Selecting appropriate outcome measures for a spread project will be driven by the specific improvements made at the local level that are being spread across the system. Examples of outcome measures for different spread projects include the following:
- A safety spread project that has achieved local improvement in reducing adverse drug events would measure the occurrence of adverse drug events across the system.
- An outcome measure for spreading the use of the Chronic Care Model to improve the care of patients with diabetes might be the percentage of diabetes patients with an average HbA1c level less than 7.5.
- Spreading the achievement of same-day access from a pilot clinic site to all primary care clinics within the medical group would measure the time to third next available appointment across all targeted clinics.
Setting a target level of performance to achieve across a system should take into consideration the current (or baseline) performance at the system level, as well as the level of improvement that was achieved at the local level.
For example, if improvement at the local level resulted in a reduction of adverse drug events (ADEs) from 20 percent to approximately 10 percent of patients experiencing an ADE, a realistic stretch goal for system performance may be to reduce ADEs by 50 percent across the targeted sites.
Achieving the goal of same-day access in a pilot clinic would drive a system-wide goal of reducing days to third next available appointment to 0 to 1 days across all targeted clinics in the spread project.
Data Collection Plan
There are important considerations in expanding a data collection approach from a single pilot site to the system level. As with all measurement for improvement, to reduce the burden of data collection, sampling
should be used in assessing improvement in spread projects. Other things to consider in collecting data at the system level include availability of data in automated systems, building data collection into the current patient care process, and refining the sampling plan.