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Why Process Measures Are Often More Important Than Outcome Measures in Healthcare

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The healthcare industry is currently obsessed with outcome measures — and for good reason. But tracking outcome measures alone is insufficient to reach the goals of better quality and reduced costs. Instead, health systems must get more granular with their data by tracking process measures. Process measures make it possible to identify the root cause of a health system’s failures. They’re the checklists of systematically guaranteeing that the right care will be delivered to every patient, every time. By using these checklists, organizations will be able to improve quality and cost by reducing the amount of variation in care delivery.

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Why Process Measures Are Often More Important Than Outcome Measures in Healthcare

  1. 1. Why Process Measures Are Often More Important Than Outcome Measures in Healthcare -Tom Burton
  2. 2. © 2014 Health Catalyst www.healthcatalyst.com Measuring Outcomes Tracking outcome measures alone is insufficient to achieve quality and cost goals. Health systems must get more granular with their data. In addition to outcome measure-ments they must also track evidence-based process measures. Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  3. 3. 1 2 © 2014 Health Catalyst www.healthcatalyst.com Three Measures Here are the three types of measures we use in healthcare analytics: PROCESS 3 1- Outcome Measure 2- Balance Measure 3- Process Measure Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  4. 4. © 2014 Health Catalyst www.healthcatalyst.com Three Measures Outcome measures are high-level clinical or financial outcomes. These measures are often reported to government and commercial payers. Some examples of metrics for outcome measures include mortality rates, readmissions rates, and surgical site infection rates. OUTCOME MEASURE Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  5. 5. © 2014 Health Catalyst www.healthcatalyst.com Three Measures Balance measures are metrics a health system must track to ensure improvement in one area does not negatively impact another. For example, let’s say length of stay (LOS) is the outcome metric. The balance metric might be patient satisfaction. If the patient feels rushed they may lower the satisfaction score even while improving LOS. BALANCE MEASURE Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  6. 6. © 2014 Health Catalyst www.healthcatalyst.com Three Measures Process measures are the specific steps in a process that lead — either positively or negatively — to a particular outcome metric. Looking at the LOS metric you might determine that a lengthy delay in pharmacy delivery impacts the discharge event. You’ve pinpointed a concrete opportunity for healthcare process improvement. PROCESS MEASURE Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  7. 7. Importance of Process Measures Process measures represent a health system’s efforts to incorporate and systematize evidence-based best practices into its improvement efforts. One goal is to identify at-risk patients for the treatment process you are analyzing. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  8. 8. Importance of Process Measures Let’s look at a patient injury prevention example—bedsores. The incidents of bedsores is your outcome measure. You know your baseline rate, and you want to reduce it, but how are you actually going to drive improvement? © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  9. 9. Importance of Process Measures The answer is straightforward: by implementing and tracking the right process metrics. Process measures in this example are the steps that should be performed every time for every bed-bound patient in the intensive care unit (ICU) or in the med-surg units. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  10. 10. Importance of Process Measures First you would perform a risk assessment using the Braden Scale for predicting pressure ulcer risk on all the appropriate units in the Hospital. Patients identified as “at risk” would then receive treatment for preventing bedsores according to your organization’s chosen best-practice protocol. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  11. 11. Importance of Process Measures For example, you might set up protocols for reassessment, nutrition, lifting and repositioning the patient, providing a special mattress, and skin care. The important thing is that each of these steps in the process can be can be tracked and measured. Over time you will begin to identify which process steps are the most important for preventing negative outcomes. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  12. 12. One of the greatest benefits of having this process metric data on hand is the ability to identify root causes. The problem does not stem from your people. It stems from your process. Often, many borderline cases go unreported because of the lack of a culture based on a learning environment and too much focus on outcomes metrics. © 2014 Health Catalyst www.healthcatalyst.com Determining Root Cause Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  13. 