kansas rural health options project quality improvement committee cah qi survey results spring, 2002...
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Kansas Rural Health Options Project Quality Improvement Committee
CAH QI Survey Results
Spring, 2002
Survey administered and analyzed,
on behalf of KRHOP,
by Stephen Blattner, MD
CAH QI Survey Results - 12/2001 Page 3/39
Executive SummarySurvey Responses - 1
• Responses were felt to be representative of CAHs• There was substantial dissatisfaction regarding the value of some current QI
measurements at CAH– Administrators were more likely to express dissatisfaction– Few respondents indicated that QI measures are linked to the broader
performance of the organization (strategic/business planning) or community health
• Responses revealed that basic QI tools and processes are not routinely utilized by CAH QI staff
– This was more likely to be seen in respondents who lacked access to new information technology (IT)
– Penetration of IT to management appeared higher than to “line staff”– Respondents indicated they were more interested in training focusing on project
selection and design rather than in tools– Although existing measurement tools may be inadequate, there was high interest
in projects for improving patient care, outcomes, and processes
CAH QI Survey Results - 12/2001 Page 4/39
Executive SummarySurvey Responses - 2
• Most systems for tracking QI performance are “home grown” • Penetration of information technology (including hardware, software, and functional
Internet access) to non-managers is limited– In several questions, respondents distinguished between access for staff and access for
managers. • Managers are aware of this and see it as a problem
– The primary impact may be that implementing improvement activities at the front line level is limited by access to IT
• There may be a secondary impact – lack of access to IT may be associated with a diminished desire to learn QI tools or a lack of awareness regarding what tools exist
• Internet access, internal networking, and network level electronic linkages are sub-optimal in configuration and distribution among staff and management
• Hospital wide QI reporting among CAHs is not uniformly frequent and, in some cases, inadequate to support a meaningful QI program
• Clinical pathways for management of common conditions are not utilized extensively by CAHs
• Financial metrics are not often included in QI indicators used by CAHs
CAH QI Survey Results - 12/2001 Page 5/39
Executive SummarySurvey Responses - 3
• There is widespread interest in peer benchmarks for CAHs• There is little formal collaboration between EMS providers and CAHs in the
assessment and improvement of emergency medical care and transport• Desired focus areas for QI Technical Assistance indicated by responses:
– Training, Tools, Technology– Staff Development– Project Selection and Design– Patient Care Operations/Processes– Network Functionality/Peer Benchmarking– Continuum of Care Issues– Clinical Outcomes– Customer/Market Focus– EMS– Care of the Elderly– Achieving Community Health Goals
CAH QI Survey Results - 12/2001 Page 7/39
CAH QI SurveyRespondent Characteristics - 1
• 42 CAH respondents– 4 non-CAH (excluded)
• Range of time at institution was 6 mos. – 40 years
• Range of time at position was 3 mos. – 20 years– Administrators: 6 mos. – 17 years
– Managers/Directors: 3 mos. – 20 years
– Participants: 9 mos. – 19 years
• No instance of duplication within a hospital (i.e. Administrator and QI Manager)
Respondent QI Job Categories (n=42)
1517
8
20
2
4
6
8
10
12
14
16
18
Administrator Director/Manager Participant Not Specified
Time in Current QI Position (n=42 CAH)
8
19
15
0
2
4
6
8
10
12
14
16
18
20
Less than 3 yrs. 3-10 yrs. More than 10 yrs.
CAH QI Survey Results - 12/2001 Page 8/39
CAH QI SurveyRespondent Characteristics - 2
Histogram of Time at Position
0
2
4
6
8
10
12
14
16
2 4 6 8 10 12 14 16 18 20 22 24 26 28 30
Years
# R
esp
on
den
ts
.00%
20.00%
40.00%
60.00%
80.00%
100.00%
120.00%
Frequency Cumulative %
Histogram of Time at Institution
0
2
4
6
8
10
12
14
16
2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40
Years
# o
f R
esp
on
den
ts
.00%
20.00%
40.00%
60.00%
80.00%
100.00%
120.00%
Frequency Cumulative %
CAH QI Survey Results - 12/2001 Page 9/39
Question 1:Do you collect process data for QI measurement purposes?
