partnership for child health jacksonville, fl 2011

Quality ImprovementPartnership for Child Health

Jacksonville, FL2011

Institute of Medicine Definition of Quality

The degree to which health services forindividuals and populations increase thelikelihood of desired health outcomes andare consistent with current professionalknowledge.

What is Quality?

...and the degree to which practice philosophy, standards and activities lay the foundation to providing care that is:

A Medical Home framework…

Patient-centered Accessible Continuous Coordinated Comprehensive Compassionate Culturally effective

What is Quality Improvement? Very simply, Quality Improvement (QI) is a

method of continuously examining processes and making them more effective.

QI is a career-long journey, whether informally…

… or formally through

o practice-based structured

QI process

o Maintenance of Certification - American Board of Pediatrics

An ongoing process….

Improve patient health Improve patient experience Increase practice efficiencies Reduce expenses Pay-for-performance Transparency in quality and outcomes

Why is QI Important?

Identifying areas of potential improvement Defining clear objectives (Aim Statements) Structured QI process Measuring and tracking progress Effective team work

Key Components QI

Answers the first question:

What are you trying to accomplish?

Aim Statement

A written statement of the accomplishments expected from team’s improvement effort -

◦SPECIFIC

◦MEASURABLE

◦ACTION-ORIENTED

◦REALISTIC and RELEVANT

◦TIMELY

Aim statement - SMART

We will learn how to implement a medical home quality improvement process at our practice.

All members of the medical home team will learn about QI by participating in the AAP EQIPP Medical Home learning module

By 1/30/11, all of the medical home team members will have completed the “QI Basics” portion of the AAP EQIPP Medical Home learning module.

Aim Statements: which one is the best?

We will offer opportunities for families to provide feedback about their child’s visit.

We will give an office visit questionnaire to all families at the end of their child’s visit.

By February 15, 2011 we will have designed a family feedback survey and a data collection and reporting process. By March 15, 2011 we will have be offering the survey (to be completed at the visit or mailed in from home) to 100% families at the end of their child's visit.

Another example

What are we trying to accomplish?

How will we know that a change is an improvement?

What changes can we make that will result in improvement?

Structured QI Process

The Improvement Model -

PDSA: Plan Do Study Act

PDSA- Plan Do Study Act

Plan Analyze the process; determine what changes would most improve it; establish a plan for making improvement; predict results

DoPut your change into motion on a small scale or trial basis; collect data

StudyCheck to see whether the change is working; compare to prediction

Act If the change is working, implement it on a larger scale. If not, refine it or reject it and begin the cycle again

Increase your belief that the change will result in improvement

Opportunity for “failures” without impacting performance

Document how much improvement can be expected from the change

Learn how to adapt the change to conditions in the local environment

Evaluate costs and side-effects of the change

Minimize resistance upon implementation

PDSA: cycles for testing

Keep it simple, don’t try to change overnight

Talk to the experts (colleagues, nurses, other staff, families)

Our take on QI

Remember – you can’t improve what you can’t (or don’t) measure

Measurement begins with identifying potential improvement areas.

Measuring tells a team if the changes they make are making a difference.

The team needs just enough data to tell if the change is making an improvement. Should speed improvement, not slow it down.

“Measurement” is not the goal.

Measurement forQuality Improvement

Medical Home Index

Medical Home Family Index

Medical Home Measurement tools

B

-building blocks and progress summary

E

- improvement activities, data collection and

progress tacking

…are based on the premise that medical home is an evolutionary process rather than a fully realized status for most practice settings.

The tools quantify "medical homeness" and measure a primary care practice's progress in this ongoing process.

Medical Home Measurement tools

NCQA Physician Practice Connections® -

Patient-Centered Medical HomeTM

Web-based data collection tool that provides a framework for QI strategies to achieve NCQA “Medical Home Recognition”

NCQA Recognition is the basis for efforts to transform payment systems and enhance compensation from public and private payers.

Measurement -and Pursuit ofRecognized Standards

http://www.ncqa.org/

http://www.ncqa.org/

Teams harness the knowledge, skills, experience and perspectives of different individuals to make lasting improvements.

Effective Team Work

American Academy of Family Physicians

… you must create an infrastructure within your practice that will support the team's work.

Before you assemble your QI team….


Be a QI champion and actively support your team. Without demonstrated endorsement from practice leaders, teams will flounder.


Physician leadership is key!


Identify the key people to help keep the QI momentum going, such as an office manager facilitator .

Cultivate a spirit of QI within your practice that encourages everyone to improve the quality of services and programs continuously.

Utilize external resources to help you get your teams started.

Develop staff members' skills in research, data collection and analysis.

To work efficiently, QI teams need diversity: people with different skills, experience, knowledge and viewpoints.

Staff members who are directly involved with the process under study should be represented on the team.

Recruiting members. ….


pre-planning by team leader and team facilitator

clearly established goals (agenda) group idea generation assigned responsibility and time allotted for

each agenda itemRefer to tools available on:

◦EQIPP (enrollment required) (http://www.eqipp.org/)

◦Building Your Medical Home toolkit (http://www.pediatricmedhome.org/qib/)

◦A Team Approach to Quality Improvement (http://www.aafp.org/fpm/990400fm/25.html)

Running effective QI meetings requires…


Where can our practice team learn

more aboutMedical Home

Quality Improvement?

Medical Home QI Training

What is EQIPP?

AAP EQIPP courses are designed to help you learn how to identify and close the gaps in your practice using practical QI tools.

By using EQIPP, you will collect data to measure your current level of care at baseline as you work to improve care through Plan, Do, Study, Act (PDSA) cycles.

The AAP now offers –

Medical Home for Pediatric Primary Care

With EQIPP online courses, you can:

learn to document improved quality care on a continuous basis

earn CME credit meet MOC (American Board of Pediatrics

Maintenance of Certification) Part 4: Performance in Practice

requirements all at once.

EQIPP guides you through: online work to review content

presentation, research linked information, and participate in activities

offline work to introduce and implement performance improvement within your own practice

Useful Tools!

Step # 1. Educate and engage all physicians and practice staff

Step # 2. Identify the children with special health care needs in the practice

Step # 3. Unite the medical home team and assess the current medical home qualities of the practice

Now what?

Step # 4. Implement a quality improvement process

Support for Your Practice

Practices participating in the Medical Home Implementation Project receive:

- Reimbursement of EQIPP enrollment fee

at AAP Member rate of $199 for one physician in your practice

if enrolled by January 31, 2011. - Upcoming Webinar about EQIPP provided by

the AAP and Center for Medical Home Improvement (February 28, 2011)

- Ongoing technical support offered by Partnership for Child Health medical home support staff.

Website: www.partnershipforchildhealth.org

Melana Smith, RN(904) 360-7070, ext 325

[email protected]

One Step at a Time….

partnership for child health jacksonville, fl 2011

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