Scenario:

I am designing an Alzheimer’s disease Intervention

Intended to provide evidence-based interventions to a population of patients with Alzheimer’s disease

Care to be delivered by a multidisciplinary team working with the client’s PCP

The PCP’s are incentivized with a P4P program

Intended outcomes include an array of clinical variables as well as client and family satisfaction

Program, although initially grant-funded, must be self-sustaining

I have arbitrarily defined two key processes in the program and using a SIPOC diagram, identified inputs and outputs and then some process and outcome measures for each process:

Quarter 1 Data:

Outcome data for the:

Intake Process-

Percentage of Potential Clients in the Health Plan Who are Enrolled:

Month / Value / Median
January / 2% / 0.125
February / 5% / 0.125
March / 10% / 0.125

Percentage of Physicians Enrolled in P4P:

Month / Value / Median
January / 2% / 0.075
February / 5% / 0.075
March / 7% / 0.075

Intervention Process-

Functional Performance Score:

Month / Value / Median
January / 25% / 0.28
February / 28% / 0.28
March / 32% / 0.28

Days Between ED Visits:

Month / Value / Median
January / 23.0 / 23
February / 20.0 / 23
March / 25.0 / 23

Client and Family Satisfaction:

Month / Value / Median
January / 98% / 0.825
February / 90% / 0.825
March / 90% / 0.825

Create a separate run chart for each of the outcome measures using the Generic Run Chart template.

1-Before using the template, open a new workbook by clicking on the “new” icon in the upper left corner of Excel. You will use this new workbook as a place to paste each run chart after it is created.

2-Minimize the new workbook

3-Starting with the first set of outcome data (Percentage of potential clients in the health plan who are enrolled), enter the results into the “value column”, starting at the top (January).

4-The template will create a run chart with the data points and a median.

5-Copy the chart and paste onto Sheet 1 of the blank workbook you opened and minimized in steps 1 and 2. Do so by right-clicking in the chart and then left clicking on “copy” in the menu box that appears. Maximize the blank workbook and paste the chart onto Sheet 1 of the new workbook by right clicking on that page and clicking on paste in the dialog box that appears.

6-Once the chart is copied label it with the name of the chart supplied above with each data set.

7- Repeat the process for all of the quarter 1 outcome data and review the findings.

Be prepared to discuss the meaning of the data and any interventions you might think are needed. Discuss with the group.

Let’s fast-forward to quarter 3.

Here are data for Q1-Q3:

Outcome Data for the:

Intake Process-

Percentage of Potential Clients in the Health Plan Who are Enrolled:

Month / Value
January / 2%
February / 5%
March / 10%
April / 15%
May / 20%
June / 20%
July / 25%
August / 30%
September / 30%

Percentage of Physicians Enrolled in P4P:

Month / Value
January / 2%
February / 5%
March / 7%
April / 8%
May / 10%
June / 10%
July / 15%
August / 18%
September / 18%

Intervention Process-

Functional performance Score:

Month / Value
January / 25%
February / 28%
March / 32%
April / 48%
May / 50%
June / 50%
July / 52%
August / 48%
September / 50%

Days Between ED Visits:

Month / Value
January / 23
February / 20
March / 25
April / 28
May / 30
June / 32
July / 35
August / 38
September / 35

Client and Family Satisfaction:

Month / Value
January / 98%
February / 90%
March / 90%
April / 85%
May / 80%
June / 80%
July / 75%
August / 70%
September / 70%

Now let’s look at some process measures for the

Intake process:

Agreement to Participate (Percent of Clients Solicited)

Month / Value
January / 85%
February / 88%
March / 82%
April / 90%
May / 90%
June / 95%
July / 93%
August / 95%
September / 95%

Days between Agreement and Evaluation:

Month / Value
January / 10
February / 12
March / 11
April / 23
May / 22
June / 25
July / 24
August / 22
September / 23

Days Between Evaluation and First team Visit:

Month / Value
January / 10
February / 12
March / 15
April / 13
May / 10
June / 13
July / 14
August / 15
September / 14

And the process measures for the Intervention Process-

Percentage of Patients Withdrawing:

Month / Value
January / 1%
February / 5%
March / 6%
April / 8%
May / 9%
June / 10%
July / 9%
August / 12%
September / 10%

Participants whose Cases Are reviewed Monthly:

Month / Value
January / 100%
February / 100%
March / 92%
April / 95%
May / 87%
June / 85%
July / 86%
August / 88%
September / 83%

Please create run charts for the Q1-Q3 outcome and process measures, following the above steps 1 through 7. Paste the outcome measures on Sheet 2 of the “blank” workbook and the process measures on sheet 3.

Review the charts:

Use the run chart rules in your slide handout titled “Practical Exercise” and determine the charts reveal random variation or if there has been special cause change. If there is real change, what story might the data be telling and is there need to improve a process?

Be prepared to discuss your observations.