Process and Outcome Measures

Lynne Hall

10-24-12

State why Process Measures are important to data gathering

Outline the use of Process Measures

Process and Outcome Measures Objectives

CMS has changed the format of what is expected from Critical Access and Small Rural Hospitals

GHAREF HEN must submit evidence of participation in all 10 Core Events

CAH’s and Small Rural hospitals will now need to change their focus to include the 10 Core Events

What is expected for Measures for GHA HEN:

Z Hospital does not provide services related to this HAC

0 Providing services to which the HAC is relevant, but is not participating

1 Engaged in work related to HAC, but not submitting data

2 Engaged in work related to HAC AND submitting data

3Outstanding improvement or sustained high performance (data for validation submitted to HEN)

4Potential mentor hospital - achieved highest possible level, now pushing for related care improvement

Scoring of HEN CAH’s and Small Rural Hospitals

PERCENT OF RURAL HOSPITALS AT STATUS 2, 3 or 4Participating and Submitting Data

PERCENT OF RURAL HOSPITALS AT STATUS 0 OR 1

Not Participating or Not Submitting Data

Percent of Rural Hospitals at Status 3 or 4Outstanding Performance

Understanding process and outcome measures is one key factor

Getting your teams together to look at problem areas

Know your data and how to collect and access it

Celebrate success All teach – all learn

How can we move forward?

Processes lead to Outcomes Both are important Measure both in healthcare

How do you determine what is a process measure and what is an outcome

measure?

To determine if a process is stable Manage the process measures To determine if the processes that lead to

the outcomes are functioning effectively and efficiently

Process measures tend to be real time

Process Measurement

There will always be inherent variation in every system component

Because all the work is accomplished in processes, it is possible to obtain measurements of key performance indicators

Process Measurement

By definition it is the results of processes Offers findings that can used to adapt,

improve, and become more effective Outcome measures tend to tell us if our

process is working

Outcome Measures

Process: How the system works Outcome: The final product, results

Quick Version

I drive to work: Process Measures:

What route did I take to work? How did I arrive: bus, train, car? When did I leave?

Simple Example

I drive to work: Outcome Measures:

How many times did I make it to work on time? How long did it take me to drive to work?

Simple Example:

Diabetic Patient Process Measures:

How often does the patient correctly give themselves insulin?

Does the diabetes team visit all in-patient diabetics?

Clinical Example

Diabetic Patient Outcome Measures:

Is A1C within range for diabetic patient? How often are the readmitted for the same

diagnosis?

Clinical Example

The following are either process measures or outcome measures:

1. Number of CHF patients that visit the ED?

2. What percentage of staff have received their flu vaccine?

3. How many of your diabetic patients receive yearly foot exams?

4. How many of smokers have quit smoking?

Test your knowledge:

Process and Outcome measures are both important in looking at your measurements

There will always be variability with your system – this is normal to an extent Watch for outliers or special causes for data

variance

Conclusion:

1. Go to www.gha.org

2. Hover over Quality and Health

3. Click Hospital Engagement Network

Submitting EED Data

1. Click on Learning Collaborative

Submitting EED Data

1. Click on OB Adverse Events

Submitting EED Data

1. Click on meetings

Submitting EED Data

1. Click on Data Measurement collection tool Early Elective Deliveries

Submitting EED Data

Submitting EED Data