Yes95%
No5%
Yes
No
CAH QI Survey Results - 12/2001 Page 10/39
Question 2:Do you collect outcomes data for QI measurement purposes?
NR2%
Yes74%
No24%
Yes
No
No Response
CAH QI Survey Results - 12/2001 Page 11/39
Question 3: If you answered YES to Q 1 or Q 2 on what basis are measurements selected
(pick all that apply)
0
5
10
15
20
25
30
35
40
Opportunities forImprovement
Customer Satisfaction Mandated byRegulators
Mandated by Board Link toBusiness/Strategic Plan
Link to CommunityHealth
CAH QI Survey Results - 12/2001 Page 12/39
Question 4:Are you currently conducting measurements that you consider not to
be useful or relevant?
No64%
Yes36%
No
Yes
CAH QI Survey Results - 12/2001 Page 13/39
Question 4 Are you currently conducting measurements that you consider not to
be useful or relevant? (By Time in Position)
9 126
6 72
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Up to 3 yrs 3 - 10 yrs More than 10 yrs
Time in Position
Yes
No
CAH QI Survey Results - 12/2001 Page 14/39
Question #4Are you currently conducting measurements that you consider not to be useful or
relevant?(By Role)
710
8
87
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Administrator Director/Manager Participant
Role
Yes
No
NOTE: 10/13 Administrators were at position 3-10 years
CAH QI Survey Results - 12/2001 Page 15/39
Question 5:What is your hospital's primary system for collecting and reporting
data?
PRO Designed Tool20%
Internally Designed System
76%
Comm Prog4%
Internally DesignedSystem
PRO Designed Tool
Commercial Program
CAH QI Survey Results - 12/2001 Page 16/39
Question 6a:Do you routinely use statistical process control charts and similar
data display tools for trended data presentation and analysis . . . at the hospital level?
No67%
Yes33% Yes
No
Question 6b:Do you routinely use statistical process control charts and similar
data display tools for trended data presentation and analysis . . . at a network level?
Yes14%
NR5%
No81%
Yes
No
No Response
CAH QI Survey Results - 12/2001 Page 17/39
Question 7In what areas would additional training be useful?
0
5
10
15
20
25
30
35
40
QI Project Selection QI Project Design Cause and EffectDiagrams
Control Charts FLow Charts Pareto Charts
CAH QI Survey Results - 12/2001 Page 18/39
Question 7:In what areas would additional training be useful?
(Pick all that apply)
(By Time in Position)
0
2
4
6
8
10
12
14
16
Statistical ProcessControl
QI ProjectSelection
QI Project Design Cause and EffectAnalysis
Flow Charts Pareto Charts
Up to 3 yrs 3 - 10 yrs More than 10 yrs
CAH QI Survey Results - 12/2001 Page 19/39
Question 7:In what areas would additional training be useful?
(Pick all that apply)(% By Role)
8 10 4
1114
6
12 11 3
9 103
77
2
8 116
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Administrator Director/Manager Participant
Role in Program
Pareto Charts
Flow Charts
Cause and Effect Analysis
QI Project Design
QI Project Selection
Statistical Process Control
CAH QI Survey Results - 12/2001 Page 20/39
Question 8:Which of these measurement areas would you like to see included in
your QI program?(Pick all that apply)
0
5
10
15
20
25
30
35
40
Care processes Follow up/outcomes Access measures Community HealthImprovement
Market/communityawareness
Discharge/referral Intake and triage
CAH QI Survey Results - 12/2001 Page 21/39
QUESTION 8Which of these measurement areas would you like to see in your QI program?
