Kansas Rural Health Options Project Quality Improvement Committee CAH QI Survey Results Spring, 2002 Survey administered and analyzed, on behalf of KRHOP,

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

http://www.ksbems.org/

http://www.ksbems.org/

Executive Summary

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



• 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



• 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

Survey Questions and Responses


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 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 %


Question 1:Do you collect process data for QI measurement purposes?

Yes95%

No5%

Yes

No


Question 2:Do you collect outcomes data for QI measurement purposes?

NR2%

Yes74%

No24%

Yes

No

No Response


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


Question 4:Are you currently conducting measurements that you consider not to

be useful or relevant?

No64%

Yes36%

No

Yes


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


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


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


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


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


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


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%


Role in Program

Pareto Charts

Flow Charts

Cause and Effect Analysis

QI Project Design

QI Project Selection

Statistical Process Control


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


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%


Role

Community Health Improvement

Follow up and outcomes

Discharge/referral/placement

Care related processes

Intake and triage

Access measures

Market/community awareness


Question 9Are QI activities hampered by inadequate access to computer

resources?

Yes38%

No62%

Yes, activities hampered No, activities not hampered


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


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


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


Question 11Do key staff and management have easy access to the Internet?

Yes81%

No19%

Yes

No


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


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


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


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


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


Question 16:Does your facility utilize clinical pathways for specific conditions?

No83%

Yes17%

Yes

No


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


Question 17:Do you routinely report and track operations and financial data through the QI

program?

No83%

Yes17%

Yes

No


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


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


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


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


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


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):


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


Question 23 "Target/vulnerable populations" prioritized:

(n=13)

11

13

0

2

4

6

8

10

12

14

Elderly Ethnic and minority Other


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

Kansas Rural Health Options Project Quality Improvement Committee CAH QI Survey Results Spring, 2002 Survey administered and analyzed, on behalf of KRHOP,

Documents

cah qi staff

qi measures

qi indicators

basic qi tools

cah respondents

responses slide

survey questions

cahs slide