Brian's Weblog

Patient Evaluations of the value of having a Clinical Care Specialist

Tue, 10 Jun 2003 15:38:14 GMT

Almost 6 months ago now Connie, Nancy and myself met to brainstorm how we might be able to have patients evaluate the value of the CCS / Patient relationship. We came to a conclusion that a paper survey with two distinct sets of questions would work best. The survey would start with the usual format of question and categorical response options. (ie, I feel cared for by my Clinical Care Specialists? Stongly Disagree, Disagree, Agree, Strongly Agree, Not Applicable.) The second part of the survey would have questions that would allow for open ended responses. It is the content of the answers to this second questions that I would like to share. (We do not yet have enough surveys completed, we have 30 and need 50, to perform a Rasch analysis of the first group of questions.)

(The answers to these questions have been copied verbatim except (My CCS) has been used as substituted for the names of the Clinical Care Specialist)

Open ended question #1: What would you like to add or change to this program?

Response #1: Very happy with relationship - couldn't be any better

Response #2: More interaction between the various physicians and providers as a cross check for patient care. I fell very strongly that the role of CCS should be expanded because the CCS provides a very vital contact for care providers and patients, note many patients are in isolated situations and cannot interact with others. The very fact that some would call is most important.

Open ended question #2: What other comments, concerns, and/or ideas do you have?

Response #1: Anything that can be done to get patients to participate in their care is positive and can be very helpful for their care providers, keeping a journal that is guided by a MD or other care provider could be used to provide very important information that would aid in caring for a patient it would also empower a patient with a felling of at least partial control of the outcome of treatment.

Open ended question #3: Share a story with us…Often times a great change begins one person at a time. We strongly feel sharing stories of success and failure will help us and others learn. If you have a story about your interactions with your Clinical Care Specialist or others in the health Care Community that you feel you would like to share please tell it out below or fill out the contact information and a staff member will contact you.

Response #1: I am beginning to feel that I can live with diabetes. My family has had this disease for many years. All have died of complications. I have information that my cousins are guessing at.

Response #2: When I need to get a test or see a specialist and can't get an appointment, (My CCS) gets me what I need very fast. When (My CCS) comes with me (My CCS) always asks the questions to help me and helps directing areas to assist me to get feeling better.

Response#3: (My CCS) has helped me in too many ways to comment. (My CCS) has improved both the safety of my care and my ability to care for myself. (My CCS) has been an educational resource for both me and for my family. I don't even want to think about coping with heart failure and diabetes without (My CCS). She is the best!

Individual Patient Surveys…more than just collecting data

Wed, 09 Apr 2003 14:39:32 GMT

Whatcom P2 is using 4 distinct individual patient surveys to assess the physical and emotional well being and capabilities of patients that have been admitted to a Clinical Care Specialist (CCS).

These 4 measures are: Depression, Simple Quality of Life, Physical Function, and Activated Patient. Each patient admitted to a CCS is asked to complete each survey at the time of initial evaluation. After the initial evaluation they are asked to complete the surveys once every 3 months. Currently we have both English and Spanish versions available for each except the Activated Patient measure, which we are working on the translation right now

Once the surveys are complete they are handed in to the P2 staff and the surveys are then key-entered into a Microsoft Access supported key-entry form specific to each survey. Once a week we (Data Analysts of P2) run a MS Access macro that extracts the results for each survey and saves it off to a text file. This text file is then loaded into Winsteps, which is the application that performs the Rasch analysis of the data. Once Winsteps crunches the data it automatically writes off a text file. Another MS Access macro is run that imports the patient scores back into the database. These scores are on a 0-100 scale. The macro also produces a report listing only those scores that have come into the database since the last time the analysis was run. (For a more complete description of what this MS Access based process looks like please read my other weblog titled: Automating Rasch Based Survey Analysis)

The results of the surveys are analyzed in a couple of different ways. First, the scores are loaded into an SPSS (Statistic/Data Management program) table that supports the graphical display of a patient’s progress. On a single chart, each survey is graphed over time. This allows the patient and caregiver to not only see the results of each survey but to also see how the dependent relationship between the surveys, ie as physical function increases depression levels decrease.

