Paula Griswold, MPH
Executive Director
Massachusetts Coalition for the Prevention of Medical Errors
Nora McElroy, MPH
General Epidemiologist, Massachusetts Department of Public Health
Bureau of Infectious Disease Prevention, Response and Services,
Epidemiology Program
Laurie Herndon, GNP
Massachusetts Senior Care Foundation

Why measure?
1.


For you

Track progress towards key improvement goals
“
How do we know a change is an improvement?
”
What gets measured gets done
2.

For us
Your experience and progress are a key component of how we evaluate our efforts (surveys, lessons shared on monthly reports, measures over time)
3.


For the CDC (our funder)
National recognition
Continued funding and opportunity to support change in the community

How to choose measures?
 Looking at processes or outcomes that demonstrate the changes in practice we are encouraging
 Good enough measures



Balance value and effort
Don ’ t let the perfect be the enemy of the good
We ’ ll give you core measures

And tools for reporting and and sharing
 Future review of antibiograms

What we measure & hope to see
How we know a change is an improvement
Measure


Percent of treated UTIs that meet the “ Protocol criteria ” (ABCs)
Rates/10,000 resident days
 new UTI diagnoses

 laboratory orders for urine culture healthcare acquired C. difficile (HACDI)
We hope to see
 Increase in UTIs meeting criteria
 Decreases in events due to less mis-identification of asymptomatic bacteriuria

Measurement for real time learning
Review and share progress monthly

How you did: excel file with measures

What you did: monthly report is in your packet you will receive email reminders.
 Teach your staff about the value of measurement in quality improvement
 Be on the lookout for unintended consequences

Don’t Forget The Law Of Unintended
Consequences
 UTI diagnosis missed
 UTI treatment delayed
 Clinical decompensation
 Hospital transfer

One Approach For Monitoring For
Unintended Consequences

Watching for trends…

Data Collection Tools and Forms

Data collection & reporting instructions

Chart review form
 An optional tool for applying the definition of a UTI in
LTC

Excel workbook
 Documentation of monthly chart reviews and summary statistics to be submitted monthly

What we are going to measure
 Rates* over time of:
 new UTI cases
 laboratory orders for urine culture
 healthcare acquired C. difficile (HACDI)
 Percent of treated UTIs that meet the ABCs criteria
* All rates calculated per 10,000 resident days

Collaborative Results 2012-2013
(N=17)
45,0
40,0
35,0
30,0
25,0
20,0
15,0
10,0
5,0
0,0
41.3
29.8
17,7
37%
11,1 45%
2,8
1,6
Facility CDI
Rate
Facility UTI
Rate
Urine Culture
Rate
27%
Baseline Period*
Prevention Activity Period**
12

Overview of Measures

2 types of measures:
 Summary statistics to track rates
 Chart review for evaluating whether ABCs criteria are met

Calculating a Rate
 The rates are calculated as in the following example:
(UTIs/Resident-days)*10,000


What are Resident-days?
 The denominator used to calculate infection rates
 Calculate resident days by adding up the daily census for an entire month

Day 1 census + Day 2 census + ……..… + Day 31 census
 If a facility has 100 beds and 90 were in use every day in October the resident days for October would be 2,790
(90*31)
 Include only residents aged 70+ in this calculated

Selecting Residents for Data
Collection

Include residents 70 years of age or older

A UTI case is any new, not recurrent, diagnosis and treatment.
 Include patients that are treated, not just those that meet the ABCs

For C difficile cases, include patients with symptoms beginning on the fourth day after admission to your facility or later

Summary data spreadsheet

Summary Data Tutorial
July 2013:
 1 C diff case, 5 UTIs, 50 urine cultures,3621 resident days
Aug 2013:
 0 C diff cases, 4 UTIs, 45 urine cultures, 3599 resident days
Sep 13:
 0 C diff cases, 2 UTIs, 43 urine cultures, 2597 resident days

Sample summary data worksheet

Overview of Measures

2 types of measures:
 Summary statistics for rates
 Chart review for evaluating whether
ABCs criteria are met

Chart Review Data Collection Form

Chart reviews will examine the characteristics of all patients treated for UTIs and whether they met the
ABCs criteria

Review up to 20 charts a month
 If you have more than 20 UTIs in a month, review the first 20 infections, otherwise review all infections

Use the optional chart review form to guide your completion of the Excel spreadsheet but only the spreadsheet will be submitted

Measurement: Practical Application
Case 1
October 15, 2013
Shangri La Nursing Home

Chart review data collection form

Chart review data spreadsheet

Completing a Chart Review with the Data
Collection Form
1 October
X
X
X
X
X
X
X
October 3, 2013

Chart Review Spreadsheet

Document chart review form answers and transcribe them onto the Data Submission Excel
Spreadsheet

Answer Yes or No to each of the questions

After completing the chart reviews each month, email the spreadsheet to
EBiocchi@macoalition.org

Completing the Chart Review Spreadsheet

Case Study 1

Case Study Walkthrough
 Read through the remaining two case studies and fill in the sample worksheet and data submission form

Case Study Summary

 There are three tools to assist the collection of collaborative data

Chart Review Data Collection Form (paper)

Chart Review Spreadsheet in the Excel file

Summary Data Spreadsheet in the Excel File
 Submit the Excel file by the 7 th of each month to:
 Ebiocchi@macoalition.org

Thank you!
Any Questions?
 Nora: nora.mcelroy@state.ma.us
 Susanne: sss@hcqi.com
 Laurie Herndon, GNP: lherndon@maseniorcare.org