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Criteria for Selecting Target Outcomes for the Process-of-Care Investigation
1.Statistically significant outcome differences
It is best to select only outcomes with statistically significant differences between groups for the subsequent investigation of care provision. It is recommended a level of .10 be used except under extenuating circumstances.
If more than three outcomes show significant differences, additional criteria should be applied to narrow the target outcomes to a maximum number of two or three.
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.Larger magnitude of the outcome differences
The magnitude of the differences is assessed by reviewing the actual percentage of patients achieving the outcome in both the current and reference groups.
For example, an outcome difference of two percentage points between groups in terms of hospitalization rates, although possibly statistically significant if sample sizes are large enough, is not as important as a difference of 10 or more percentage points.
Similarly, even if both are statistically significant, an outcome difference of three percentage points for one measure may be more important to an agency than others Improvement in transfers vs. Improvement in shopping.
.Adequate number of cases
At least 0 eligible cases should be represented
4.The actual significance levels of the differences
If an outcome report has no statistically significant differences at the 0.10 level, be aware that the actual significance level is important.
Don't choose a target outcome whose differences are at levels greater than .5; it is simply too probable that there really is no underlying difference between the agency and the comparison population.
5.Importance or relevance to our agency's goals
Review our goals for our program and QI program. What do we want? Do we have a high number of wound care patients? Are we looking at new programs? Are we looking at improving functional status of our patients?
6.Clinical significance
If the outcome difference points to potentially serious clinical problems in quality of care, these outcomes have important clinical ramifications for immediate remediation.
It may also be that the clinical focus is on caring for certain types of patients because of payer mix, the community served, or the nature of referrals.
Depending on the case mix, the agency can focus on specific outcomes perceived to be important for dominant patient types.
Apply the criteria in the order listed above. Statistical significance is a necessary condition for selecting target outcomes. Only in those instances where no outcome differences are statistically significant should an agency pass directly to other criteria in choosing its target outcomes for further investigation. Even in this case, the agency should always examine significance levels and attempt to select as target outcomes those significance levels that are smaller (closer to .10). Focus on large differences rather than small ones. Be sure that at least 0 cases are included in the outcome computation for a potential target outcome. If it appears that a serious problem exists in terms of a particular outcome being markedly inferior, this outcome clearly should be chosen as a target outcome assuming the difference is statistically significant.
Do we select a target outcome from the descriptive or the risk-adjusted sections of the outcome report? Select from either section as long as you follow the criteria above. Because risk adjustment has not been done for the 1 outcomes included in the descriptive report, some additional care will be required when selecting cases for further investigation. There is no reason to exclude these thaough.
What's next? Managers should share the reports with staff as well as the selection of target outcomes and why those were chosen.
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