Second, within the Winsteps application an analysis tool is used for a detailed evaluation of a single patient’s set of responses. This tool, Person KeyForm, is able to compare how the patient actually answered each question with how Winsteps approximated they would answer it. The approximation is base on the patient’s 0-100 score. This table is particularly useful as it is able to quickly pinpoint areas of concern. For example, a patient takes the Depression Measure and analysis shows a low score. (Low score for depression is good!) If on the question: ‘I worry a lot about the past.’ the pt answered ‘Agree Strongly’. The Person KeyForm table could possibly show that their answer is significantly different than what would be expected from someone with that low of an overall score. The Clinical Care Specialist will immediately be able to identify that the patient’s answer to this question is an outlier and that it might warrant further discussion with the patient. The CCS may then be able to have a discussion with the patient about why they worry about the past and how that worrying is affecting their overall health. The Person KeyForm is able to instantaneously identify outliers, ie areas of possible concern or even areas of positiveness.

This individual analysis is able to produce the remarkable effect of creating a tool that works for the individual patient. This is a paradigm shift in many ways. The shift isn’t that we have produced a survey that seems to accurately collect data on the levels of patient depression, physical function, etc or that the data is then reported in an aggregate form that describes the overall status of the population we are working with. Instead, the shift is that this data gathering and measurement tool does all that AND is able to be applied, in a timely fashion, as a clinical tool to open dialogue with a patient about where they are at and why. It aids the clinician in evaluating a person in their entirety. It is the beginning of treating the patient as an entire individual as opposed to treating their chronic “medical” conditions without addressing their physical and emotional well being.

In summary, these tools that are being developed and utilized with our P2 patients are beginning to bridge the gap. The gap between the type of care the patients have been receiving and the type of care they need. The tools are new and their

Some specific learnings that we have had are:

With the activated pt measure ….acute episode eliminates their activation.

Other learning……all interrelated. It has been seen in some patients that as their physical function improves so does their activation and their depression.

Automating Rasch Based Survey Analysis:

Fri, 04 Apr 2003 18:02:39 GMT

Automating Rasch Based Survey Analysis:

This weblog will be designed to explain how we store patient survey data as well as explain how we have automated many of the steps of the analysis. It will be very technical in nature with the thought that the treasure is in the details and available to those that can recognize it…..meaning, that if I generalize much of this it won’t do anyone any good and by keeping it technical it will be very useful to those that may have the skills to implement some of the ideas and learnings we have had. With the understanding that all of my contact information is available and that I am always very happy to explain further.

Initially, it would take us almost 2 hours to take a patient survey (Activated Pt, Depression, or Physical Function) and analyze it into a useful result to be used by the Clinical Care Specialist. It did not matter if there were 2 or 200 surveys, it still took 2 hours to run through the multiple step process, ie storing the data, cleaning the data so it could be brought into Winsteps, exporting the data into SPSS so it could be graphically displayed, and then storing the data for use at a later date.

After learning and understanding the reporting needs, data structure requirements, and limitations of each application we were using for this process: Excel, MS Access, Winsteps, MS Word, SPSS, and Wordpad we were able to lay the groundwork to automate many of the steps. It is important to note that it is our expectation that with each step of automation we will not only save ourselves time but we will make the process easier to understand and less prone to user error. Each step of automation will decrease the likelihood that a mistake can be made.

The OVERVIEW

Once the surveys are complete they are handed into the P2 staff and their responses are key-entered into a Microsoft Access supported key-entry form specific to each survey. Once a week we (Data Analysts of P2) run a MS Access macro that extracts the results for each survey and saves it off to a text file. This text file is then loaded into Winsteps which is the application that performs the Rasch analysis of the data. Once Winsteps crunches the data it automatically writes off a text file. Another MS Access macro is run that imports the patient scores back into the database. These scores are on a 0-100 scale. The macro also produces a report listing only those scores that have come into the database since the last time the analysis was run.

