Introduction to Measurement
Presenter Name
Bright Futures Training Intervention
With Office Staff
Workshop I
1
Session Objectives
 Describe importance of measurement and general
principles of measurement for improvement.
 Discuss measurement strategy for Bright Futures.
 Gain familiarity with one Bright Futures data collection
tool.
 Review Plan-Do-Study-Act cycles and describe role of
measurement within them.
2
Why Measure?
 “All improvement is change, but not all change is an
improvement.”
 Need measures to know if we are reaching our Aims.
3
Key Principles of Improvement
Measurement
 Focus on a few measures (usually 5-7).
 Keep it simple and easy.


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Integrate measurement into daily routine.
Consecutive sampling.
Use existing data when possible.
 Plot data over time.
4
Measurement for Improvement
 IS

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Designed to help your team and other teams learn.
Like a growth curve: it’s not where you are, but where you are
going.
 IS NOT
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Designed for criticism or punishment.
Supposed to end (it should be sustainable).
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Measurement for Research Versus
Improvement
Research
 Generate new
knowledge.
 Single test.
 Need to collect all
possible data “just in
case.”
Improvement
 Put new ideas into
practice.
 Many sequential
tests.
 Collect “just enough
data.”
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Bright Futures Core Measures
 Global project measures
 Overall results related to project Aim
 Based on 6 components of Bright Futures
framework
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Core Measure 1
 Bright Futures component: Use of preventive
services prompting sheet
 Measure: Percent of well-child visits of children
younger than 5 years in which a preventive
services prompting sheet is used
8
Core Measure 2
 Bright Futures component: Use of structured
developmental assessment
 Measure: Percent of well-child visits of children
younger than 5 years in which Ages and Stages
or Parents’ Evaluation of Developmental Status
is used to evaluate development and behavior
9
Core Measure 3
 Bright Futures component: Evaluation of
parental strengths and needs
 Measure: Percent of well-child visits of children
younger than 5 years in which parent strengths
and needs are assessed
10
Core Measure 4
 Bright Futures component: Development of
recall and reminder system
 Measure: Score on recall and reminder items
on practice team survey
11
Core Measure 5
 Bright Futures component: Development of
linkages to community resources
 Measure: Score on community resource
linkage on practice team survey
12
Core Measure 6
 Bright Futures component: Identification of
children with special health care needs
 Measure: Percent of well-child visits of
children younger than 5 years in which there is
documentation that provider asked about
special health care needs
13
Measurement Tools
 Chart review
 Practice team survey (Bright Futures Office
Systems Inventory)
14
Team Measurement Exercise:
Completing the Bright Futures
Office Systems Inventory
15
Additional Measures
 Pilot refinement measures


Volume 1: Improving Preventive Care in Your Office:
Tools for Office Improvement usefulness
Volume 3: Training Materials to Improve Preventive
Care in Office Practice: Bright Futures Workshop
Materials usefulness
 Balancing measures

Cycle time (average number of minutes in office per
patient
16
Creating Your Practice’s Own
Additional Measures
 Measure only the things you need to know.
 Make sure they are related to your Aim and
goals.
 Create a Measurement Plan for each additional
measure.
17
Sources of Additional Measures


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Your team members.
Other teams.
Goals in your Prework.
Think of “balancing measures.”
18
Balancing Measures
 Don’t want to improve one part of system at the
expense of others.
 Think of potential unintended consequences and
parts of your system distant to the area you are
trying to improve.
 Example: patient flow may be affected by
changes to preventive visit content—measure
cycle times.
19
Create a Measurement Plan
 Clarify the data collection goals.
 Develop procedures for each additional
measure.
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How is it defined?
What data will be collected?
On which patients?
How will the data be collected?
Who will collect the data?
When?
20
For Each Additional Measure
 Carefully define numerator and denominator.
 Begin tracking measures immediately and
gather historical (baseline) data, if available.
 Develop run charts to display your measures
each month (use paper/pencil or Excel).
21
Using Measures:
Annotated Run Charts
Clinician education
Practice wide
guidelines
Reminder system
22
Measurement of
Plan-Do-Study-Act Cycles
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Global Project Measures Versus
Plan-Do-Study-Act (PDSA) Measures
 Global Project Measures: Overall results related
to the team Aim (core measures and teams’
additional balancing measures)
 PDSA Measures


Quantitative data on the impact of a change
Qualitative data to help refine the change
25
Measurement for Plan-Do-Study-Act
(PDSA) Cycles
 “Study” is specific to the PDSA cycle.


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Usually not one of core measures
Usually begins and ends with PDSA cycle
Often qualitative
 Identify/create tools to be used for data
collection—make it simple and easy.
26
Use the Plan-Do-Study-Act Cycle for
 Testing or adapting a change that relates to
project goals
 Implementing a change
27
Multiple Plan-Do-Study-Act Cycles
Help Achieve Project Goals
28
Summary
 Measurement for improvement is simpler and more




focused than research.
Measurement is necessary to assess success and track
progress.
Usually need 5 to 7 measures to ensure that the system
is improved.
Practices are encouraged to add a few additional
measures, including balancing measures.
Practices complete data collection and team status
reports monthly.
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