(By Position)
7 82
9 8 4
43
9 15
5
87
2
811
6
107 3
0%
20%
40%
60%
80%
100%
Administrator Director/Manager Participant
Role
Community Health Improvement
Follow up and outcomes
Discharge/referral/placement
Care related processes
Intake and triage
Access measures
Market/community awareness
CAH QI Survey Results - 12/2001 Page 22/39
Question 9Are QI activities hampered by inadequate access to computer
resources?
Yes38%
No62%
Yes, activities hampered No, activities not hampered
CAH QI Survey Results - 12/2001 Page 23/39
QUESTION 9Are QI activities hampered by inadequate access to computer
resources?(By Position)
6 9
512
44
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Yes, activities hampered No, activities not hampered
Activities Hampered?
Participant
Director/Manager
Administrator
CAH QI Survey Results - 12/2001 Page 24/39
Question 10:Do key staff and management have easy access to spreadsheet, database, and
word processing software?
NR2%
NO29%
YES69%
Yes, easy access to tools
No, not easy access to tools
No Response
CAH QI Survey Results - 12/2001 Page 25/39
Question 9 v Question 10For those respondents who indicated that QI activites were hampered
by inadequate resources, do they perceive easy access to tools?
NO62%
YES38%
Yes, easy access to tools
No, not easy access to tools
CAH QI Survey Results - 12/2001 Page 26/39
Question 11Do key staff and management have easy access to the Internet?
Yes81%
No19%
Yes
No
CAH QI Survey Results - 12/2001 Page 27/39
Question 12Are Internet connections by cable, telephone, "fast line" (I.e. T-1, ISDN, etc.)?
"Fast line" 17%
Standard telephone
45%
Cable38%
Standard telephone
"Fast line" (T-1, ISDN)
Cable
CAH QI Survey Results - 12/2001 Page 28/39
Question13aIs your hospital on a computer network that enables easy information sharing...within the
hospital?
Yes53%
No45%
NR2%
Yes
No
No Response
Question13b:Is your hospital on a computer network that enables easy information...within the
hospital affiliated network?
Yes43%
No52%
NR5%
Yes
No
No Response
CAH QI Survey Results - 12/2001 Page 29/39
Question 9 v Question 19For those respondents who previously indicated that QI activities were hampered by lack of access to tools, does a computer network that enables easy information sharing exist?
Yes44%
No56%
Yes
No
CAH QI Survey Results - 12/2001 Page 30/39
Question 14:How frequently does your hospital QI program produce structured reports of all hospital
QI activities ?(NOTE: Most frequent reporting interval shown for each resondent)
0
5
10
15
20
25
Yes, Monthly Yes, Quarterly Yes, Annually No Hospital Wide Reporting
Most Frequent Reporting Interval
CAH QI Survey Results - 12/2001 Page 31/39
Question 15:Do your departments and/or services produce structured quarterly, monthly, and/or
annual reports of their QI activities?
0
5
10
15
20
25
30
Yes No SomeDepartments
CAH QI Survey Results - 12/2001 Page 32/39
Question 16:Does your facility utilize clinical pathways for specific conditions?
No83%
Yes17%
Yes
No
CAH QI Survey Results - 12/2001 Page 33/39
Question 16:If "yes" (to question 16), for which conditions does your facility utilize clinical pathways?
0
1
2
3
4
5
Acute MI Pneumonia Acute Stroke CongestiveHeart Failure
Diabetes ChestPain/Angina
OB/Newborn Psychiatricemergencies
PressureUlcer
Management
Asthma COPD
CAH QI Survey Results - 12/2001 Page 34/39
Question 17:Do you routinely report and track operations and financial data through the QI
program?
No83%
Yes17%
Yes
No
CAH QI Survey Results - 12/2001 Page 35/39
Question 16 v Question 17:If YES to Question 16, YES v NO to Question 17
4
3
0
1
2
3
4
5
Do Pathway Users Track Financial Data?