The FIRST Step:

The first step was to set up the MS Access database, which we have been using to store the results, to handle a key-entry form specific to each survey. The form would allow the surveys to be key-entered directly into the database. The results had previously been key-entered into an Excel spreadsheet. We have the functionality to use the Teleform technology but an efficient process could not be set up to utilize it. The advantage of a MS Access based key-entry form is that it is easier to read for the end user and it has the ability to have better control over data quality. The forms can be set up to not allow duplicate entries, tight controls can be placed on the type of data entered into each field as well as not allowing fields to be left blank. The user is not required to save the file during or after entry. Further more, the volume of surveys is fairly small currently <10 per week. A short cut is placed on the user desktop that takes them directly into the MS Access dB menu screen that allows them to choose which form to key-enter.

The SECOND Step:

Next, functionality had to be put into place within the dB structure to allow us to identify patients and all of the surveys they took. Within the dB is survey data that may not be specific to P2, meaning that there is survey data from the large groups of folks that were used to test and calibrate the instruments. The functionality put into place allows each survey completed to have a unique id as well as to be labeled as a to whether or not it is a P2 patient. The database is also set up so that by using a patients PeaceHealth medical record number we can link a single patient to every survey they ever took.

The THIRD Step: Looking for new surveys

A 6 step macro is run that looks for new surveys, ie surveys that have been key-entered but not analyzed. This macro takes ~10sec to run.

Step 1 of the macro is to change the MS Access default so that all program warnings are turned off. A query that comes later in the macro is a MakeTable query which when run will produce various program warnings asking the user to confirm that they want to make a new table, etc. This first step just turn these warnings off which allows the macro to run in its entirety with out any further input by the end-user.

Step 2 is a MakeTable query that identifies all new Activated Pt surveys. This first query is a MakeTable query while the queries in steps 3&4 are append queries. The reasoning behind this is as Step 2 is run it is actually deleting the table currently there, which contains the listing of unique ids from the last time this macro was run. By replacing the table this MakeTable query is able to list just the unique id of the new surveys.

The structure of this query is parallel with the structure of the queries in steps 3 & 4. The table holding all of the key-entered surveys for the Activated Pt survey is joined to the Crosswalk table in a LEFT OUTER JOIN. The unique id filed is brought into each query. (The unique id field in the CrossWalk table is updated much later, during the export process. Therefore if the survey is new it will not have a unique id in the CrossWalk table.) A criterion is placed on the unique id field coming from the CrossWalk table to only bring back results that are NULL. The effect of this is that a new survey is identified IF it has a unique id in the key-enter table but not in the CrossWalk table.

Step 3 & 4 are append queries that identify new Depression and Physical Function surveys and appends their id to the table that was created in Step 2.

Step 5 is a select query that counts up the number of Ids, which represents the number of new surveys.

Step 6 turns warning back on.

The FOURTH Step: Exporting the data to Winsteps

The process to export the data of all 3 surveys is controlled by one macro. The macro consists of approximately 11 steps. The result of the macro is that 1 text file for each survey is written off to a specific network folder. The text file is in the exact format needed for placement of the data into the Winsteps control file. The only input required by the end-user is for them to hit the start button to initiate the macro. The macro takes about 1 minute to run completely.

Step 1 of the macro is to change the MS Access default so that all program warnings are turned off.

Steps 2-6 are a set of queries that select the survey data and ready it for export. Each survey requires 2 queries; currently we are analyzing 3 surveys so that is why this section has 6 steps. The following steps will describe the process for only one of the surveys with the understanding that the process for the others is separate but exactly the same.

