the internist as quality advocate application of qi tools kim tartaglia, md fall 2010
TRANSCRIPT
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The Internist as Quality Advocate
Application of QI Tools
Kim Tartaglia, MD
Fall 2010
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Objectives Review Model for Improvement Review steps for successful completion
of QI project Discuss additional resources and tools
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The NY Times, Aug 21, 2010
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Why Address QI Professional duty to provide high quality
of care Training Requirements (ACGME) Pay for Performance Maintenance of Certification Academic Medicine Niche Publication Worthy
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IOM: Dimensions of Quality
• Safety
• Timeliness
• Effectiveness
• Efficiency
• Equity
• Patient Centered
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Steps of QI project
• Identify opportunity and assemble team
• Review literature and best practices
• Identify current practice
• Collect baseline data (QI dept to help)
• Develop strategy for improvement
– Implement Model for Improvement
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Importance of Creating Teams
• Stakeholder analysis
• Gain Buy-In
• Identify Champions
• Help Create Solutions
• Should be done at the beginning of a project!
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Ideas for Developing Change Evaluate current system
Process Maps, Root Cause Analysis Review Best Practices
Benchmark to compare to current practice Technology Creative Thinking Change concepts
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Using Process Maps A process map is a picture of the steps
in a process (in sequence) Must understand the current process in
order to make change and affect outcomes
Used to identify areas where change can be made
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Root Cause Analysis Find and address the underlying cause of
a problem
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Steps of QI project
• Identify opportunity
• Review literature and best practices
• Identify current practice
• Collect baseline data (QI dept to help)
• Develop strategy for improvement
– Implement Model for Improvement
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AIM Statement Description of what you want to
accomplish Includes the following:
Quantification (How much?)
Time frame (By when?) Specific patient population that is the focus
(For whom?)
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AIM Statement
Should be set high enough to have impact on care but not be unrealistic
Should be flexible to allow for different solutions
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Measures
How will you know change is an improvement
Types of Measures Process (Hand-washing rates) Outcome (Rate of hospital-acq infection) Balancing (Decreased contact with patient)
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Piloting an Improvement Idea“All improvement will require change, but not all
change will result in improvement.”
PDSA cycle:
– Used to test ideas for change
– Framework for creating an efficient trial-and-error process
Langley GL, et al, . The Improvement Guide: A Practical Approach to Enhancing Organizational Performance.
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PDSA cycle
PLAN:
– Develop interventions
– Plan to carry out changes and collect data
– “Who does what when?”
DO:
– Implement the necessary changes
– Document problems and observations
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PDSA cycle
STUDY:
– Measure the effect of the change
– Complete data collection and analysis
ACT:
– Discuss changes to make for next cycle
– Develop a plan to hold any gain / spread the improvement
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Linking PDSA cycles
• Each cycle builds on the next
• Cycles start out small and rapid, eventually get larger
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Example: Linking PDSA cycles
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Sharing Your Results
• SQUIRE Guidelines (Standards for Quality Improvement Reporting Exercise)
– http://squire-statement.org/
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Additional Reading/Resources
Institute for Healthcare Improvement www.ihi.org (Open School QI modules
Langley GL, et al. The Improvement Guide
Gawande, A. The Checklist Manifesto