Home 5 Hip & Knee OA Clinician Standards 5 Measuring Quality Care

 

 

 

 

Standards

1-3: Setting Up for Success
4-6: Core Treatments
7-9: Rounding out the OA Journey

CLINICIAN STANDARDS

Standard 9. Measuring Quality Care

For any health care intervention or program to reliably demonstrate success, a multi-faceted approach to continuous measurement of outcomes must be applied. The influence of these standards in Alberta will be measured, but measurement of outcomes can also happen at a local level.

Overview

Key Messages for Measuring Quality Care

  • There are two types of data: administrative data and patient reported experience/outcome measures (PROMs and PREMs) and collecting this data helps to improve business operations and patient care. The following is recommended to implement measurement of quality care at your clinic:
    • Collect data electronically using an Electronic Medical Record (EMR) system with effective extraction
    • Work towards achieving four measurement goals:
      • Define the cohort of the OA patients at your centre. This may be done by adding a specific label (e.g. ‘OA’) or creating a ‘panel’
      • Collect PROMs every 12 months at a minimum to track the individual’s OA symptom progression (EQ5D-5L and the AOAPF)
      • Collect PREMs to ensure the individual’s perspective is informing the delivery of care (AOAEM)
      • Care plan created using the hierarchy of treatments for each patient (or follow care plan if supporting provider)
    • Assign clear roles in your team for responsibilities with tracking, analyzing, interpreting, and actioning measurement results to continuously drive the improvement of the quality of your care
KEY RESOURCES:
View All Resources View References

IIHO and provincial care teams are committed to making big improvements in Alberta’s conservative OA care. It will take time to build many trusting partnerships with multi-disciplinary providers and with individuals. If your organization would like to share your data with IIHO, or partner with IIHO to strengthen your data collection, please do not hesitate to get in touch: info@iiho.ca

Introduction

Alberta has a proud history of demonstrating successful high-quality healthcare using measurement of outcomes, particularly in bone and joint healthcare. We define quality care with seven dimensions: peope-centred, accessible and timely, effective, efficient and sustainable, safe, equitable, integrated.

Bringing measurement into your local setting can help you improve business operations as well as demonstrate that the care you are delivering is of high quality and successful in supporting individuals with OA.

Types of Data

There are two types of data that can be collected:

Administrative data is the responsibility of the provider and can include anything to do with the workflow at the local centre. Collecting administrative data helps improve business operations to offer efficient and accessible services for the individual with OA.

‘Patient reported’ data consists of two types:

  1. Patient Reported Outcome Measures (PROMs)
  2. Patient Reported Experience Measures (PREMs)

It is important to gather both PROMs and PREMs to properly evaluate the effectiveness, acceptability and appropriateness of the care delivered. See below for guidance on which PROMs and PREMs to use for conservative management of OA.

    Measuring Outcomes

    1. Collect data electronically using an Electronic Medical Record (EMR) system with effective extraction.
    2. Work towards achieving four measurement goals:
      • Monitoring your OA patients as a cohort at your centre. This may be done by adding a specific label (e.g. ‘OA’) or creating a ‘panel’
      • Collect PROMs every 12 months at a minimum to track the individual’s OA symptom progression (unless discharged – Standard 3)
        • For the purposes of conservative management of OA EQ5D-5L, the Subjective OA Performance Score (SOAPS) are recommended
        • The Patient Specific Functional Scale (PSFS) is also a useful tool for attaching outcomes to goals the individual has set
        • The Health Resources Matrix provides guidance on which PROM/PREM is appropriate for which Standard
      • Collect PREMs to ensure the individual’s perspective is informing the delivery of care
        • For the purposes of conservative management of OA: the Alberta OA Experience Measure (AOAEM) is recommended and
        • The Health Resources Matrix provides guidance on which PROM/PREM is appropriate for which Standard
      • Care plan created using Conservative OA Treatments for each patient (or follow care plan if supporting provider)
    3. Assign clear roles in your team for responsibilities with tracking, analyzing, interpreting, and actioning measurement results to continuously drive the improvement of the quality of your care
      • If your organization would like assistance in this area, you can contact the Institute for Improved Health Outcomes (IIHO) for information on services that are available: info@iiho.ca