The first query points at the table that supports the key-entry form for the Activated Pt survey. This table contains all of the responses for all of the Activated Pt surveys. This first query is a MakeTable query that grabs the unique id (a MS Access generated AutoNumber) of each completed survey as well as converts that id to a format that fits well into the Winsteps control file. The Winsteps control file requires the id field to be fixed width so the query reformats the id by adding 10,000,000 to each id that way the id will always be 8 digits long. For example, an id of 15 would become 10,000,015 and an id of 115 would become 10,000,115. These two fields are written off to a holding table. The purpose for this holding table is that it acts as a type of CrossWalk table that allows the pre-Winsteps and post-Winsteps survey results to be linked.

The second step of this two step process is another Make Table query that brings in this newly created 8 digit id and adds all of the responses to the survey question. These are responses that are in a numeric format, ie a response of Poor=1, Good=2, etc. This table has the sole purpose of holding the data in a place where it can be exported using predefined export specs. (A side note: if the responses were in a text format the functionality of converting them to numeric could easily be accomplished in this step by simply adding a link to a conversion table.)

As mentioned above the previous two steps are repeated 2 more times within the macro, once for each survey.

Steps 7-9 of the macro export the contents of each export table using a predefined export spec. Each text file is given a predefined name and written off to a predefined folder.

The last step of the macro turns the MS Access warning back on and produces a message notifying the user that export has been completed.

The FIFTH Step: Integrating Winsteps

Again, this set of steps is separate but parallel for each survey being analyzed. Winsteps is opened and the control file is opened for editing. The text file written off by the MS Access macro is opened in notepad. The contents of the notepad file are copied and pasted over the previous results in the Winsteps control file. The programming commands of the Control File are not pasted over, they are left as is. It is only the survey data that is replaced.

The end result is that the control file now contains all of the same results as it did previously with the addition of any new survey results that have come in since the last time the survey was analyzed. The Winsteps control file is saved and then run. Winsteps automatically writes off the necessary person file to a predefined folder with a predefined name.

The SIXTH Step: Cleaning the Winsteps Person File

MS Excel is used to open the just created Person File. The person file is cleaned up: all columns are deleted except for id, score and error. The file is saved as a text file. (Side note: this step will be looked at for possible automation.)

The SEVENTH Step: Import the results back into the MS Access dB

The MS Access import macro is an 8+ step process that automatically brings the results into the dB and creates a report listing the results of only the new surveys. “New” meaning surveys that have come in since the last time this analysis had been run. This macro takes ~~3 min to run.

Step 1 of the macro turns all warning off.

Steps 2-4 imports the cleaned up person files into 3 tables, one for each survey. There is an index on each table to prevent duplicate entries. This index prevents any unique id to come into the table if it is already there. At the end of step 4 there is 1 table for each survey. In each table is unique id, score, and date stamp. For the surveys that are new the date stamp field is blank.

Steps 5-7 run a query for each survey that places a date stamp, today’s date, in the blank fields of the new surveys. This date stamp is required for the next step to function properly.

Step 8 creates a report that is based off of the 3 score tables. This report grabs all survey scores, survey ids, and patient names for all new surveys. This is why the date stamp field is critical as well as the previously created Crosswalk tables. The actual score table only has 3 fields in it: unique id, score, and date stamp. The crosswalk tables are used to grab patient name and medical record numbers.

The last step turns all warning back on.

The EIGTH Step:

Now, the user has a report that lists the results of all new patient surveys. This printout is used to update an SPSS file that is used to graphically represent the patient’s results of all surveys over time.

REVIEW

To set up this automation in its entirety took approximately 16 hours. This investment will pay for itself within 9-10 weeks as we usually analyze new surveys 1x per week and that analysis would have taken approximately 2hrs each time. Above and beyond the gained efficiency, the automation of this process has made the analysis less prone to error. Multiple manual steps have been reduced down to a few with the remaining “work” being done automatically. Another large benefit is that all survey data is now being stored in a stable environment and it is being stored in a way that allows us to easily extract it. We are able to quickly and easily extract the data in just about any iteration and format that is needed. A single patient can be linked multiple ways to multiple surveys and multiple scores. This database will provide us the flexibility required to meet the reporting needs that have not yet been anticipated.

