Months Satisfaction
Effective & Efficient Healthcare Effective Healthcare • Clinical & administrative processes that produce quality outcomes & customer satisfaction Efficient Healthcare • Clinical & administrative processes that operate within optimal time & cost specifications Fee-for-Service/Volume-Based Care Focus is on Efficiency Value-Based Purchasing Focuses on Efficiency & Effectiveness Measurement-based Care
Why is the Use of Data for Clinical & Administrative Decision Support so Difficult? “The main reason seems to be a lack of integration of (data) health IT into clinical workflow in a way that supports the cognitive work of the clinician and the workflows among (partner) organizations, within a clinic and within a visit.” Source: Carayon & Karsh, (2010). AHRQ Publication No. 10-0098-EF
Collecting, Using, & Sharing Health Data BARRIERS BENEFITS 1. Lack of Leadership 1. More efficient workflow (e.g. less time spent handling laboratory results) 2. Lack of strategic plan for data use & health IT 2. Improved access to clinical data 3. Costs of EHR implementation 3. Streamlined referral processes 4. Cost of establishing and maintaining 4. Improved quality of care--Better health links between EHRs and HIE outcomes networks 5. Improved patient safety, including fewer prescribing errors and fewer 5. Security and privacy issues hospital readmissions 6. Liability Provider’s concern to be held 6. Cost savings (e.g. eliminating costs of liable for information from outside sources/labs storing paper records) 7. Increased revenue (e.g. government 7. Misaligned incentives (who pays and who benefits) incentives for use of health IT) 8. Pay-for-performance incentives 8. Provider reluctance to relinquish control of patient information to competing systems 9. Technical barriers (e.g. lack of interoperability among EHRs) 10. Lack of IT training and support Source: Fontaine, Ross, et al. (2010). Systematic Review of HIE in Primary Care Practices, JABPM
Analytics at Work: Smarter Decisions Better Results by Davenport, Harris & Morison D for accessible, high-quality Data E for an Enterprise orientation L for analytical Leadership T for strategic Targets A for Analytical talent
Creating the Culture of Continuous Quality Help
Data + Information + Knowledge = Help ‣ Data Granular or unprocessed information ‣ Information Information is data that have been organized and communicated in a coherent and meaningful manner ‣ Knowledge Information evaluated and organized so that it can be used purposefully ‣ Help! Putting knowledge into use/action for our clients
What is the ultimate purpose of data? To turn it into Help! Continuous Quality Help! Data HELP Information Knowledge
How does data help you help your clients? ‣ Clearly links the organization’s purpose/mission to the clients’ needs ‣ Provides the means for the agency to articulate its’ value proposition to funders to keep and expand services ‣ Provides objective picture of how the person is doing and what they want ‣ Allows for means to engage in health literacy through the discussion of symptom monitoring tool data, ‣ What else??
Ok, I agree it can be useful but how do we do this… ‣ Let’s look at data use from the standpoint of traditional Continuous Quality Improvement first ‣ Then we’ll look at it from the standpoint of Continuous Quality Help
Continuous Quality Improvement Process to Respond to Findings 1/10/2020 16
Adapted from: Kolhbacher, et al. (2008) AHCMJ Compare Performance Results Target Actual Strategic Plan Target Dashboard Performance Performance Target=100% Provide smoking 100% of Data aggregated & Actual=60% cessation consumers will displayed services be screened for smoking Take Corrective Medical Record Action Adjust Objectives ? Screening data or stored Keep Monitoring? Staff enter screening data Discharge/ Consumer Care Pathway Intake Referral (Staff trained to provide smoking screening) Data Action Information Knowledge
Adapted from: Kolhbacher, et al. (2008) AHCMJ Compare Performance Results Target Actual Strategic Plan Target Performance Performance Dashboard Target=100% Provide smoking 100% of Data aggregated & Actual=60% cessation consumers will Act Plan displayed services be screened for smoking Take Corrective Medical Record Study Action Adjust Objectives ? Screening data or stored Keep Monitoring? Staff enter screening data Do Discharge/ Consumer Care Pathway Intake Referral (Staff trained to provide smoking screening) Data Action Information Knowledge
Continuous Quality Help Process to Respond to Client Needs Develop Person Centered Plan based on Strengths & Level of Readiness If it worked, Celebrate! Support Client in If it didn’t work, Doing the Plan Celebrate the effort & develop a better plan! Engage to Study & see if it worked?
Meet with Client & Compare 30 Day Action Target Actual Plan: Results Performance Performance Diary Card Person Centered Plan Reduce smoking Target=3 cigs Data aggregated & Goal Area: Smoking by3 cigs a day Actual=1 cig. displayed through mindfulness Update PCP with new goal? Adjust Objectives ? Diary Card New Skills? Keep PCP as is? client enters # smoked daily Client Client Leaves Client’s Experience/Work btw Appts Returns to Appt Appt Data HELP Information Knowledge
Where to start? 1. Choose an area of your practice that is of great concern (people are not getting better…) or great excitement (we’re doing great work here but have no data to show for it). 2. Find a data point(s) that is relevant and determine how to capture and process the data (e.g., reliable and valid tools, registry, dashboards, etc.) 3. Incorporate data into discussions about progress with your team, clients, and their natural supports by using a data tracer checklist 4. Conduct ongoing CQI/CQP to respond to the findings and to monitor progress
Choosing a good measure? Data are The metric modestly can be collectable by impacted by reliable the client source Client understands Method for how the data collecting is tells their understood story Source: Adapted from Data Fluency by Gemignani & Gemignani
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