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Quality Improvement SeriesSession 9

Baseline Data

Windy StevensonCindy Ferrell

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Today’s Agenda

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Recap

Problem: The DCH ambulatory clinic problem lists are incomplete and inaccurate.

Problem: Patients with BMI>85%ile do not have obesity or overweight listed on their problem lists.

AIM: >95% of patients >2yo seen by a provider in the gen peds clinic or Westside clinic (including acute care; excluding healthy lifestyles) who have a BMI >85%ile will have “BMI; category” listed on their problem list.

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Current status

Future state taking shape

Order set request in EPIC queue- ready for PDSA Obtaining heights on acute care visits- what state? EPIC requests for populating problem list from an order and

driving PCP appointment generation Exploration of adding prompt to notes template Baseline data available (next slides!)

Pt >2yo checked in and ht/wt recorded

EPIC uses ht and wt to generate BMI and

flags if >85%ile

Provider sees banner under

Quality issues and clicks associated

smart set

Family stops at desk to get appt

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Baseline Data- The process

1. Residents define inclusion/exclusion criteria1. Population, setting, timing2. How to define a YES

2. Windy attempts to accurately describe criteria to non-clinical data guy (Adam)

3. Adam clarifies request, determines he can’t access BMI calculator

4. Adam builds BMI calculator and runs data5. Windy validates data by doing chart review6. Windy and Adam redefine search criteria7. Windy begins data analysis; builds graphs for

review8. Team validates data (DO IT. Take the time.)

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The baseline data

The pull: patients >2yo and <18yo seen by a provider in the gen peds clinic, adolescent clinic, or Westside clinic (including acute care; excluding healthy lifestyles) from 07-01-10 to 03-31-11 who have a recorded BMI >85%ile, with stratification of those who have any of the identified problems noted on their problem list

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The baseline data

37% overall success (457/1220 patients)

Adolescent Campus Peds West32

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Percent of patients >2yo with BMI >85%ile with problem listed

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The Science of Reliability

Reliability Level Reliability Expression

Reliability Rate Failure Rate

Level 1 10‾¹ 80-90% reliable 1-2 failures in 10 opportunities

Level 2 10‾² 95% reliable <5 failures in 100 opportunities

Level 3 10‾³ 99% reliable <5 failures in 1000 opportunities

Level 6(Six Sigma)

10‾6 <5 failures in 1,000,000 opportunities

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Baseline Data, continued

275

340156

449

Number of Patients by BMI category

85%ile 90%ile 95%ile >99%ile

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Questions to ponder

Should this count?

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1 2 3 40

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100

150

200

250

300

350

400

450

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Number of children per BMI Category

populated not populated

85-90% 90-95% 95-99% >99%

Problem List

Baseline Data, continued

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Questions to ponder

Does age matter (this one is 5yo)?

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Questions to ponder

What about the first time you meet a 3yo?

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Age and BMI

2-3yo 4-6yo 7-9yo 10-12yo 13-15yo 16-18yo05

101520253035404550

Percent of pts with BMI>85% with populated problem list, by age

(years)

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Questions to ponder

How important is the REMOVAL of the problem from the list?

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Future State- data

What do we want to know? – Will EPIC (retrospective) reports be sufficient?

When do we want to know it? Where can we post it? How can we use it to motivate and maintain?

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Measurement

What’s the Hawthorne Effect? What’s a run chart?

– What’s it good for?