A simple tutorial has been created that will allow just about any analyst to step in and adequately perform the analysis. Prior to this it would have taken several days of training and extensive documentation for someone unfamiliar with the analysis to complete it from start to finish. In a work environment where task and assignments are shared with a partner, the simplification and standardization of any process is a huge benefit.

A partial history of the Clinic Patient Satisfaction Touchscreen Survey

Mon, 24 Mar 2003 15:27:36 GMT

History and Timeline of the Whatcom County Pursuing Perfection (P2) Clinic Patient Satisfaction Survey.

Although still in the process of change, the Clinic PSAT has gone through a long journey. This log is intended to describe some of that journey, not a comprehensive description but rather some highlights along the way. Highlights that may help others build off of the challenges and success we have had.

Prior to the launch of Whatcom P2, PeaceHealth created a sixteen-question survey that was designed to measure the level of satisfaction of a patient’s office visit experience. Whatcom P2 decided to build off of this fully functioning tool by adding 7 questions that specifically addressed the Pursuing Perfection promises made to the patients of this community. It was decided to administer this new survey by implementing the use of TouchScreen technology. The survey was to be web based, using the connectivity of PeaceHealth and HiNet. The patient would be able to simply touch the monitor screen to log their responses. With questions and response categories written in a large font and a user interface that seemed to have no barriers a successful implementation seemed easy as pie. Only identified by clinic, the data would be extracted and then analyzed using Rasch methodology. Every month, the clinics would receive a score between 0 and 100. This score would represent the satisfaction level of the patient. It was thought, as we implement the strategies and interventions of the P2 project, we will see scores climb. Patients will become more satisfied.

That was the plan.

With a tight deadline in place, Touchscreen Go-Live in all clinics by August 5, 2002, we set the wheels in motion to make it happen. Those given the new responsibility of implementing the survey naively felt that we would just walk over to each clinic, plug the device in, and turn it on….Presto, Good to go!

Not quite.

The barriers to implementation came fast and furious. Beginning with the discovery that it had not been decided where in the clinic these devices should be placed and quickly moving to the identification of a lack of process to identify which patients would take the survey (ie Would every pt on every visit take the survey? If not, how would they be selected? When during their office visit would they take the survey, etc). Further more, some clinics did not have network connectivity in the area that had been selected for the device to be placed and some did not have proper furniture to place the devices on.

Quickly, we re-grouped and identified the issues and possible solutions. A key note here is that in a time of extreme high stress the P2 team worked well together, staying on task and positive at all times. Looking back, it was one of those moments where the power of the Team is really quite amazing. The discussions were not about blame but instead they were about “What do we need to do to make this successful?” Put into place during our team building retreat this was to be a real world test of our strength and commitment to each other and to the success of the project. An excellent foreshadow of what our team dynamics would look like throughout the entire grant.

Over the next 8 weeks barrier after barrier was identified, addressed and solved. Each week we felt as if Go-Live was to be “sometime early next week”. Some may look at the date of actual Go-Live, late October, and see it as not meeting expectations or even as a failure. I think within the Project Team we look at it as a 100% success. Together, Project Staff and Pilot Sites, acknowledged the barriers and created solutions. Concerns were listened to and not ignored. As a result we have a fully functioning tool in each pilot site with over 4 months of complete data showing PSAT scores for each clinic.

Within each month’s anlysis each clinic receives their overall score as well as a frequency distribution graph for each question showing the percentage of respondents to each response category. Further more, each clinic will be receiving a run chart that charts their score over time. This run chart will also points of interest marked. These being large and small scale implementations the clinic has undertaken, ie the implementation of the Congestive Heart Failure Registry. The hope with including these markers is twofold: build a historic timeline showing

An interesting note is that the story doesn’t stop here. Listening to concerns about the questions specific to the Pursuing Perfection Promises we, as a group, decided to create a proposal of how we might evaluate how well these question work. This proposal includes holding at least 2 patient focus groups where we will ask for patient feedback on what they think of the questions. We will compile and evaluate their comments and use their comments as the driving force behind any revisions we make.

