How to Measure and Interpret Quality Improvement Data

Abstract

This article will demonstrate how to conduct a quality improvement project using the change idea generated in "How To Use Quality Improvement Tools in Clinical Practice: How To Diagnose Solutions to a Quality of Care Problem" by Dr. Ziv Harel and colleagues in this Moving Points feature. This change idea involves the introduction of a nurse educator into a CKD clinic with a goal of increasing rates of patients performing dialysis independently at home (home hemodialysis or peritoneal dialysis). Using this example, we will illustrate a Plan-Do-Study-Act (PDSA) cycle in action and highlight the principles of rapid cycle change methodology. We will then discuss the selection of outcome, process, and balancing measures, and the practicalities of collecting these data in the clinic environment. We will also introduce the PDSA worksheet as a practical way to oversee the progress of a quality improvement project. Finally, we will demonstrate how run charts are used to visually illustrate improvement in real time, and how this information can be used to validate achievement, respond appropriately to challenges the project may encounter, and prove the significance of results. This article aims to provide readers with a clear and practical framework upon which to trial their own ideas for quality improvement in the clinical setting.

Keywords: Ambulatory Care Facilities; Chronic; Goals; Home Dialysis; Humans; Model for Improvement; Quality Improvement; Renal Insufficiency; Run chart; peritoneal dialysis; renal dialysis.

Figure 1.

Rapid cycle change. Multiple PDSA cycles may be required in building from a change idea to a tangible result. PDSA, Plan–Do–Study–Act.

Figure 2.

PDSA worksheet for testing change, as suggested by The Institute for Healthcare Improvement.

Figure 3.

Run chart showing the effect of introducing a nurse educator on the proportion of new referrals to a clinic being evaluated for home dialysis suitability. PDSA, Plan–Do–Study–Act.

Figure 4.

The rules of run chart for determining nonrandom change. (A) Shift: six or more consecutive points lying on one side of the median. (B) Trend: five or more consecutive points either ascending or descending. (C) Run: either too few or too many crossings of the median line. (D) (see shaded areas) Astronomical point: a point on the graph that subjectively appears out of keeping with others (shaded areas).