Variable Life Adjustment Display (VLAD) Graph Case Study (Case Study Sample)

Variable Life Adjustment Display (VLAD) Graph
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Introduction
According to QHG, (2014), the VLAD was introduced with an aim to monitor the quality of services provided. Furthermore, the methodology provides an easy way to understand a graphical overview of medical outcomes over a period and draft the cumulative difference between the expected result and the actual consequences (Søvik, 2014). Also, the data which is used to develop the VLAD often gotten from the corporately patient data that was submitted. The purpose of this article is to interpret the VLAD graph and analyzing it and identifying how the pyramid of investigation contributes to the changes experienced on the VLAD graph (Gan, 2017). Furthermore, the article describes the strategies that should get put in place to monitor stroke management and understand the patient experience feedback.
VLAD Graphs Interpretation
The VLAD graph got drafted when the cumulative sum gets plotted against the patients' consecutive numbers; thus the chart will not get affected by the changes in the number of admissions per period unit. Moreover, a stable performance may produce a linear VLAD graph; therefore, the horizontal linear VLAD graph denotes stable performance (Neuburger, 2017). It is often identical to that of the chosen reference model, and in from the information in our case, the horizontal line represents the case number of stroke In-Hospital Mortality VLAD. Furthermore, a point of downward deflection represents a decline in performance while an upward deflection in the graph indicates an improvement of performance. Also, when the VLAD graph rises subsequently in a linear manner, then the performance is stable though better than the model of reference. Therefore, continuous improvement in performance creates an upward-curving graph while a constant downward-curving chart indicates a decrease in the performance. Also, the chart is presented to differentiate the number of actual deaths and expected deaths over a period and uses the cumulative sum test.
Features of the VLAD Graph
According to ACSQHC (2014), the central black line acts as a representation of the deaths in the medical facility thus it is used as an estimate of the statistical lives lost or gained below or above the expected rate for the patients that got treated for the conditions monitored in the medical facility. Furthermore, the red and blue lines that are below and above the central black line gets termed control limits. Therefore, the central black line crosses either of the control limits thus indicating the level of variation between the medical facility and the average of the state. Therefore, there are often three possibilities of VLAD graph trend, for instance, the central black line remains broadly level thus staying within the lower and upper control limits. It indicates that the medical facility's mortality rate is similar to the national mortality rate. Secondly, the central black line may move down and touch the lower control limit which indicates that the medical facility has a higher mortality rate compared to the national average mortality rate. From the information in the VLAD graph, the central black line touches the lower red control limit line which indicates that the mortality in the hospital is higher than that of the state. Thirdly, the central black line may move up touching the upper control limit which indicates that the medical facility has a lower mortality rate compared to the national average mortality rate (ACSQHC, 2014). From the information in the graph, the central black line touches the upper blue control limit which indicates that the mortality in the hospital is lower compared to that of the state. Furthermore, by reviewing the chart of a patient associated with the downward trend of the VLAD graph may help in identifying the factors that contributed to the increase in deaths. Also, the contributing factors to the rise in the mortality rate in a medical facility may be due to incorrect documentation or coding issues. Hence, the review may help in identifying resources and professional problems that require to get changed to address the increase in the mortality rate of the medical facility.
Analysis of the VLAD Graph
From the information in the VLAD graph, the vertical line of the chart (-10 to 20) acts as an estimate of the statistical lives gained while the horizontal line on the VLAD graph (324 to 639) indicates the cases of the number of Stroke In-Hospital Mortality VLAD that got reported. Furthermore, there are indented lines that appear from the horizontal line to the top of the graph which acts as the period that is from 09/11/2011 to 16/07/2014. There is the central black line which serves as a representation on the estimate of the statistical lives lost or gained below or above the expected rate for the patients that got treated for the conditions monitored in the medical facility. Moreover, from the VLAD graph, the central black line touches the blue upper control limit (369 to 414) which is within the period 09/11/2011 to 17/05/2012. Furthermore, the estimated lives gained are about five from where the central black line touches the blue upper control limit. Hence, this indicates that the mortality rate in the medical facility was lower compared to that of the state which shows that there was professionalism in healthcare services that led to saving of lives. However, the central black line touches the red lower control limit which indicates that the mortality rate in the hospital was higher compared to that of the state. It is an indication that there was poor professionalism in delivering health care services which led to the increase in the mortality rate in the hospital. It got experienced at a period that is beyond 16/07/2014 mean that lives got lost.
Causes of the Problems in the VLAD Graph Using the Pyramid of Investigation
1 Data
According to the VGHI (2012), data is the place for the Director of the Acute Stroke Unit to begin the investigation because some of the factors contributing to the change in the VLAD graph may be due to change in coder or change in the coding standards. According to Johnson, (2016), the action that can be put in place to investigate this change is by accessing the data because there are always information systems that collect essential activity data. However, this can be problematic because most IT issues are either local or national governance information issues. Furthermore, accessing the skills may help in investigating the changes experienced on the VLAD graph because some of the techniques require a reasonable competence level of manipulating large datasets and understanding the statistics.
2 Patient Case Mix
It should also get noted that patient case mix may act as a contributing factor to this change in the VLAD graph because the central risk adjustment often only allows data that gets contained within the VAED (VGHI, 2012). According to Rogers (2004), another action that can be put to investigate this change may be by the use of the risk-adjusted method which helps in controlling the mixed case in sequential monitoring in health outcomes. However, the disadvantages and advantages of different forms of unadjusted charts have an equal effect on their risk-adjusted counterparts (Novick, 2006).
3 Structure of Resources
In this category, some of the factors that may have contributed to the change may include bed availability or when the patients in a particular group get cared for in a different cite in the hospital. The actions that can be put in place to investigate these changes understand whether the hospital operates differently from others in the region or country. Moreover, it is essential if the hospital knows if it has different care pathways, especially for the end-of-life care. Also, other structural differences such as not having weekend discharges can form an excellent base for investigating the changes. Furthermore, an action that can be put in place to understand the admission process of patients into the medical facility and ensure that there is a well-resourced emergency department and the medical healthcare system that is dependable.
4 Process of Care
Some of the contributing factors in this category may include new policies and protocols that may have affected the normal operations of the medical facility. Moreover, the implementation of new care pathways may result in an improved outcome that promotes the saving of lives (VGHI, 2012). The actions that can be used to investigate this issues is by understanding the appropriate healthcare services that get used when administering care to all patients. Therefore, when health professionals understand the intensive clinical assessment process, this will help in managing the conditions of the patients.
5 Professional
In this category, the contributing factors the changes on the VLAD graph may be due to the care that the clinical staff offers the patients. Therefore, a change in the clinical team or the techniques that they used to administer may cause the difference in the performance of the medical facility just as indicated in the VLAD graph. The actions that would be put in place to investigate this changes understands how the experienced team of stroke coordinators, consultants, and nursing staff helped in monitoring each that got treated in the facility (ACSQHC, 2014). It will assist in reviewing all the clinical care that got provided as required by the clinical guidelines regarding treatment and medication of the patients.
Strategies Put in Place to Monitor Stroke Management
1 Stroke Unit Care
It is essential that patients who suffer from stroke get admitted in the medical facility, and they get treated in the stroke unit which will have a multidisciplinary team who are well equipped to deal with stroke-related cases. Also, all the pat...