Implications of Changing QIC Reports
Periodically, it becomes necessary to make adjustments to the reports contained in the Quality Improvement Calculator (QIC). This occurs for various reasons: sometimes errors in calculations are reported, sometimes we strive to have the QIC reflect different practice methods for recording/collecting the data, and sometimes code sets are updated.
Updating code sets occurs periodically as they are made available by outside organizations. For example, the measure for chlamydia screening for sexually active females is based on patients who are on oral contraceptives. As new medications with new RxNorm codes are added, these will change what is included in the denominator for that measure.
Office Practicum does not have the ability to “freeze your old QIC” at a certain time and install a new one. We update the QIC periodically as improvements and updates are made available, and there is no way to maintain or revert to previous performance measures.
How does this impact your practice?
If you are reporting specific numbers/performance on certain measures to outside entities, you should always take a screenshot that includes your performance as well as the date the screenshot was taken.
Some users include the date/time in the PC toolbar to document as part of the screenshot while others put a date/time stamp on the screenshot. Regardless, if you are ever asked to “repeat the report you ran two years ago,” you may never be able to reproduce it exactly, so you would need to produce the report/screenshot you timestamped when you originally ran the query. Also, some auditors do not understand that this query changes over time and may require an explanation, including release notes.
If you are running measures repeatedly for internal quality improvement or PCMH which does not have strict performance requirements for many measures, you need to be aware of these changes when they happen, so that you can explain discrepancies to your QI team who is doing this work. In most cases, it is the trend you are considering as you work to improve, and exact numbers are less crucial.
In some cases, when you get an update, you may want to rerun for some old dates and attempt to reconcile the differences. Regardless, benchmarking where you are and working to improve are the most important parts of QI work, not making sure that every last numerator/denominator is perfectly consistent over time. Changes will be inevitable. Reading release notes and keeping yourself apprised of updates is important to interpreting the data in a meaningful way.
Remember, the “C” in QIC...Continuous Quality Improvement. That applies to updating the QIC as well.