No Yes
CAH QI Survey Results - 12/2001 Page 36/39
Question18:If you answered "yes" to question 17, which measures are the most useful [financial
metrics] managerially as key performance indicators?
0
1
2
3
4
5
6
7
Days A/R TotalProfit
Margin
ALOS %Medicare
Days
CurrentRatio
%Medicaid
Days
OpExp/Adj
Disch
Op ProfMarg
Days OpExp inCash
Occ Rate MedicareCMI
FTE /AdjADC
Sal/Ben as% of Op
Exp
OpRev/Adj
Disch
Financial Metric
CAH QI Survey Results - 12/2001 Page 37/39
Question 19:Would your hospital benefit from the availability of more closely matched peer
benchmark operations and/or financial data in the above areas (i.e., from peer hospitals in Kansas or the Midwest)?
Yes72%
No21%
NR7%
Yes
No
No Response
CAH QI Survey Results - 12/2001 Page 38/39
Question 20a:Do you work with your local/regional EMS provider(s) to collect and assess pre-hospital
and transfer...clinical quality data?
Yes26%
No72%
NR2%
Yes
No
No Response
Question 20b:Do you work with your local/regional EMS provider(s) to collect and assess pre-hospital
and transfer...operational data?
NR2%
Yes26%
No72%
Yes
No
No Response
Question 20c:Do you work with your local/regional EMS provider(s) to collect and assess pre-hospital
and transfer...benchmark or peer comparison data for pre-hospital transport?
Yes2%
No96%
NR 2%
Yes
No
No Response
CAH QI Survey Results - 12/2001 Page 39/39
Question 21:If you answered "yes" to any part of Question 20, please describe the interactions you
have with EMS service(s) reqarding Quality Improvement:
0
1
2
3
4
5
6
Joint Conferences Joint Improvement Planning Joint Data Review Joint Strategy Development
CAH QI Survey Results - 12/2001 Page 40/39
Rank QI Priorities Respondents Selecting1 Clinical Outcommes 562 Patient, Customer, Market Focus 433 Patient Care Operations 274 Staff Development 255 Community Health Goals 206 Prevention 197 Discharge, Referral, Follow Up 198 Organizational Performance 179 Benchmarking/Peer Hospitals 1610 EMS 1511 Information Management 1512 Leadership/Management 1413 Target Populations 1314 Specific Clinical Conditions 1315 Hospital Operations 1216 Access to Care 1217 Strategic Planning 1118 Network Functionality 919 Intake/Triage 820 Technical Capabilites 821 State Health Goals 522 Regionalization 223 Defining Value 2
Question 23:If a Statewide Rural Health Quality Initiative was to be undertaken, it
should focus on the following (pick up to 10):
CAH QI Survey Results - 12/2001 Page 41/39
Question 23: If a Statewide Rural Health Quality Intitiative was to be undertaken, it should focus on the
following priority areas (pick up to 10):
Clinical Outcomes
Patient, Customer, Market Focus
Staff Development
Patient Care Operations
Community Health Goals
0
10
20
30
40
50
60
CAH QI Survey Results - 12/2001 Page 42/39
Question 23 "Target/vulnerable populations" prioritized:
(n=13)
11
13
0
2
4
6
8
10
12
14
Elderly Ethnic and minority Other
CAH QI Survey Results - 12/2001 Page 43/39
Question 24:If you marked "specific conditions or disease states" on Question 23, please specify which
areas you feel should receive high priority (check all that apply):
0
1
2
3
4
5
6
7
8
9
10
Prevention Diabetes Mental Health Stroke Chest Pain Pulm Dis Cancer Heart Disease CHF Hospice Alzheimers Teen Pregn Dental Asthma HIV/AIDS
Q 24 - Prioritized Conditions TotalPrevention 9Diabetes 8Mental Health 8Stroke 6Chest Pain 6Pulm Dis 6Cancer 6Heart Disease 5CHF 5Hospice 5Alzheimers 5Teen Pregn 4Dental 4Asthma 2HIV/AIDS 1