Measurement is a key component of AIM. It helps healthcare providers understand the performance of their current system, identify the areas on which to focus attention, set goals for improvement and assess the results of changes made.
Measurement is important to a clinic as they work towards becoming more efficient and effective. In the short term, measurement assists by helping healthcare teams understand how their clinic or program is performing and identifies areas to focus on. As a result, teams are better able to set goals for improvement and assess the results of the changes made. In the long term, healthcare teams are able to collect a set of measures to demonstrate that the changes resulted in improved outcomes.
Prepare to Measure
AIM has developed a guide for practices that are considering embarking on a measurement journey. Our Practice Level Measurement Planning Template is intended to help you and your team members identify what data and measurement questions need to be asked at each step of the improvement journey.
Measurement for improvement usually means collecting just a few measures that are most relevant to the problem you’re trying to solve. This template should help you consider what information you might want to collect. If you’re having some trouble nailing down the right measures or just want to check in to see if they are most relevant for your problem, we’d be happy to connect with you.
What to Measure
Below are some terms for you to be aware of when starting to measure data in your clinic or practice.
Delay measures track the amount of backlog and/or the amount of future available capacity of the healthcare team. The most basic measure of access is the number of calendar days to the third next available (TNA) appointment. The third next available appointment is used, rather than the first or second, because it is a better reflection of system availability; the first or second next available appointment may be available due to a cancellation or some other event. Delay measures provide feedback on the amount of time a patient has to wait to see the provider and is also a measure of the success of backlog reduction.
Demand refers to the number of appointments booked for “today,” regardless of when the appointment (calls, fax, email, walk in, squeeze in, follow-up, etc) will occur. Demand measures provide information on how patients are accessing the system and better enable clinics to match supply with demand.
Supply is a measure of provider capacity or availability, or simply, the number of hours that members of the healthcare team are available each day to see patients. Supply measures provide information on the planned number of appointment slots each provider has to supply and is used to look at the balance between supply and demand.
Activity is a retrospective measure of the number of appointment slots actually used during the day. Activity measures provide information on how many appointments slots were completed each day.
Panel size refers to the number of unique patients for whom a provider is accountable. Panel size provides information about which patients and providers have a relationship. This measure helps the practice anticipate demand.
Caseload is the term used in specialty care to describe the number of patients for whom the provider is responsible. Caseload size is an important tool for anticipating demand. This is a measure of how the new patients are divided. The goal is to achieve an equitable distribution between providers.
Continuity is a measure of how often that a patient sees their own provider when receiving care. Improvements in continuity lead to better patient outcomes, increased patient and provider satisfaction, decreased demand, decreased return visit rates and lower no show rates.
No shows refer to the number of scheduled appointments for which patients fail to appear. No shows contribute to wasted appointment supply, non-productive provider and staff time, and additional work required to reschedule the visit.
Cycle time is the time from when a patient enters the office or clinic until the patient leaves. Cycle time measures provide information on office efficiency and patient flow, as well as the delay the patient experiences during the office visit.
AIM Online Measurement Tool
The OMT enables providers and their teams to use relevant and current data in an easy, meaningful way so they can accurately assess if changes applied in the practice actually result in an improvement. Healthcare improvement teams can use this tool to easily and conveniently enter, save and analyze clinic data while clearly tracking their clinic’s progress.
Signing on to the tool eliminates the need for paper-based measurement tracking, hence offering PCN staff the ability to offer streamlined data collection and transfer for member practices. This can then be exported into a PCN data file, or directly reported out of the online tool. As such, PCNs can be confident they have reliable data sources for internal measurement and evaluation activities related to business planning, medical home action planning or any quality improvement initiative.
For instructions on how to use the OMT, click here to access the OMT Manual.
If you are experiencing any technical issues accessing the Online Measurement Tool, please contact firstname.lastname@example.org for assistance.
Panel/Caseload Identification Tool
This tool is crafted for discovery—to compare what we think is going on to what is actually going on. The goal is to match supply and demand while reducing variation. It is available within the Online Measurement Tool, or for those without access, click here to download the template (Microsoft Excel required).
Care Team Workload Analysis Tool
This tool helps identify how much time staff are spending on activities. It can show where potential improvements in office efficiency may be possible. Click here to download the template (Microsoft Excel required).
Why is measurement important?
Understanding what is important to you, your staff and patients, as well as your practice, is essential for good measurement. Successful measurement is the foundation to achieving what matters to you. Measuring what matters is necessary for successful improvement. Measurement doesn’t have to be difficult or time-consuming. The key is to pick the right measurements, so that you can see results quickly and adapt your interventions accordingly, putting less strain on resources and more focus on outcomes. Our team can help you create a measurement plan and guide you to measure what matters so you can achieve your goals.
What does the Online Measurement Tool (OMT) do?
The OMT enables providers and their teams to use relevant and current data in an easy, meaningful way so they can accurately assess if changes applied in the practice actually result in an improvement. Healthcare improvement teams can use this tool to easily and conveniently enter, save and analyze clinic data while clearly tracking their clinic’s progress. PCNs can use it to support collection and reporting of third next available (TNA) appointment. This can help get a sense of where member practices are at to support priority setting around access improvements.
What is Third Next Available (TNA)?
The third next available (TNA) appointment is a measure of the delay your patients experience in accessing providers for a scheduled appointment. The TNA appointment is considered a more accurate system measure of access than the “next available” appointment since the next or even the second next available appointment may have become available due to a cancellation or other event that is not predictable or reliable.
Why measure third next available (TNA) appointment instead of first next available appointment?
The third next available appointment is used, rather than the first or second, because it is a better reflection of system availability, since the first or second next available appointment may be available due to a cancellation or some other event (ie, uncontrollable variability).
Why measure demand today?
When compared with supply of appointments, demand for appointments can help determine whether providers have more work than they can reasonably manage, or whether they have excess capacity. It also helps teams decide which change strategies to test first. For example, if demand is clearly greater than supply, providers might use strategies to reduce demand before attempting the difficult work of backlog reduction.
How often do you measure cycle time?
Strive to collect a representative sample for each provider for each weekday. An example of a representative sample may look like the following:
- 1st appointment of the day
- Last appointment of the morning (patient before lunch)
- 1st appointment of the afternoon (patient after lunch)
- Last appointment of the day