3/12/2010

Management of Data
and Information for
Healthcare Quality
y Leaders
CPHHA Workshop
March 2010
AGI Consulting, LLC
USA

Men trip not on mountains, they trip on

stones. --- Hindustani Proverb

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Two parts
Statistics in Healthcare Quality
Quality tools
Tools for Collecting and Displaying of Data
Analysis tools: Tools for Making Improvements

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3/12/2010

STATISTICS
He uses statistics as a drunken man uses
lamp posts for support rather than
illumination.
Andrew Lang

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What Are Statistics?

Statistics = State Tools
Statistics = the science that deals with the
collection, classification, analysis, and
interpretation of numerical facts or
d t
dataand
d [[uses]] mathematical
th
ti l theories
th i off
probability to impose order and regularity on
aggregates of more or less disparate
elements.
Statistic = a numerical fact or datum, esp.
one computed from a sample
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Scientific Credibility
1.
2.
3.
4.

Dont base your decisions on one study.

Look for preponderance of evidence.
Expect independent confirmations.
Dont rely on secondhand summaries of
studies.
5. Use of universal languagescience first,
statistics second!
6. Similarity in reporting format.
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Hypotheses
The null hypothesis
The alternate hypothesis
What type of hypothesis is this:
There is no difference in taste between
Coke and Diet Coke.

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Steps of An Experiment
1.
2.
3
3.
4.
5.
6.

Study sample and study population

Experimental vs. Control groups
P t t establish
Pretest
t bli h b
baseline
li
Administer experiment effect
Posttest measures (based on pretest)
Statistical significance testing
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but remember, bad data will result in bad

information (GIGO)
also, data can be no more accurate than the
i t
instruments
t and
d th
the systems
t
used
d ffor
recording them and reporting them e.g.
infant mortality rates, export vs. import
quantities, and bushel measurements

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What Is Information?
knowledge gained through study,
communication, research, instruction,
etc
Information
I f
ti is
i a resultlt off processed
d data
d t

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The Sequence...
1.
2.
3.
4.
5.

Thought.
Data.
Information.
Knowledge.
Wisdom

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Types of Data
Parametric vs. NonNon-parametric
Nominal vs. Ordinal
Discrete vs. Continuous

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Sampling
Population vs. samples
Random vs. nonnon-random samples
Types of sampling:
Simple random
Stratified random
Systemic random

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Sample Size
Minimum sample size
Calculating sample size:
Quota sample
Convenient sample
Formula:
n=(z/e)2 p(1
p(1--p)

Sample power

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Surveying
Method

Telephone
Mail
Web
Interview

Questionnaire; validity and reliability

Response rate
Bias
Data processing; coding and QC
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Descriptive Statistics

Mean
Median
Mode
St d d D
Standard
Deviation
i ti ((computation
t ti off
dispersions)
Sigma=sq root of sum(xbar
sum(xbar--x)2/n
x)2/n--1

Ranges
Frequencies
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Relational Statistics
Relationships (two variables) tests
Parametric tests
Pearsons correlation

Non
Non--parametric
Spearman Ranks
Rank s correlation
Kendalls Tau

Measure of Reliability: Cronbachs

The Correlation Coefficient

Direction of Relationship
Statistical Significance
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Explanatory Statistics
Regression analysis:
Uses
Relationships
Linear
Non
N -linear
Nonli

Dependent and independent variables

Multivariate Linear Regression
Stepwise Regression
Logistic Regression (e.g. Logit, Probit, etc.)

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Interpreting Regression Analysis

The Model
R squared
F value
t value
Stat Significance
Refining the Model

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Inferential Statistics
Uses
Application
Parametric tests
t-test
ANOVA (F test)

Non
Non--Parametric tests
Chi Square
Others; KriskalKriskal-Wallis, MannMann-Whitney, Wilcoxon,
Friedman, Scheffe, etc.
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Measures of Validity
Sensitivity; a measure of true positive
Sn = a/a+c
Specificity; a measure of true negatives
Sp = d/b+d
Predictive Value; a measure of predicting
accuracy of a measure
Pv = a/a+b
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Test/
indicator

Disease/
problem

total

total

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Unplanned Quality
return to
issue
ER
yes

total

no

yes

15

10

25

no

70

75

total

20

80

100

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TOOLS IN HEALTHCARE QUALITY

Familiarity with the tools is crucial to
selecting the best ones
Sticking with the same set of tools to collect,
measure and present the same types of
data keeps it simple and tells a better story
Do not under estimate the value of
qualitative tools
Do not hide behind the tools
tools-----logic
logic goes a
long way
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HC Quality Tools 1/3

Tools for Collecting and Displaying of Data
Focus Groups
Surveys
Check
Ch k Sh
Sheets
t
Logs
Histograms
Pareto Charts
Trends and Run Charts
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HC Quality Tools 3/3

Tools for Making Improvements

Flowcharts
Brainstorming
Affinity Charts
Relationship Diagrams
Cause
Cause--and
and--Effect Diagrams
Force
Force--Field Diagrams
Decision Matrices
Prioritization tools
Tree Diagram
Tools for Action Planning
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Dead Horse Theory.

HOWEVER............ In healthcare, more advanced
strategies are often employed, such as:
1. Buying a stronger whip.
2. Changing riders.
3. Appointing a committee to study the horse.
4. Arranging visits to see how others ride dead
horses.
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Dead Horse Theory.

5. Lowering the standards so that dead horses can be
included.
6. Promoting the dead horse to a supervisory position.
g outside contractors to ride the dead horse.
7. Hiring
8. Harnessing several dead horses together to increase
speed.
9. Providing additional funding and/or training to increase
dead horse's performance.

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Dead Horse Theory.

10. Doing a productivity study to see if lighter riders would
improve the dead horse's performance.
11. Declaring that because a dead horse does not have to be
fed, it is: less costly, carries lower overhead and therefore
contributes substantially more to the bottom line of the
economy than do live horses.
12. Rewriting the expected performance requirements for all
horses.
13. Reclassifying the dead horse as living
living--impaired.

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References
Bauer, Jeffrey C. (2001). Statistical Analysis for decision
Makers in Healthcare,
Healthcare, HFMA, McGrawMcGraw-Hill: NY.
Ed.),,
Glantz, Stanton A. (2002). Primer of Biostatistics (5th Ed.)
McGraw--Hill: NY.
McGraw
GOAL/QPC (1994)
(1994). The
Th M
Memory JJogger,
Jogger, GAOL/QPC:
GAOL/QPC
Methuen, MA.
Leebov, Wendy; Ersoz, Clara J. (1991). The Health Care
Managers Guide to CQI,
CQI, AHA: Chicago.
Longo, Daniel R.; Bohr, Deborah (1991). Quantitative
Methods in Quality Management,
Management, AHA: Chicago.

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Leaders act decisively in the

absence of certainty.
--- Bertrand Russell

Any ???

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