More to come…..

Learnings from Patients

Mon, 24 Mar 2003 15:22:51 GMT

Learning from a patient focus group.

This past week we held our first of what we hope will be several patient focus groups to help us re-design the P2 specific questions on the Clinic Patient Satisfaction Survey. The intent of the P2 specific questions is to help determine if we (Pilot Sites) are fulfilling the P2 Promises to Patients.

A few of the many highlights of this first group were:

P2 Survey Question: The evidence-based guidelines for diabetes (heart failure) that we used to develop my written Shared Care Plan were easy to understand.

It became obvious that the phrase “evidence-based guidelines” was not understood by all of the patients. Even the patients that did know what evidence-based meant felt that they would not know if their doctor was using them or not. Paraphrasing, it seemed that the patients all assumed that the doctor would not use guideline that were not evidence based. The patients recognized that guidelines change over time and what was important to them AND what they felt better defined the intent of the question was replacing “evidence-based” with “up to date”. A patient mentioned that they are aware of the ADA guidelines for diabetes and how they have changed over the years. It was important to him that his doctor was using the most recent or “up to date” version. It seemed that using the phrase “up to date” was in the minds of the patients analogous to the intent behind “evidence-based”.

P2 Survey Question: I have complete access to all of the clinical information, either about me or my health, that I need.

The big learning from patients on this question was that just because patients are given physical access to their clinical information, ie given a copy of there medical record or operation report, does NOT mean that THEY have access to it. Meaning that the medical jargon is impossible for them to understand and having copies of their reports isn’t giving them access to anything because they can’t make any sense out of it.

Complete access would mean having both physical access as well as being able to read and understand what has been provided to you. I found this to be very insightful especially as we think about P2’s spread to non-native English speaking members of this community and to those that are illiterate.

We look forward to holding more patient focus groups. I have a feeling we will refine our methods as we go and become a bit more efficient at getting more quality feedback from patients. It is a challenge to provide enough context so that the patients can understand why it is that they we are asking for their help and at the same time leave enough room on the agenda to make sure we get all of their ideas and feedback. We want the patients experience at these focus groups to not only be positive but empowering. We want them to continue to want to participate because it is obvious that we can’t do it without them!

Radio Weblog – A story of a concept that has outpaced its technology?

Fri, 28 Feb 2003 14:10:40 GMT

Radio Weblog – A story of a concept that has outpaced its technology?

Those of us heavily involved in the Whatcom County Pursuing Perfection (P2) are beginning to feel as if the experiences we are having, trying to write our stories, is a parallel of the patient experience in our broken system of health care. Most of us agree that in order for the power of patient centered health care reform to take hold we must be able to spread our stories; our stories of success, missteps, and learnings. The World can learn from us and we can learn from the World.

Creating that paradigm is the problem. For the project staff of Whatcom P2 we have many issues with the Radio user interface, the interface that is designed to help us create our weblogs. For some, knowing that all of their written thoughts will be read by anyone in the world is enough to create a chronic condition, ie writer’s block. For others, written thoughts come out easily but the lack of usability of the tool creates further barriers. Wonderful stories are carefully written only to be lost in the void. Distantly analogous to being discharged from the hospital without any discharge instructions. Halfway down the road of spread we loose our way. Others publish to the WWW only to find that the beauty they have sculpted is just a jumble of words that have lost all formatting. Analogous to the patient end of the patient/doctor experience. Paragraphs run together, words bolded that were never intended to be, sentences missing, etc. Lots of words and good intentions but really just a jumble of text that has lost most of its meaning.

Much to the dismay of those that feel Radio is THE answer the P2 staff fail to write their stories. The P2 staff are asked why they are not in “compliance”. Pressure is put on us to write, to share our important stories with the rest of the World. The need is acknowledged and we try to comply. We remember our stories and carefully articulate them only to be stymied by the technology. The Radio believers ask again, but again we give the same response: “We want to but the barriers are too much.” Radio believers use a stronger voice: “You must comply”. Unable to navigate the system, our activation plummets and our depression rises. Puzzled, frustrated, and ultimately defeated we give up. The Radio believers push harder for compliance as we move further away.

