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Data for Decision-Making Processes: Linking Data to Quality Improvement Initiatives Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network
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Page 1: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Data for Decision-Making Processes: Linking Data to

Quality Improvement Initiatives

Bisma Sayed, M.S.W.University of MiamiDepartment of Sociology

John Dow, M.S.W.South Florida Behavioral Health Network

Page 2: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Understand the value of utilizing data for decision-making

Determine what should be measured and what data elements should be used

Data analysis and interpretation

Recognize limitations

Validate findings using other data sources

Objectives

Page 3: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

The recent recession coupled with health care reform has had cascading consequences on behavioral health care service delivery in Florida.

Current funding limitations and budget cuts have increased the urgency for cost-effective and efficient delivery of behavioral health care services.

Page 4: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

How can behavioral health care organizations lower cost, raise quality, and still offer accessible services to increasing numbers of consumers?◦ Meet standards◦ Coordinate◦ Demonstrate outcomes◦ Eliminate duplication◦ Produce reportable, effective, and sustainable

results

Behavioral Health Care Service Delivery

Page 5: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Quality Improvement vs. Quality Assessment

Quality Improvement

Page 6: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Quality Improvement Processes allow organizations to analyze current practices, identify strengths and weaknesses, set goals, and monitor progress

Quality in the behavioral health care setting may be defined as the ‘extent to which a health care service or product produces a desired outcome’

Behavioral Health Care: Quality Improvement Initiatives

Page 7: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Quality of care measures◦ Effective◦ Appropriate◦ Safe◦ Efficient◦ Responsive◦ Accessible◦ Continuous◦ Capable◦ Sustainable

Quality Improvement Initiatives

Page 8: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Examine current organizational functioning

Identify target problems

Identify quality of care measures

Identify goals (short term or long term)

Measure baseline performance on quality measures

Quality Improvement Processes

Page 9: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Develop and conduct interventions designed to affect the targeted measures

Repeat measurement of performance based on quality indicator

Document and disseminate results.

Quality Improvement Processes

Page 10: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

“If you do not measure it (or cannot measure it), it didn’t happen.”

How can we measure it?

Quality Assessment

Page 11: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Data provides the foundation for quality improvement initiatives◦ Timely◦ Transparent◦ Presented with humility◦ Based on past lessons learned◦ Accountability◦ Presented with compassion and understanding

DATA

Page 12: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

The shift to evidence based care coupled with increased technological and statistical advances have resulted in an explosion of data. . .

Page 13: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

. . . However, this knowledge remains to be harnessed

Page 14: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

The influx of data has led organizations to report data, rather than analyze data.

Data Reporting Data Analysis

Behavioral Health Care: Data and Quality Improvement Initiatives

Page 15: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Data

Information

Knowledge

Decision

Action

Quality Improvement and Data: A continuous relationship

Page 16: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Quality Improvement◦ What is happening?◦ What factors affect delivery◦ How can we influence them

Reactive and Proactive

We need data to guide this.

“Data helps to push improvement (by identifying problems) and pull improvement (by identifying opportunities)”

The link between QI and Data

Page 17: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Facts and statistics collected together for reference or analysis

What is data?

•Surveys• Literature

Reviews•Key

informants•Surveillance

data• Focus Groups

Page 18: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Develop overall goal for improvement

Identify objectives using quality of care measures

Identify target populations

Identify data to be collected

Why use Data for Decision Making?

Page 19: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Determine data sources and/or collection method.

Determine data storage, management, and analysis techniques.

Analyze and Interpret Data

Utilize data for decision-making

How to use Data for Decision Making?

Page 20: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Data Collection and Management

Page 21: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Plan◦ Consider scope and purpose◦ Target Audience

Learn ( Do not reinvent the wheel)◦ Literature Reviews◦ Other sources of data

Test◦ Pilot-test on a smaller scale to identify challenges

Team work◦ Involve and Integrate

Data Collection and Management

Page 22: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Internal Data External Data Administrative or Clinical

Regardless of source of data or type of data, it must be reliable and valid◦ What is reliability and validity?

Types of Data

Page 23: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Process mapping: (Who? How long? Steps? Costs?)

Brainstorm

Quantitative or Qualitative◦ Nominal◦ Ordinal◦ Interval◦ Ratio

Data collection techniques and tools

Page 24: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Surveys and questionnaires

◦ Ethical Standards

◦ Confidentiality and Anonymity

◦ Response Rates

◦ Existing Surveys

◦ Guidance

◦ Pilot test

Data Collection

Page 25: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

What is your target population? ◦ Consumers? Their families? Providers?

Community?

Data Collection

Page 26: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Clear and Understandable◦ Specific◦ Not loaded or leading◦ No double barreled question◦ No jargon or acronyms

Allow choice of only one option

Provide reasonable ranges of variation in the response options

Data Collection: Survey Questions

Page 27: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Social Desirability Bias

Target towards population◦ Appropriate for age, culture and literacy

Include adequate demographic information

Data Collection: Survey Questions

Page 28: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Why do we sample?

Sampling must be representative of your population

Selection bias

Sampling

Page 29: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Important step that can cause significant error if not done properly

Identify inconsistencies◦ For example, the mean age of adolescents

sampled across the nation is 23.5. The range is 13-56.

