BUILDING MEASUREMENT AND DATA-COLLECTION INTO MEDICAL-PRACTICE

Clinicians can use data to improve daily clinical practice. This paper offers eight principles for using data to support improvement in busy clinical settings: 1) seek usefulness, not perfection, in the measure ment; 2) use a balanced set of process, outcome, and cost measures; 3) keep measurement simple (think big, but start small); 4) use qualitat ive and quantitative data; 5) write down the operational definitions o f measures; 6) measure small, representative samples; 7) build measure ment into daily work; and 8) develop a measurement team.The following approaches to using data for improvement are recommended. First, begin with curiosity about outcomes or a need to improve results. Second, t ry to avoid knee-jerk, obstructive criticism of proposed measurements. Instead, propose solutions that are practical, goal-oriented, and goo d enough to start with. Third, gather baseline data on a small sample and check the findings. Fourth, try to change and improve the delivery process while gathering data. Fifth, plot results over time and analy ze them by using a control charter other graphical method. Sixth, refi ne your understanding of variation in processes and outcomes by dividi ng patients into clinically homogeneous subgroups (stratification) and analyzing the results separately for each subgroup. Finally, make fur ther changes while measuring key outcomes, over time. Measurement and improvement are intertwined; it is impossible to make improvements wit hout measurement. Measuring and learning from each patient and using t he information gleaned to test improvements can become part of daily m edical practice in local settings.