Monday, May 20, 2002

Pursuing Perfection Evaluation site visits From: Irene.Cramer@med.va.gov [mailto:Irene.Cramer@med.va.gov] Sent: Friday, May 17, 2002 11:57 AM Subject: Pursuing Perfection Evaluation site visits We are looking forward to having the opportunity to meet each of you and the members of your staff involved in the Pursuing Perfection effort. As RWJF's John Fiorillo and Linda Bilheimer described in their memo this week, we will be present at the May 29 IHI meeting to introduce the evaluation aspect of this project. We will also provide you with more specific information next week. The evaluation of the Pursuing Perfection effort has several aspects to it with the first being a visit to each of your facilities, hopefully in June. We will be on site for two full days and would like to meet individually with senior and line staff knowledgeable and involved in the Pursuing Perfection effort. In addition, we will want to become familiar with your system for performance based data collection. Because each site varies, we will need to identify the appropriate people site by site and will look to your counsel as well to help us identify the people and set up the appointment times prior to our visit. At this time we are asking you to choose from the times listed below, the three best time slots for a site visit. Please indicate your first, second and third choices. If possible, we would like to complete the site visits in June. We have three teams available, each with three people. 1st choice 2nd choice 3rd choice June 3 and 4 ________ ________ ________ June 4 and 5 ________ ________ ________ June 5 and 6 ________ ________ ________ June 6 and 7 ________ ________ ________ June 10 and 11 ________ ________ ________ June 11 and 12 ________ ________ ________ June 12 and 13 ________ ________ ________ June 13 and 14 ________ ________ ________ June 17 and 18 ________ ________ ________ June 19 and 20 ________ ________ ________ June 20 and 21 ________ ________ ________ June 26 and 27 ________ ________ ________ If you cannot choose three dates in June, please indicate from among the July dates as well. 1st choice 2nd choice 3rd choice July 9 and 10 ________ ________ ________ July 10 and 11 ________ ________ ________ July 11 and 12 ________ ________ ________ July 15 and 16 ________ ________ ________ July 16 and 17 ________ ________ ________ July 18 and 19 ________ ________ ________ If you have questions, please give me a call or e-mail me. Thank you for your assistance. Irene E. Cramer, Ph.D., Pursuing Perfection Evaluation Project Manager Management Decision and Research Center VA Boston Healthcare System (152-M) 150 South Huntington Avenue Boston, MA 02130 Telephone: (617) 232-9500 ext. 5758 Fax: (617) 278-4438 e-mail: irene.cramer@med.va.gov 1:19:02 AM

From: Donelson, Sarah Sent: Tuesday, May 14, 2002 9:57 AM To: Minniti, Mary Cc: Pierson, Marc Subject: RE: [p2projectdirectors] nhs performance indicators Well, it depends on which ones you want to use and why and if you are going to use the risk adjustment that they developed in the UK. Their health care system is very different from ours, so prior to adopting any risk adjustment, I would want to examine the models carefully. Also, an indicator like "going home after a hip replacement" may or may not be getting at what you want to get at. If you are the hospital where the surgery was done, but then you send patients to a step down facility for rehab and then they go home - you would have very few, if any patients "going home after hip replacement". In the British health care system, you would have your rehab there in the hospital (at least about 8 years ago you would have and I'm guessing that hasn't changed in the UK from the use of this indicator). So, if you could be more specific about which ones would be used and why you are looking at them, that would be helpful. I would also want to look to see if these were indicators being tracked more broadly in the US to facilitate comparisons and drawing policy conclusions down the road. Ultimately, we are going to need to show that there are sound reasons to adopt some of the learnings of PP and that it makes good sense from a national policy perspective. I couldn't get to the second link as it was not available (according to the message that I got). I hope that this is helpful - Sarah Donelson Director, Methods, Outcomes Measurement & Statistics Healthcare Improvement Division PeaceHealth Tel: (541) 687-4945 / Fax: (541) 434-7450 sdonelson@peacehealth.org Assistant: Summer Meyer (360) 715-6478  -----Original Message----- From: Minniti, Mary Sent: Monday, May 13, 2002 7:43 PM To: Donelson, Sarah Cc: Pierson, Marc Subject: FW: [p2projectdirectors] nhs performance indicators What do you know about these indicators and their value? They are being discussed in P2 as possible indicators...are they a gold standard from your perspective? Thank You! Mary Minniti, CPHQ, Project Manager Clinical Quality - HealthCare Improvement Division (360) 319-0651 [cell)] or (541) 984-4063 phone- Eugene Fax (360) 738-6393 Bellingham; Fax (541) 686-8947 Eugene -----Original Message----- From: jo bibby [mailto:jo@hollocklee.evesham.net] Sent: Monday, May 13, 2002 8:09 AM To: P2 Project Directors Subject: [p2projectdirectors] nhs performance indicators Dear colleagues, here are the links to the NHS national performance indicators. Some of them do, I think, cover the areas that were discussed at our recent conference call. There is also further information available or forthcoming from clinical audit databases (and consequently better risk adjusted). I will look into this further. Jo http://www.doh.gov.uk/nhsperformanceindicators/2002/ha.html http://www.doh.gov.uk/nhsperformanceindicators/2002/trust.html 1:12:02 AM

