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In his preface to the new Joint Commission book Managing Performance Measurement Data in Health Care, Jerod Loeb, PhD, vice president of research and performance measurement at the Joint Commission on Accreditation of Health-care Organizations (JCAHO), says that while there are a "plethora of publications" available covering the basics on statistical analysis, and plenty of tomes on performance improvement, there are few that bring the subjects together.
"Within health care today," he says, "the measurement of performance is a given. Organizations devote significant resources to the very act of measurement, but too often, measurement itself is the sole goal."
Loeb tells Healthcare Benchmarks it is "abundantly clear" that health care organizations aren’t doing a good job at managing their data. "We are good at collecting them. We have financial, utilization, and clinical data in spades. But we aren’t good at turning them into information. That translational process is complex, and is one that is somehow filled with mystique, and requires some grounding among individuals in health care. . . . We collect data, but we don’t turn them into information. Or we turn it into information, but we don’t turn that information into change. Or if the data don’t fit some preconceived notion you have, you justify them."
For instance, a physician will discount data by saying his patients are sicker. "It can be a data-be-damned attitude."
Health care has waited too long to understand and utilize the tools that are available in other sectors, most notably in manufacturing, Loeb says. Thus the need for a book such as this. "That is the driving rationale behind why we think it’s so important for a book like this to be available."
The book offers chapters on how to collect data, tools for data analysis, and statistical analysis of performance measurement data. All of the chapters are written by health care experts. Particularly useful are the five case studies in the final chapter. They cover the entire continuum of health care, from hospital and health network, to skilled nursing facility, home health care, and behavioral health.
"Problem-based learning" has been an approach that has proven its worth over the years in health care. "We can find a situation that we can relate to and learn from," he says, but warns readers to not skip the first chapters covering the basics and only try to digest the information from the cast studies.
"You have to have some elemental education to gain useful information from the case studies," he says. "You have to know the ingredient list before you bake a cake."
Along with getting a basic education in information management, Loeb says there are some key steps that health care organizations should take to improve their performance in this area.
"First, be sure you are collecting data in the same manner each time. Then, be sure that you are comparing yourself against yourself over time. That will reduce the ability for some to discount data by stating his or her patients are sicker. Over time, it all evens out."
Make sure you also compare yourself against others, Loeb says, but be careful to determine if definitions of data are the same. In a cesarian section, for instance, one organization might define all nonvaginal births as their cesarian rate, while others may define it as something else, for instance, the cesarian number minus the number of VBAC trials.
"We found 17 different ways to define C-section," he says.
Lastly, don’t get too hung up in the dirty details of statistics. "Not every QI nurse needs to know how to plot a P chart," Loeb says. "That’s why we have statisticians."
The purpose of the book, he says, is to provide basic information and point people on the right path. "We need to get everyone on the train: We have to measure, manage, mine, and then do something with the information."
[For more information, contact:
• Jerod Loeb, PhD, vice president, research and performance measurement, Joint Commission on Accreditation of Healthcare Organizations, One Renaissance Blvd., Oakbrook Terrace, IL 60181
For more on the book or to order, visit www.jcaho.org.]