13. © 2014 Health Catalyst www.healthcatalyst.com Determining Root Cause Every system is perfectly designed to get the results it gets.” — Paul Batalden, MD If you don’t have a well-designed process in place to prevent pressure ulcers, it should be no surprise if you don’t perform well on that outcome metric. Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  14. 14. © 2014 Health Catalyst www.healthcatalyst.com Determining Root Cause By tracking process measures, you can pinpoint the root cause of the system’s failure. Many process issues could be behind the pressure ulcer problem. Shortage of pressure-redistributing mattresses Failed to do solid patient risk assessment Skincare product unavailable when needed Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  15. 15. Using Measures to Reduce Variation © 2014 Health Catalyst www.healthcatalyst.com Process measures improve quality and cost by enabling organizations to reduce the amount of variation in care delivery. Establishing process metrics at potential points of variation in a care process enables you to monitor and reduce inappropriate variation. Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  16. 16. Using Measures to Reduce Variation A value stream map outlines the steps in a process that deliver value to a patient. Each step may have a process measure useful in measuring process consistency. By measuring these steps, you can find points of variation. It’s possible to standardize processes so that all patients consistently receive the highest-quality care at the lowest possible cost regardless of which unit, which hospital or which clinic they are visiting. © 2014 Health Catalyst www.healthcatalyst.com Value Stream Map Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  17. 17. © 2014 Health Catalyst www.healthcatalyst.com Use an EDW to Track Metrics Healthcare organizations normally don’t have the infrastructure to handle both outcome and process metrics. If they only have the resources to track one of these, they’ll choose outcome metrics, because those are the measures that must be submitted to Centers for Medicare and Medicaid Services (CMS). Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  18. 18. © 2014 Health Catalyst www.healthcatalyst.com Use an EDW to Track Metrics The reason organizations struggle to track both types of measures is because their analytics methodologies rely too much on manual work. When you don’t have the right technology infrastructure in place to automate extraction and distribution of data, you end up having to do it manually. MANUAL HUMAN ERRORS PROCESS Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  19. 19. © 2014 Health Catalyst www.healthcatalyst.com Use an EDW to Track Metrics That’s where an enterprise data warehouse (EDW) with a robust, flexible analytics architecture comes in. An EDW eliminates manual processes and forms the foundation for healthcare analytics by bringing all health system data into a single source of organizational truth. ENTERPRISE DATA WAREHOUSE Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  20. 20. With an EDW, analysts can focus their time on discovering data patterns which will lead to understanding, insight, and ultimately action. But without an EDW, it will be very difficult for analysts to provide reliable and repeatable reports and in-depth analyses of areas that will provide the best opportunities for improving outcomes. © 2014 Health Catalyst www.healthcatalyst.com Use an EDW to Track Metrics Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  21. 21. Link to original article for a more in-depth discussion. Why Process Measures Are Often More Important Than Outcome Measures in Healthcare The Key to Real Process Improvement Outcomes: Linking Clinical and Financial Data Bobbi Brown, VP of Financial Engagement 6 Steps for Implementing Successful Performance Improvement Initiatives in Healthcare Bobbi Brown, VP of Financial Engagement How to Reduce Sepsis Mortality Rates by 22% with Clinical and Process Improvement Services — A Success Story from MultiCare Health System © 2014 Health Catalyst www.healthcatalyst.com More about this topic The Best Approach to Healthcare Analytics Tom Burton, Co-Founder, Senior VP of Product Development Healthcare Analytics Adoption Model: A Framework and Roadmap (white paper) David Burton, MD, SVP; Dale Sanders, SVP; and Denis Protti, ScD Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  22. 22. © 2014 Health Catalyst www.healthcatalyst.com For more information: Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  23. 23. Other Clinical Quality Improvement Resources Mr. Tom Burton is a co-founder of Health Catalyst and former President of the company. He brings 14 years of process improvement and IT experience to the company. Mr. Burton was a member of the team that led Intermountain Healthcare's nationally recognized improvements in quality of care delivery and reductions in cost. He has taught courses in the Toyota Production System, Agile Software Development and currently teaches in the Advanced Training Program at Intermountain Healthcare's Institute for Health Care Delivery Research. Mr. Burton holds an MBA and a BS in Computer Science from BYU. © 2014 Health Catalyst www.healthcatalyst.com Click to read additional information at www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.

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