Hello Everyone, There have been some questions regarding measures.  Ron Moen wrote an e-mail to help clarify... Having common measures within each Pursuing Perfection Learning Group should increase the opportunity to learn from one another. To establish common measures, we went through the measures you sent us the first week in May and identified those most similar and removed those that were sufficiently different. Four tables were created, one for each learning group. If your measure is included in a table sent out last Wednesday, the row next to your organization will be filled out except for the last column. You should complete the last column asking for 1) your current baseline and 2) list databases used for comparison. As an example: 1) 3rd next available measure is stable and has averaged 23 days for the last 6 month, and 2) we use the Premier Perspective database. If you find a blank row next to your organization for a common measure, we would like you to consider developing a measure similar to that measure and definition included in the table as examples. You have to decide if you want to include one or not. You should try to include as many common measures as possible so you can benefit from being part of the learning group. Consider those that will help accomplish your project's goals and promises. If you complete the information in the table for a common measure that will be new for your organization, you probably would not have any baseline data to include in the last column but you may be able to answer the question in the last column regarding databases. This work on common measures does not preclude you from collecting data on the other measures your organization included in your Phase II application. Janice Gagnon, Institute for Healthcare Improvement 12:42:28 AM

	Saturday, May 18, 2002

Medication System, measure related to quality.  Common Measures            1. Adverse Drug Events (ADEs) per 1000 doses (safety)            2. Therapeutic Range (effectiveness)            3. Cycle time to medication for certain medications (timeliness) 8:19:04 AM

	Wednesday, May 15, 2002

Common Measures: Medication System           1. Adverse Drug Events (ADEs) per 1000 doses (safety)           2. Therapeutic Range (effectiveness)             3. Cycle time to medication for certain medication (timeliness) 8:03:03 PM

Common Measures             1. 3rd next available appointment (effectiveness)       2. Total time for a visit (efficiency)       3. # of patients on a wait list to be assigned a primary care physician (effectiveness)       4. Percent of patients “highly satisfied” with appointment scheduling (patient centered)       5. Percent “no show” (efficiency) 7:55:43 PM

Key Components of Whatcom Consortium's approach to Pursuing Perfection in Healhtcare. Pursuing Perfection Components in Whatcom County. We will use this or a similar graphic on the home page of the future to guide users to the parts they are interested in. We will also add search capabilities by these categories... in the future, the near future I hope. 6:19:18 PM

	Saturday, May 11, 2002

Bill Mahoney begins the open dialogue on Patient Centered care when he posts: Activated patientness is not a trait but a state. The state is created by the care team (in whatever form) providing patient-centered care. The only importance of patient traits is that they (e,g, locus of control, self-esteem, soci-economic status, location in the social structure) specify the probability of x level/type of patient-centered care activity resulting in y level of activation. The biggest barrier (if the focus groups done 2 years ago tell us anything) is not the patient, but the provider. Building patient-centered care (CCM's productive interactions) is identical to building team development (it is team development.....patient as full partner in the care team). The absolutely essential foundation of patient-centered care is the creation of team cohesiveness (see team measure) and this will require that providers redefine their role, the patient's role and the nature of the patient-provider relationship. My hypothesis is that few will be willing to go there and we may easily revert to blaming it on those noncompliant patients...an animal that does not exist. [Bill Mahoney's Radio Weblog]   11:11:22 AM

© Copyright 2002 Marcus Pierson, MD. Last update: 5/5/2002; 8:44:57 AM.