◦ Why do we have a 56 year old adolescent?

Data entry, checking, and cleaning

Page 30: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Spreadsheet programs◦ Reporting, not analysis

Database programs◦ Database changes – Store data with reports◦ Reporting, not analysis

Statistical Programs◦ Analysis

Storing and Managing Data

Page 31: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Data Analysis

Page 32: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Understand the variables◦ Categorical and numerical variables

Frequency Distribution Median and Percentile Counts and Sums Measures of central tendency Measures of variability

Analyzing Quantitative Data

Page 33: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Measures of Central Tendency◦ Mean◦ Median◦ Mode

Data Analysis for Numerical Variables

Page 34: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Range

Standard Deviation

What does this tell you about your population?

Measures of Variability

Page 35: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

What is the goal of data analysis in QI?

Descriptive Analyses and Measures of Variation are useful, but. . .

Inferential statistics can add to the power of your conclusions.◦ Examine Relationship/Estimate size of difference◦ Confidence Intervals◦ Tests of statistical significance

Statistical Analyses

Page 36: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Correlation Analysis◦ Correlation Coefficient: Pearson Product Moment

Correlation Coefficient (r)

Scatter plots◦ Linear Relationships◦ Non-Linear Relationships

Correlation does not equal causation

Statistical Analyses

Page 37: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Nominal Level Data: Non-Parametric Tests◦ Chi Square◦ Cramer’s V/ Contingency Coefficient/Others

Numerical Data: Parametric Tests◦ T-tests (independent or dependent)◦ ANOVA◦ Regressions

Confidence Intervals◦ What are they? ◦ How can they be used?◦ Sample size matters

Statistical Analyses

Page 38: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

When you combine your sample value with the margin of error, you obtain a confidence interval.

The confidence interval is the level of confidence that the sample value represents the true value as seen in the overall population.

Statistical Analyses

Page 39: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

For example, the waiting time for appointments for clients referred to your clinic might be expressed as a mean of 13.5 weeks with a 95% confidence interval of 11.6 to 15.3 weeks (95% CI 11.6-15.3).

This means that you expect your population on average would wait between 11.6 and 15.3 weeks for an appointment.

Page 40: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

The p value is the probability that the difference you have observed in your study samples could be due to chance.

Smaller p value = lowered probability that results are due to chance

Statistical Significance

Data Analysis: Statistical Significance

Page 41: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

The size of the p value depends on the size of the sample, so be aware of possible mistakes that can occur in interpreting these values.

Statistical significance does not mean clinical significance.

Data Analysis: Statistical Significance

Page 42: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Keep it simple Consistent units Decimal Points Include raw numbers and percentages Always include n Identify missing data Group data appropriately

Presenting Data: Tabulating Data

Page 43: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Keep it simple Avoid complexity Clear headings Scale Carefully Raw numbers and percentages Always include n Group data appropriately

Presenting Data: Graphs

Page 44: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Basic population characteristics: Pie chart; bar graph

Measures of magnitude including comparisons: Bar chart or box plot

Presenting Data: Graphs

Page 45: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Frequency: Pie chart; bar chart

Trends over time: Line graph

Distribution of Data: Histogram; Scatter plot

Relationship between two things: scatter diagram

Presenting Data: Graphs

Page 46: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Data Analysis and Interpretation

Page 47: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Whether you are collecting your own data or relying on external sources, there is a difference between compiling/reporting data and analyzing data◦ Data : petabytes◦ Reports : terabytes◦ Excel : gigabytes◦ PowerPoint : megabytes◦ Insights : bytes◦ One business decision based on actual data:

Priceless1

Data Analysis and Interpretation

Page 48: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

What is the problem?

What can you improve?

How can you improve?

Have you achieved improvement?

Have we sustained improvement?

Data Analysis and Interpretation

Page 49: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

State and national datasets provide important information about key health indicators and can serve as basis for comparison.

However, we must be careful in interpreting and analyzing this data.◦ Understand limitations

Understand how data is presented◦ Mean, Median, Mode◦ Raw sums or percentages

Data Analysis and Interpretation

Page 50: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Level of variables◦ Individual◦ Community◦ State

State level data can help guide decisions, but you must examine individual data in your community to determine if the problem exists at a local level.

Data Analysis and Interpretation

Page 51: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Data Analysis and Interpretation: Ecological Fallacy

Page 52: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

What does data drive?◦ Assessment◦ Priority setting◦ Allocation of resources◦ Directives to staff and community◦ Evaluation of clinical outcomes ◦ Basis of QI for providers◦ Feedback◦ Sets the groundwork for comprehensive planning

Using Data for Decision-Making

Page 53: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Assess performance and identify gaps

Understand the needs and opinion of stakeholders

Prioritize problems and improvement projects

Establish overall aims and targets for improvement

Using Data for Decision-Making

Page 54: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Establish a clear case for the need for improvement.

Data assists in sustained improvement: feedback to reinforce change and demonstrate benefits.

Using Data for Decision-Making

Page 55: Bisma Sayed, M.S.W. University of Miami Department of Sociology John Dow, M.S.W. South Florida Behavioral Health Network.

Thank you


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