A seemingly sad tale with a dismal outcome…..then again maybe not. Leave it to the P2 team to band together, to see the problem, and to find a workable solution. A user-centered solution!! Remove the barriers and we will write our stories. Instead of using Radio we will write them any way we can: in Word, Notepad, on paper, etc. We will write them whenever we have time: at the office, at home, together at lunch. Complete or incomplete we shall leave traces of our thoughts so that every revelation, every “ah ha”, every oops, and every WOW can become a story. We may not write the entire story but we will leave a trace that will allow others to learn. Once written we will have the believers, those that have mastered the system, translate our stories to Radio. Together we shall post them to the World and they shall be found and read by all……………

Thu, 19 Dec 2002 20:45:11 GMT

Week ending 12/20/2002

A little overdue so this review will attempt to cover the past 3 weeks, in general starting from most recent and moving backwards.

1) Completed December pull of measure: 3rd next available appointment for routine diabetic/CHF check. Christine had been doing all of the work around this measure and to be honest I was dreading it a bit. Knowing how busy the staff are in the pilot sites I was not looking forward to interrupting their day. To say the least they were all very VERY helpful and my unease quickly subsided. Some questions did arrise on how some of the calculations were performed and their opperational definitions. I will be attempting to touch base with Christine about these.

The holidays will play a role in the stats for this month, as many clinic staff will be out of the office a lot over the next few weeks. Will be sure to put a footnote on the graph to make a note of this effect.

2) Patient Surveys: Depression Measure, Physical Function, and Activated Pt.

Worked closely with Bill Mahoney and Sara Jane Satre, both of the Methods Outcomes Measurement and Statisitics team to analyze or implement the above listed surveys.

With both, the Depression and Physical Function Measure we completely analyzed the results and then met with the Clinical Care Specialists to walk them through how to interpret and act on the results. Bill provided a wonderful tool that attempts to utilize a pts score to determine what level of intervention, if any, is required from the CCS.

The Activated Pt survey was finalized and a Teleform, form that allows the survey to be read as a fax and automatically stores it in a data file, was created. An initial process was established on how to score the survey. In some instances the CCS will score the completed survey with the pt and they will then discuss the results. The CCS will then return the survey to us so we can perform a more detailed analysis and provide that to the CCS as well.

Feedback from the CCSs was positive and thankful for having such excellent tools at their fingertips.

3) In an attempt to address the concerns that were expressed at the 12/4/02 Implementation Meeting about the Clinic Pt Satisfaction Survey I created a rather thorough document with the intent of this document being: to provide background knowledge of Rasch, clinic PSAT, and HCCC. It was designed to provide the reader with as much detail that was desired, no more no less. ie simple overviews with links to further detailed description. The link to this document is:

http://www.peacehealth.org/apps/p2/document/DocumentDisplay.asp?DocumentID=178

This is being stored on the Hinet based site so it may not be accessible to the entire WWW.

4) Worked with the Clinical Care Specialists to brainstorm and create an informal survey that we will use to gather feedback from the patients, and members of their care team, who have been admitted to a CCS. The basic rules that we followed were:
1) Keep it short
2) Keep it simple
3) 1 page front and back
4) Anonymous with option to provide id if pt wished to discuss the survey results and/or feedback about the survey itself.
5) One version for the pts and one version for members of their care team. The same questions but worded differently.

5) P2 Goes to Orlando

Much of the time spent the few days prior to the IHI Conference in Orlando was focused on producing charts and graphs for the presentation storyboard and other meetings/learning huddles.

End product of the storyboard was most impressive!

6) Continued work on System Dynamics – Congestive Heart Failure data pull.

Except for financial and procedure data we have completed both the SJH CHF and Center for Senior Health CHF data pull. Pulled all visit and pt info and sent off to finance.