    How to Start

    Questions to Ask Tips
    How you collect your data
    • Are you collecting Electronically or manually?
    • Are you using an Electronic Medical Record (EMR) system?
    • Consider collecting data electronically to strengthen data tracking and data
      preservation
    • Consider using an EMR that provides you with the flexibility to adapt your data
      collection to your needs
    The frequency at which you will collect your data
    • What does the evidence tell you is a reasonable frequency to collect data?
    • How can you balance this with the administrative duties of your business?
    • Standard 3 provides some guidance on
      reasonable frequency for checking on an individuals’ progress with specific types of
      treatments
    Roles of team members
    • Which team members are responsible for managing the data?
    • Which team members will review the data?
    • Consider having one team member for managing data, and one for reviewing
    • Planning ahead about data collection methods and frequencies will make these roles
      more straightforward
    Establishing a baseline
    • Before you make any changes to your care: what is the current quality of your care?
    • Change cannot be measured if there is nothing to compare it to
    • Gather a baseline before making any changes to the care your team delivers
    Communicate results to the team
    • How will your full team know what the data says about the care they are delivering?
    • How will your team understand the importance of the changes they need to make?
    • How will you celebrate your team for the changes they do make?
    • Consider using simple graphs to highlight changes and celebrate success
    Using the data to continuously drive quality improvement of care
    • Which team members will be responsible for investigating your data?
    • How will your team make decisions about what changes to make to your service delivery
      to improve your data?
    • How will you hold each other accountable to track those changes?
    • Form a quality team that meets regularly
    • Review the data together and understand what it says about the quality of your service
      delivery
    • Work together to understand and investigate problems
    • Carefully plan changes including understanding which data should shift if the change
      can be identified as successful

    Research vs Quality Improvement

    A Project Ethics Community Consensus Initiative (ARECCI) program is hosted by Alberta Innovates. It was established to assist with the planning for ethical risks for projects that are not research projects. These projects might include program evaluations, quality improvement, health innovations or knowledge translation. All of these projects involve people and their information and therefore careful planning is required to protect that information. ARECCI provides support for this planning by providing decision support tools, training opportunities and ethics consultants.

    ARECCI has all their tools and additional information available here. In particular, the ARECCI Screening Tool is useful for determining if your project is a research project or not. The Screening Tool asks questions to help you think through the purpose of your project.

    Quality Improvement vs. Research Projects

    Quality Improvement Research
    Purpose Use existing knowledge to improve local care Discover new, generalizable knowledge
    Strategy Multiple small sequential observable tests; interventions, adapted based on learnings Usually one large, well-controlled study; interventions planned in advance
    Ethics Review Performed according to local policies

      Performed by a research ethics board
      Sample Size Focus on gathering enough information to achieve a reliable measurement; project continues until aim is achieved and may involve ongoing measurement to ensure change is sustained Sample size calculation with goal of adequate power to detect a meaningful difference; study ends when enrolment met
      Analysis Occurs in an ongoing manner throughout multiple tests of change; often utilizes run charts and control charts Occurs after data collection complete or at a defined interim analysis; often utilizes hypothesis testing
      Dissemination Findings shared locally; may be shared broadly for purpose of sharing learning from local efforts Findings shared broadly for purpose of increasing knowledge

      Quality Improvement vs. Research Data

      Quality Improvement Research
      Aim To bring new knowledge into daily practice To discover new knowledge
      Tests Many sequential, observable tests One large blind test
      Bias Accept consistent bias Design to eliminate bias
      Sample Size Gather “just enough” data to learn & complete another cycle Gather as much data as possible, “just in case”
      Measuring Improvement Run charts, Shewhart control charts Hypothesis, stat tests (t-test, F-test, chi square), p-values
      Confidentiality Data used only by those involved Subjects’ identities protected