Data Collection and Reporting
How Will You Know You’re Making a Difference?
Collecting Data and Devising Metrics: Introduction
Data collection, analysis, and presentation are key to the success of any heart failure improvement program.
It is the intent of the SHM Heart Failure Task Force to provide a practical approach to data collection and measurement of the quality of heart failure care. We will primarily address issues related to:
1. Heart failure core measures.
2. Measurement of daily care processes for heart failure patients.
Underlying Key Principles of Data Collection and Reporting
A. General considerations
- Prioritize what you collect. Don’t be data rich, info poor (a DRIP). To guide the performance improvement process, you need a combination of both,
- Measuring outcomes is important, but focusing on performance indicators is essential to getting quick feedback and will allow you to focus on the steps that lead to improved outcomes.
- Sampling/paper collection is quite acceptable if automated data collection is not yet possible. Collect just enough data to inform your team of baseline processes and clinical performance indicators and whether you are making a difference.
- Carefully define what you want to see. Imagine the end product of data collection and reporting, and make sure it’s what you want.
- Define how data will be collected and reported, and assign responsibility for carrying this out.
- Try different methods and measures — they will evolve over time.
B. Heart failure core measures
- Heart failure care is publicly reported at the U.S. Department of Health and Human Services Hospital Compare Web site.
- The measures reported there have been developed by the Joint Commission and the Centers for Medicare & Medicaid Services (CMS).
- The measures are:
- Heart failure core measure 1 — Discharge instructions, including all the following:
- Diet.
- Discharge medications.
- Activity level.
- What to do if symptoms worsen.
- Follow-up appointment.
- Weight monitoring.
- Heart failure core measure 2 — Left ventricular ejection fraction assessment.
- Heart failure core measure 3 — Prescription of ACEI or ARB at discharge to eligible patients (or documentation of contraindication).
- Heart failure core measure 4 — Smoking cessation.
For a complete description and definition of each of the heart failure core measures, see the Joint Commission's heart failure core measures.
The core measures serve as important evidence-based practice measures and are also routinely collected at most hospitals, so the data collection strategies may already be in place at your institution. It is important for the improvement team leader to become familiar with these processes and with the people involved in them at your organization.
- The process for patients ending up in the heart failure core measure set of patients is very important to understand. Using a process flow map.
- Service-floor- and health-care-provider-specific data are helpful.
- In addition to the outcome data, any data looking at the use of specific tools that have been developed to improve performance are also helpful, as they may help to identify the problem or gap resulting in the outcome core measure.
C. Heart failure daily care measures
- The relationship between core measure performance and resource utilization and mortality of patients with heart failure has been studied (Werner RM, Bradlow ET. Relationship between Medicare's hospital compare performance measures and mortality rates. JAMA. 2006 Dec 13;296(22):2694-702.), which has identified that measuring core measures alone may be inadequate.
- Studies from registries like the ADHERE registry point out that there are gaps in heart failure care including inadequate diuresis.
- When developing heart failure care measures, it is important to keep the following issues in mind:
- Examining the reasons for readmission may further target which heart failure care processes you may want to target.
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