Take a snapshot of case management's results with internal report cards
Try benchmarking against yourself
Internal report cards can give you a picture of case management's impact on patient care with a single snapshot of outcomes data, including morbidity and mortality rates, patient satisfaction data, costs, charges, length of stay (LOS), and productivity rates.
"Case managers need this information in a central location to ensure that they are monitoring all of the areas they need to be monitoring. These areas should be monitored on an ongoing basis as frequently as possible to spot trends and patterns," says Judy Homa-Lowry, RN, BS, CPHQ, director of quality improvement for The Delta Group in Greenville, SC, who works out of Canton, MI.
Report cards also can be used to prove case management's effectiveness to administration and managed care companies, she explains. (For more information on what managed care companies may look for in a hospital report card, see the related story, p. 82.)
"Internal report cards are a way to look at how you're performing in your organization," Homa-Lowry continues. "As a result of that, these data should drive the areas for performance improvement and also the selection of your pathways, product lines, and DRGs. Most hospitals have a lot of data, but they never centralize it, so the case manager is going to a number of places to look at items."
Salem (OR) Hospital is using an internal report card to enhance case management procedures. For example, the internal report card enables the staff to detect variances in charges more quickly, says Jill Jackson, director of quality review, who has been spearheading the 6-month-old project.
While preparing a report for a medical staff department meeting, Jackson noticed a wide variance in surgery charges for a particular case. The figure "should have been in a range of $4,000 to $6,000; instead, it was down to $2,000. We did a quality control check and discovered that we had never billed for that surgery. So we were able to present the data and say, 'This variance is due to X,'" Jackson says.
As with critical paths, internal report cards come in many formats, and there are many ways to design this type of tool. "You may have a section addressing mortality and a section addressing morbidity. Each product line or DRG can then be categorized by each month. You also can design report cards by product line if you want to look for data specifically for surgery or cardiology, for example," Homa-Lowry says.
"I have [the data] broken down into service quality areas, for example, and categorized by four quarters. This way I can look at my patient satisfaction overall, employee satisfaction, visitor injuries, patient falls, emergency department incidents, and visitor complaints," says Mary Jo Brinkman, MA, CPHQ, performance improvement director for Crawford Memorial Hospital in Van Buren, AR.
Internal comparisons work well
Brinkman uses a performance improvement and risk management report card. For comparison purposes, Brinkman uses data from the previous year as her benchmark, "so we are comparing ourselves to ourselves," she adds. (To see what kind of information is included in the internal report card, see the Dashboard Report, p. 83.)
In addition to the service quality areas included in Brinkman's five-page report card, other areas in which data are collected and reviewed include:
* utilization of services;
* safety/risk management issues;
* human resources;
* health records;
* clinical outcomes;
* blood utilization;
* operative/invasive procedures;
* medication usage.
A space is included at the bottom of the last page of the report for updated documentation regarding pathway development, continuous quality improvement (CQI) team developments, preparation status for the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations' survey, and other significant issues.
"It's a good report card that covers a lot of different areas. I include comments under each service quality area that explain where we have improved each quarter or areas that we are working on. Our case managers use this information to monitor patient care problems and to help determine what needs to be incorporated into a case map," Brinkman explains.
Case managers who have developed internal report cards offer the following advice to consider before developing your own internal tools:
* Form a small steering committee.
Jackson first convened a small steering group to determine which data needed to be included in her reports and to set standard definitions. "Our CEO wanted us to have a point person that all data are cleared through. We do not allow any data to be given to our physicians without it going through that one point of reference," Jackson explains.
In addition to Jackson, the committee includes one staff member each from medical records, quality review, and information systems. Keeping the group small allows for better control and consistency, Jackson adds.
Brinkman works with a CQI leadership committee composed of administration and physicians. Brinkman's reports are submitted quarterly to the executive committee of the medical staff and then to the medical staff meeting, and ultimately to the board of trustees.
* Define your data.
In the early stages of developing the report card, Jackson explains that data often were misinterpreted. "It was good data, but the person analyzing it didn't understand it," she says.
Make sure that you have clearly defined what type of data you are asking for, Homa-Lowry warns. "If you get data from other people internally, or externally, you better make sure that they are describing complications the same way you are, so that it is consistently used."
Also check existing computer information systems within the hospital before including data from those systems. Multiple software programs available in the hospital "can give you the same title of what you are asking for, but it is not the same data," Homa-Lowry warns.
* Determine your outcomes.
Before you can begin collecting data, you must first determine what the expected outcomes will be, says Jackson. "The hardest thing for many people to do is to understand what their expected outcome should be," she explains.
Yet most case managers already know how to determine appropriate outcomes -- it's just a matter of transferring that skill. "When writing a pathway, you really have to know your end product because you can write a pathway when your end product should be three days length of stay, and if you don't know that to start with, your pathway may give you six days," says Jackson. *
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content