1. Johnson, Eileen RN, BC, MSN, Reviewer

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MANAGING PERFORMANCE MEASUREMENT DATA IN HEALTH CARE Joint Commission Resources, Inc., a nonprofit subsidiary of JCAHO Joint Commission on Accreditation of Healthcare Organizations One Renaissance Boulevard Oakbrook Terrace, IL 60181 Telephone: 1-877-223-6866 E-mail: Web: ISBN: 0-86688-693-1 Price: $55


The primary goal of Managing Performance Measurement Data in Health Care, as defined in the Introduction, is to help readers collect, analyze, display, and use data more effectively. The premise is that although many books have addressed one or more of these functions of data management, there is not a resource that addresses all. This book is an attempt to fill that gap.


This is a Joint Commission on Accreditation of Healthcare Organizations (JCAHO) resource. Therefore, the examples, language, and tone all are very much a reflection of that organization. Similarly, because JCAHO is an organization that accredits healthcare organizations in the United States, the book is very much geared to US audiences. With JCAHO bias recognized, much of the general information, suggestions, and other content are applicable across cultures and types of healthcare organizations.


The authors assume that all facilities use a performance improvement model for improvement. If that assumption is accepted, chapter 1 provides a good overview of the general principles of data management from within that framework. The chapter includes an overview of data collection and analysis and defines the concept of performance improvement. It has a very good section on the various goals of data management that might be established by a healthcare organization. This section addresses both the clinical and nonclinical outcomes and processes that should be addressed in a data management system.


Chapter 2 deals a little more with the "nuts and bolts" of the data management process. This chapter specifically addresses the uses of organizational data: priority setting, evaluation of data, identification of expected results, and creation of teams that reflect how the data will be collected and used. The section on teams and team building was an especially effective portion of this chapter.


Chapter 3 addresses the data collection portion of the data management process. Although much of the general information is applicable to anyone in any setting, this chapter has an abundance of ORYX tips applicable only for facilities submitting that information to JCAHO. Despite the continued relevance of the ORYX tips for the facilities still submitting that data, most acute care facilities have transitioned to the core measures initiative. Therefore, these references to ORYX seem somewhat outdated for many organizations. The section on documenting the data collection plan is a short discussion that should be required reading for all quality directors and informatics specialists. This section recommends "parsimonious data collection," in essence, charting of all the data currently being collected, recording who is collecting the data and from what sources, and documenting why the data are being collected. The primary aim of this exercise is to combat the data-rich, information-poor (DRIP) environment and waste in many organizations by identifying the data being collected "because we always have" and the data being collected by multiple people in different silos. At first blush, this chapter seems to be the most JCAHO-specific. However, many of the general ideas presented make this chapter one of the most potentially helpful for any organization.


Chapter 4 includes a broad discussion of tools for the data analysis process. This chapter includes a good discussion about the refinement of raw data into information through the use of basic tools. These tools include process control tools such as flowcharts, cause-and-effect diagrams, brainstorming, critical pathways, control charts, Pareto charts, and scatter diagrams. The chapter provides a short, concise description of many of the common tools and provides a good reference list for a reader wanting more specific information on some of the tools. A basic list of quality improvement journals and newsletters is included with mailing addresses, Web sites, and e-mail addresses. Although this information and the information on the Malcolm Baldridge Quality Award seemed somewhat out of place in this chapter, it might be helpful information to have.


For readers with little experience in statistical analysis, chapter 5 provides a good, basic introduction to the statistics most often used for JCAHO data analysis. The instructions for building charts without the aid of a statistical program are clear and to the point, and the examples given are helpful. However, for readers requiring more in-depth information on statistical analysis, there are better resources.


The case studies in chapter 6 are examples of how facilities have used data for process improvement in healthcare. These real-life examples of the data management process are perhaps the most useful component of the book because they tend to pull together some of the principles mentioned in earlier chapters. The Case Study exercises in Appendix A, on the other hand, did little to clarify any of the preceding information. It would have been helpful to have exercises included that are more than simple fill-in-the-blank sentences. Facilities anticipating a JCAHO survey will find Appendix B (How Joint Commission Surveyors Will Use ORYX Data) helpful. Included in these few pages are samples of questions that might be asked about the data management process in a facility. Although the questions are specific to the ORYX process, they can be generalized easily to any data management process to assess the effectiveness of that process.


This book would be a good resource for anyone looking for a primer on what JCAHO is looking for in a data management plan. The editors have limited the usefulness of much of the book for many users by using ORYX-specific references. Given this limitation, Managing Performance Measurement Data in Health Care would be a good starting point for anyone unfamiliar with the concept of data management. Although the book does succeed in its goal of providing a wide scope of information in one book, individuals requiring more than a basic knowledge of the data management process probably would be better served using other resources.


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