Quality Improvement Series Session 9 Baseline Data Windy Stevenson Cindy Ferrell
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Transcript of Quality Improvement Series Session 9 Baseline Data Windy Stevenson Cindy Ferrell
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Quality Improvement SeriesSession 9
Baseline Data
Windy StevensonCindy Ferrell
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Today’s Agenda
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Recap
Problem: The DCH ambulatory clinic problem lists are incomplete and inaccurate.
Problem: Patients with BMI>85%ile do not have obesity or overweight listed on their problem lists.
AIM: >95% of patients >2yo seen by a provider in the gen peds clinic or Westside clinic (including acute care; excluding healthy lifestyles) who have a BMI >85%ile will have “BMI; category” listed on their problem list.
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Current status
Future state taking shape
Order set request in EPIC queue- ready for PDSA Obtaining heights on acute care visits- what state? EPIC requests for populating problem list from an order and
driving PCP appointment generation Exploration of adding prompt to notes template Baseline data available (next slides!)
Pt >2yo checked in and ht/wt recorded
EPIC uses ht and wt to generate BMI and
flags if >85%ile
Provider sees banner under
Quality issues and clicks associated
smart set
Family stops at desk to get appt
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Baseline Data- The process
1. Residents define inclusion/exclusion criteria1. Population, setting, timing2. How to define a YES
2. Windy attempts to accurately describe criteria to non-clinical data guy (Adam)
3. Adam clarifies request, determines he can’t access BMI calculator
4. Adam builds BMI calculator and runs data5. Windy validates data by doing chart review6. Windy and Adam redefine search criteria7. Windy begins data analysis; builds graphs for
review8. Team validates data (DO IT. Take the time.)
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The baseline data
The pull: patients >2yo and <18yo seen by a provider in the gen peds clinic, adolescent clinic, or Westside clinic (including acute care; excluding healthy lifestyles) from 07-01-10 to 03-31-11 who have a recorded BMI >85%ile, with stratification of those who have any of the identified problems noted on their problem list
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The baseline data
37% overall success (457/1220 patients)
Adolescent Campus Peds West32
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Percent of patients >2yo with BMI >85%ile with problem listed
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The Science of Reliability
Reliability Level Reliability Expression
Reliability Rate Failure Rate
Level 1 10‾¹ 80-90% reliable 1-2 failures in 10 opportunities
Level 2 10‾² 95% reliable <5 failures in 100 opportunities
Level 3 10‾³ 99% reliable <5 failures in 1000 opportunities
Level 6(Six Sigma)
10‾6 <5 failures in 1,000,000 opportunities
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Baseline Data, continued
275
340156
449
Number of Patients by BMI category
85%ile 90%ile 95%ile >99%ile
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Questions to ponder
Should this count?
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1 2 3 40
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100
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Number of children per BMI Category
populated not populated
85-90% 90-95% 95-99% >99%
Problem List
Baseline Data, continued
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Questions to ponder
Does age matter (this one is 5yo)?
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Questions to ponder
What about the first time you meet a 3yo?
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Age and BMI
2-3yo 4-6yo 7-9yo 10-12yo 13-15yo 16-18yo05
101520253035404550
Percent of pts with BMI>85% with populated problem list, by age
(years)
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Questions to ponder
How important is the REMOVAL of the problem from the list?
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Future State- data
What do we want to know? – Will EPIC (retrospective) reports be sufficient?
When do we want to know it? Where can we post it? How can we use it to motivate and maintain?
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Measurement
What’s the Hawthorne Effect? What’s a run chart?
– What’s it good for?