Quality Improvement Strategies

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Quality Improvement Strategies

• Root Cause and Subgroup Analyses

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Root Cause Analysis
A way of looking at unexpected events and
undesirable outcomes to determine all of the
underlying causes and recommend changes that are
likely to improve them.
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Root Cause Analysis

• Also known as causal/barrier analysis.
• The causes/barriers identified are the reasons
  (root causes) why the study indicator results are
  not meeting performance standards.

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Root Cause Analysis

• Root cause analysis should
• Primarily focus on systems and/or processes.
• Identify changes that can be made in systems
  and/or processes.

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Root Cause Analysis
Data analysis
Root cause analysis Subgroup analysis
Develop and implement solutions
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Root Cause Analysis

• Will help the organization understand the
  barriers to achieving desired outcomes.
• Allows interventions to be streamlined and
  focused to address the barriers.
• Required for PIP documentation (critical
  element).

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Root Cause Analysis Tools

• Brainstorming
• Survey
• Focus Group
• Process Map/Flow Chart
• Fishbone Diagram
• Scatter Diagram
• Pareto Chart
• Run Chart

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Subgroup Analysis

• Why perform a subgroup analysis?
• Determine if any subgroup within the population
  has a disproportionately lower rate that
  negatively affects the overall rate.
• Develop targeted interventions to the identified
  subgroups, allowing the implementation of more
  precise, concentrated interventions.

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Population Subgroups

• Race/Ethnicity
• Age
• Gender
• Geographic Location
• Provider

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Factors to Consider

• Are the data elements for the subgroups
• Available?
• Accurate?
• Complete?
• Is the size of the subgroup
• Adequate for analysis?
• Require grouping?
• Require additional subgroup analysis?
• Are the subgroups reasonable, i.e., do they make
  sense?

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Measure-Specific Examples

• Follow-up after discharge for a mental illness
• Age
• Race and ethnicity
• Geographic location
• Zip codes
• Can be used as a proxy for race/ethnicity

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Measure-Specific Examples

• Coordination of Care
• Geographic location
• Provider
• High volume
• Specific provider practice

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Initial Subgroup Analysis

• Before implementing improvement strategies
• Identify disparities, i.e., do performance rates
  vary by subgroup?
• Determine the impact of the disparity on the
  overall rate.
• Identify subgroup-specific barriers, if
  applicable.
• Root cause analysis
• How can systems or processes be changed to
  improve performance?

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Ongoing Subgroup Analysis

• After implementing improvement strategies
• Evaluate the effectiveness of the performance
  improvement strategy for all subgroups.
• Monitor using interim measurements.
• Consider rapid cycle improvement to test for
  changes in rates and make real-time
  refinements.
• Reevaluate barriers.
• Root cause analysis.
• Revise or standardize interventions.

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Activity VII-Implement Interventions and
Improvement Strategies

• Ensure that the root cause analysis process is
  completely documented in Activity VII.
• Document when it was completed.
• Include who was involved (e.g., quality
  improvement committee, work group, etc.).
• Provide the tools that were used (e.g., fishbone
  diagram, brainstorming, etc.).

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Activity VIII-Analyze Data and Interpret Study
Results

• If subgroup analysis is completed, document this
  in Activity VIII.
• Include the outcome of the analysis as well as
  the follow-up activities planned as a result.
• Subgroup analysis is not required however, it is
  recommended as a way to target interventions.

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PIP due dates

• PIPs due to HSAG on 12/14/11.
• Address all Partially Met and Not Met scores from
  last year, as well as all Points of
  Clarification.
• Reference the PIP Summary Form Completion
  Instructions for guidance.
• HSAG is available to provide technical
  assistance. Contact ddriscoll_at_hsag.com to
  request.

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Questions/Comments
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