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Home Healthcare, Hospice, and Information Technology Innovations Conference

Innovations in Home Healthcare, Hospice, and Information Technology

A forum towards achieving evidence-based diffusion and implementation of innovations

Fri, Nov 3, 2017
Friday, Nov 3, 2017, Washington - D.C.
H3IT: Home Healthcare, Hospice, and Information Technology Conference Chicago, IL, 2016
Measure, Share, Improve: Using Performance
Dashboards to Impact Home Health Documentation
Times and Quality
Juanita Gross, Cheryl Adams, Mark A Bassett
n the fall of 2014 a pilot project was initiated at Sparta Community Hospital (Sparta, IL) to study the impact
of a new clinical dashboard that displays timely performance measurements for its eld clinicians. Recognizing
that “you can’t improve what you don’t measure” the organization worked with its home care software vendor
to develop a new tool for capturing and displaying key performance indicators, like the percentage of TP9
(discharge) visit notes as well as regular visits notes completed during the visit. The results were dramatic: Sparta’s home
health agency increased the rate of in-home completion of regular visit notes by more than 35% (from 60% to over 95%).
Moreover, they reported a marked improvement in documentation quality, including a signicantly lower error rate during
the plan of care process. And these were not short-lived gains. Sparta’s improvements in the timeliness and accuracy of
their home health documentation have been lasting (> 2 years). In essence, they have set a “new normal” and established a
signicantly higher baseline for quality, accuracy, and timeliness that has made them one of the top-performing agencies in
their region. Upon learning about these results, SwedishAmerican (Rockford, IL) agreed to participate in a follow-up study
to validate the impact of real-time clinical dashboards on clinician performance. This expanded study focuses on an agency
with more than 5,000 regular visits per quarter, with a current completion rate of end-of-day-shift documentation near 68%.
Methods: Swedish-American will discuss with its sta its desire to improve in-shift visit note documentation rates as a means
of improving quality and clinician job satisfaction. Four pairs of clinicians, each with similar documentation completion rates,
will participate in a blind study with a control group. Under the guise that they are testing a software update, one clinician
from each pair will have access to a web-based dashboard displaying their current performance results. The rates of in-shift
documentation completion will be calculated on a weekly basis through the acquisition and analysis of visit metadata, and
transferred to a dashboard that renders overall agency results as well as individual performance results for the four clinician
test subjects. The results will be compared between the partners in each cohort/pair to determine if the mere presence of a
performance dashboard improves their in-shift documentation completion rate.
Results: As in the pilot study, we expect to see measurable, statistically-signicant improvements in performance even
amongst the clinicians without dashboards, as a result of the Hawthorne Eect (also known as the “observer eect”) wherein
improvements in performance result simply because the individuals know their performance is being observed. We will also
compare performance improvements between those with access to performance dashboards and those without access to this
data. The study duration will be one calendar quarter (three months), after which time the dashboards will be adopted by
all clinicians. Improvements in documentation timeliness and quality will continue to be measured after completion of the
ocial study.
Conclusion: Improving quality and eciency requires rst measuring what you wish to improve, then sharing the data with
those in a position to aect the improvement. This study aims to validate positive preliminary ndings that suggest signicant
quality and eciency gains are possible when home care eld clinicians’ have access to timely personal and organizational
performance data. Data from both studies will b e presented along with conclusions about the value and impact of real-time
performance feedback on performance improvement.
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