title: How to Measure and Interpret Quality Improvement Data.
abstract: This article will demonstrate how to conduct a quality improvement project using the change idea generated in "How To Use Quality Improvement Tools in Clinical Practice: How To Diagnose Solutions to a Quality of Care Problem" by Dr. Ziv Harel and colleagues in this Moving Points feature. This change idea involves the introduction of a nurse educator into a CKD clinic with a goal of increasing rates of patients performing dialysis independently at home (home hemodialysis or peritoneal dialysis). Using this example, we will illustrate a Plan-Do-Study-Act (PDSA) cycle in action and highlight the principles of rapid cycle change methodology. We will then discuss the selection of outcome, process, and balancing measures, and the practicalities of collecting these data in the clinic environment. We will also introduce the PDSA worksheet as a practical way to oversee the progress of a quality improvement project. Finally, we will demonstrate how run charts are used to visually illustrate improvement in real time, and how this information can be used to validate achievement, respond appropriately to challenges the project may encounter, and prove the significance of results. This article aims to provide readers with a clear and practical framework upon which to trial their own ideas for quality improvement in the clinical setting.
authors.affiliation: Division of Nephrology, University Health Network-Toronto General Hospital.
authors.forename: Rory Francis
authors.initials: RF
authors.lastname: McQuillan
authors.affiliation: Division of Nephrology, St. Michael's Hospital.
authors.forename: Samuel Adam
authors.initials: SA
authors.lastname: Silver
authors.affiliation: Division of Nephrology, St. Michael's Hospital.|Keenan Research Center, Li Ka Shing Knowledge Institute of St Michael's Hospital.
authors.forename: Ziv
authors.initials: Z
authors.lastname: Harel
authors.affiliation: Division of Gastroenterology, Mount Sinai Hospital.
authors.forename: Adam
authors.initials: A
authors.lastname: Weizman
authors.affiliation: Division of Nephrology, St. Michael's Hospital.
authors.forename: Alison
authors.initials: A
authors.lastname: Thomas
authors.affiliation: Institute of Health Policy, Management, and Evaluation, and.|Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Chaim
authors.initials: C
authors.lastname: Bell
authors.affiliation: Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.affiliation: Division of Nephrology, University Health Network-Toronto General Hospital.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Chan
authors.affiliation: Keenan Research Center, Li Ka Shing Knowledge Institute of St Michael's Hospital.|Department of Nephrology, Humber River Regional Hospital, Toronto, Ontario, Canada.
authors.forename: Gihad
authors.initials: G
authors.lastname: Nesrallah
mesh_terms: D006437:Hemodialysis, Home; D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D010353:Patient Education as Topic; D058996:Quality Improvement / Q000458:organization & administration* / Q000706:statistics & numerical data
keywords: Ambulatory Care Facilities; Chronic; Goals; Home Dialysis; Humans; Model for Improvement; Quality Improvement; Renal Insufficiency; Run chart; peritoneal dialysis; renal dialysis