Had extensive discussions, in person and over email, around the procedure data that has been requested. More specifically, what are the relevant cardiac/cath lab procedures that we are to pull. After getting feedback from the Nancy and Dr. Lomabardi I think we have identified what it is we are trying to pull. Also worked with Dee Garcia, SJH Coding Manager, to identify the correct corresponding procedure codes. As always, Dee provided very timely and valuable information.

7) Completed the monthly Diabetes and CHF report for IHI as well as the Pilot Site Specific reports. These were submitted to IHI and to each clinic. Still have been unable to cement a meeting date with the Bellingham Fire Department to discuss the sharing of Emergency Medical Information

8) Have been intermittently doing a significant amount of research into the new HIPAA regs (Federal confidentiality laws). New regs go into effect April 1, 2003 and am hoping to have a very solid handle on what is ok, what is not ok, and also what is changing.
9) Pt Satisfaction Data for SJH-Inpts was received for the month of September. Survey questions specific to P2 were analyzed and the results were distributed to the hospital guidance team.
10) We continue to report the number of clinic PSAT surveys completed per day. Although variable from day to day the results are beginning to show a stable pattern. Overall it looks as if we are receiving enough completed surveys to meet the minimum requirements for analysis.

Week In Review (Week ending 11/22/02)

Thu, 21 Nov 2002 22:59:52 GMT

1) Completed and submitted the analysis of the SJH Inpt PSAT P2 specific questions for the month of August. In addition, August data was compared to July using a line (run) chart. This chart will be transitioned into a SPC chart once we have enough data points to do so. Thanks to Sarah Jane Satre of the PeaceHealth MOMS Team for her strong knowledge of SPSS and continued help with this analysis.

2) Later this week we will begin the first analysis of the Clinic PSAT Touchscreen Survey data. We currently have >250 completed surveys in the hopper which is a perfect amount to create the necessary anchor file. In addition to the creation of the anchor file we will also be able to provide the clinics with actual PSAT scores. With the feedback gathered from the most recent Implementation meeting we will hope to reformat the clinic specific PSAT report into a more user friendly manner. The PeaceHealth Survey Subteam of Aaron Ignac, Sarah Jane and of course Bill Mahoney will be instrumental in making this analysis a reality.

3) Began work on the Systems Dynamics data pull for Congestive Heart Failure. This has proven to be a bit confusing and more complex than the Diabetes data pull. At the very least it looks like an impressive challenge that we look forward to tackling.

One of the main challenges is staying in compliance with the patient confidentiality rules and regs, especially the new HIPAA regs that go into effect April 2003. While all of us truly have patients at the center and have an enormously high regard for patient confidentiality the new HIPAA regs are creating some challenges not previously experienced. Simply relying on our self judgment of what is "reasonable" doesn't cut it anymore. The HIPAA regs are very specific and have teeth. Violating these regs, even inadvertently, could sink our efforts, on a personal level as well as community level.

The first step of the Systems Dynamics pull is fairly straight forward and we should be able to submit "Phase I" data to the consultants in the very near future. The phase I data does not involve the release or sharing of any pt identified data so we will be able to move quickly on completing this request.

Many thanks to Dori Robart from SJH and Sarah Donelson of the MOMS Team for providing their continued support and guidance with the security and confidentiality rules and regs.

4) We created a database to assist us in tracking the rate of completion of the clinic PSAT survey. This has proved useful in providing the clinics with immediate (daily) feedback on the # of surveys completed at their offices. Run charts are faxed or emailed to each pilot site on a weekly and/or daily basis depending on their preference.

5) Data collection for the measure: 3rd Next Available Appt was conducted and completed. This is the second month of data collection for this measure. The processes, established last month, created a very useful and efficient template for this month's data collection. We hit a few barriers with contact folks being out of the office but in each instance the specific clinics responded positively and quickly to getting the issues resolved and helping us complete the data collection. A big thanks to all of the pilot sites!!