Learning to Love Data JEFF CAPOBIANCO, PHD What well be discussing - - PowerPoint PPT Presentation

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

• f 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

Low Intensity/$ High Intensity/$$$ Moderate Intensity/$$ Level of Service Criteria/Cost

Screening & Assessment Target Parameters Length of Care/ Time to Tx

Moderate Intensity 9-18 Months High Intensity 18 -28 Months

Improved Academic Performance Substance Cessation

• r Reduction

PHQ-9 Score <10 Appt’s Kept Use of Crisis Plan No self harm No Hosp. & ED Use Satisfaction

Medication On-going Screening Crisis Plan

• Cog. Beh. Therapy

Smoking Cessation Academic Supports

Service Bundle

Female, 18 yrs old Substance Addicted (nicotine) Depressed Self-harming Poor Academic Performance

Low Intensity 0-9 Months Level of Engagement Maintenance/ Relapse Prevention Precontemplation & Contemplation Action Preparation

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

“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

Why is the Use of Data for Clinical & Administrative Decision Support so Difficult?

Collecting, Using, & Sharing Health Data

BENEFITS

1. More efficient workflow (e.g. less time spent handling laboratory results) 2. Improved access to clinical data 3. Streamlined referral processes 4. Improved quality of care--Better health

• utcomes

5. Improved patient safety, including fewer prescribing errors and fewer hospital readmissions 6. Cost savings (e.g. eliminating costs of storing paper records) 7. Increased revenue (e.g. government incentives for use of health IT) 8. Pay-for-performance incentives

BARRIERS

1. Lack of Leadership 2. Lack of strategic plan for data use & health IT 3. Costs of EHR implementation 4. Cost of establishing and maintaining links between EHRs and HIE networks 5. Security and privacy issues 6. Liability Provider’s concern to be held liable for information from outside sources/labs 7. Misaligned incentives (who pays and who benefits) 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

Information Knowledge

HELP

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

Strategic Plan Provide smoking cessation services Performance Target 100% of consumers will be screened for smoking

Compare Results

Target=100% Actual=60%

Take Corrective Action

• r

Keep Monitoring?

Dashboard Data aggregated & displayed

Consumer Care Pathway

(Staff trained to provide smoking screening)

Adjust Objectives ?

Target Performance Actual Performance Staff enter screening data

Medical Record

Screening data stored

Data

Action

Intake Discharge/ Referral

Adapted from: Kolhbacher, et al. (2008) AHCMJ

Strategic Plan Provide smoking cessation services Performance Target 100% of consumers will be screened for smoking

Compare Results

Target=100% Actual=60%

Take Corrective Action

• r

Keep Monitoring?

Dashboard Data aggregated & displayed

Consumer Care Pathway

(Staff trained to provide smoking screening)

Adjust Objectives ?

Target Performance Actual Performance Staff enter screening data

Medical Record

Screening data stored

Data

Action

Intake Discharge/ Referral

Adapted from: Kolhbacher, et al. (2008) AHCMJ

Plan Do Study Act

Continuous Quality Help Process to Respond to Client Needs

Develop Person Centered Plan based

• n Strengths & Level
• f Readiness

Support Client in Doing the Plan Engage to Study & see if it worked? If it worked, Celebrate! If it didn’t work, Celebrate the effort & develop a better plan!

Person Centered Plan Goal Area: Smoking 30 Day Action Plan: Reduce smoking by3 cigs a day through mindfulness

Meet with Client & Compare Results

Target=3 cigs Actual=1 cig.

Update PCP with new goal? New Skills? Keep PCP as is?

Diary Card Data aggregated & displayed

Client’s Experience/Work btw Appts

Adjust Objectives ?

Target Performance Actual Performance client enters # smoked daily

Diary Card

Data

Information Knowledge

HELP

Client Leaves Appt Client Returns to Appt

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

Source: Adapted from Data Fluency by Gemignani & Gemignani

The metric can be impacted by the client Data are modestly collectable by reliable source Method for collecting is understood Client understands how the data tells their story

Choosing a good measure?

What is a Dashboard?

• A dashboard translates your organization’s strategy and/or

your client’s person centered plan into metrics that provide timely information and insights that enable people to proactively improve decisions, optimize processes, and plans.

• In short, it enables us to monitor, analyze, and manage a

shared process like strategic organizational improvement

• r person centered plan development and execution.
• Source: Performance Dashboards: Measuring, Monitoring, &
• Managing Your Business. 2nd Edition 2011 Wayne Eckerson

23

Dashboards Elements

• Cost: Service Utilization, Case

Rates, etc.

• Operations: No Shows,

Insurance Mix, etc.

• Staff Work Plan:

Performance on Scope of Practice Tasks

• Benchmark Comparisons:

Between Organizations, Clinicians, Teams, etc.

• Clinical: Diary cards,

Motivational Interviewing Scales, Labs, Assessment/Screening Results, Vitals, etc.

• Care Coordination:

Medication Reconciliation, Referral Appt Attendance, etc.

• Risk Cutoffs: Reveal when

data are out of specification (e.g., A1c > 6)

w w w . T h e N a t i o n a l C o u n c i l . o r g

Organizing & Operationalizing Data w/ Dashboards

25

Using Data Tracer Checklist to Leverage Data

Purpose of using a Data Tracer Checklist is to trace data from granular level/first collection through to everyday aggregation/use.

• 1. What hypothesis/question do you want to answer? What data do

you want to access to address a clinical or administrative concern

• r to celebrate a success?
• 2. What valid tool do you have to reliability capture and

report/dashboard these data?

• 3. What is the protocol for how it is captured?
• 4. How are staff, clients, and their supports educated about why the

data are being collected and how it serves them/their needs?

• 5. When is the data reviewed, how, and by whom?
• 6. How is it used by the consumer, consumer’s natural supports,

care provider(s), administrator(s), funder(s) & accrediting bodies?

Takeaways…

• You’ll recognize you do many of these things already…minor

tweaking to your clinical practice could have major dividends.

• Helping a client improve their wellness is the same process used

by staff to improve workflow processes.

It’s all continuous quality improvement!

Discussion!

What is a question, concern or insight you have from what we’ve discussed? What could you do tomorrow so that your data are helpful?

Please contact us…

Jeff Capobianco capoj@umich.edu For CTAC questions, email ctac.info@nyu.edu

Visit us at www.ctacny.org

Upcoming CTAC Events:

• The Evidence Based Practitioner

Wednesday, January 15th at 12 PM

• Applications of Play Therapy

Thursday, January 23rd at 12 PM

• Kinship Care 101

Tuesday, January 28th at 12:30 PM