QUALITY OF CARE

Drilling Down Data to Understand Barriers to Care

Looking Behind Numbers to Improve Care in Your Clinic

March 2015

Prioritization Strategies

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To most effectively target your resources to those in need, consider prioritizing follow-up interventions by clinical information, patient characteristics, and service utilization. For example, you can assess by the following factors:

Viral load. Using the most recent viral load measurements on record, calculate the average viral load among all patients experiencing each barrier. The highest average viral loads can be used to help your facility identify the patients and barriers on which to focus. Keep in mind that one patient with an abnormally high viral load can skew the average. Be sure to closely examine the data to evaluate whether clinic-wide or individualized interventions will be most appropriate.

Key populations. Assessing problems by subpopulations (men who have sex with men (MSM), women, transgender populations, injection drug users, sex workers, those with unstable housing, prisoners, etc.) can help identify groups most in need of interventions and can help you design the most appropriate interventions for each population.

Those with frequent hospital and emergency department use. Identifying reasons why individuals frequently use hospital and emergency department resources in place of routine medical visits can help engage these patients in your clinic and ensure that resources are used efficiently.

Examples:

Prioritizing by Average Viral Load
Barrier No. of Patients Avg. Viral Load
(copies/mL)
Transportation 10 290 
Housing Instability 4 1,580
Insurance 1 74
Disclosure Issues 13 5,439
Refuses Treatment 1 30,982
Identifying Barriers to Retention Among MSM 
Barrier No. of Patients
Transportation 4
Housing Instability 6
Insurance 1
Disclosure Issues 11
Refuses Treatment 1

What is Drilling Down Data?

Drilling down data is a process of analyzing your patient care data in increasing detail to understand who is meeting performance measures and who is not. Through this process, key patient populations in need of attention and the barriers most relevant to these populations can be identified, which enables you to design population-specific and individual patient-specific interventions while efficiently targeting your resources.

By focusing on those patients most in need and tailoring follow-up activities to best meet those needs, your clinic will be more likely to achieve improvement and use resources wisely. Reaching out to patients in a way that meets their specific needs can foster ongoing relationships that improve overall engagement in care.

Four Main Steps to Drilling Down Data

  1. Develop a list of patients who do not meet the defined criteria of your measure.
  2. Identify reasons each patient does not meet the criteria.
  3. Tally the reasons.
  4. Develop targeted plans to address the most common or relevant issues.

Why Drill Down Data?

Data can reveal important information about barriers to care experienced by your patient population. With simple analysis of your data, you can identify areas for improvement and develop targeted plans to address those areas. In the following panels, a step-by-step method of drilling down your data is presented. This process can be used for any measure of patient care, but retention is the example used throughout this brochure.

Engaging your multidisciplinary team to regularly collect and drill down data is the most effective way to elucidate the reasons why standards are not met in specified populations and to develop follow-up plans. This team may include physicians, case managers, nurses, social workers, pharmacists, peer navigators, the data team, or any other clinic staff involved in providing care for the patient. Regular (e.g., weekly, monthly, or quarterly) team meetings for case review should occur to maintain involvement of all team members, share information and patient status updates, and identify areas for improvement.

Four Steps to Drilling Down Data

Example: Assessing Patient Retention

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Helpful Tips and Resources

Tips

Designate a person or team to manage the drill down process and ensure that it is repeated at regular time intervals.

Set a regular process for discussing and presenting data to staff and at regular committee meetings.

Involve peers in discussions, especially concerning strategies to address stigma.

If using an electronic system, create a routine report template of patients who do not meet the standard measured by the indicator. Set it to run at regular intervals; for example, immediately after the end of the month.

For follow-up with patients:

  • Establish a protocol for contacting patients; i.e., determine the most effective methods of contact.
  • Establish a time frame for follow-up as well as a minimum and maximum number of attempts for follow-up.
  • Document contact and follow-up attempts, dates, and results.
  • Determine a policy for patients who are not successfully contacted within the follow-up time frame

Resources

Further reading: NYSDOH AIDS Institute brochure: Do You Know Where Your Patients Are? Using an Active Patient List to Monitor Patient Retention in HIV Care and Improve Health Outcomes

Case study: Utah State University: Drilling Down to Understand Outcome

Resources for Locating Patients: