Improvement Activity: Success in Quality Improvement (Clinical Arena) Priya Radhakrishnan, MD Jenn Sommers Gerri Lamb, PhD (Tucson) Lesley Manson, PsyD (Tucson)

Goals Select improvement activity/activities important to your population/practice (2-4 activities for a minimum of 90 days) Identify team to facilitate QI process Choose a QI method and identify resources to assist you Think about meaningful/feasible measures

Disclosures No conflicts of interest pertaining to this activity Priya Radhakrishnan is a physician advisor for Practice Innovation Institute and a member of the ACP Medical Informatics committee Jenn Sommers is an employee of Practice Innovation Institute

Quality Improvement Activities New Category Attestation Areas of Focus Care Coordination Beneficiary Engagement Patient Safety Needed?

2 Improvement Activities 4 Improvement Activities QI activities 4 improvement activities for a minimum of 90 days. Groups with fewer than 15 participants or if you are in a rural or health professional shortage area: Attest that you completed up to 2 activities for a minimum of 90 days. Participants in certified patient-centered medical homes, comparable specialty practices, or an APM designated as a Medical Home Model: You will automatically earn full credit. Participants in certain APMs under the APM scoring standard, such as Shared Savings Program Track 1 or OCM: You will automatically be scored based on the requirements of participating in the APM. For all current APMs under the APM scoring standard, this assigned score will be full credit. For all future APMs under the APM scoring standard, the assigned score will be at least half credit. Participants in any other APM: You will automatically earn half credit and may report additional activities to increase your score. 2 Improvement Activities 4 Improvement Activities

Select QI Activity Achieving Health Equity Behavioral and Mental Health Beneficiary engagement Care Coordination Emergency Response and Preparedness Expanded Practice Access Patient Safety and Practice Assessment Population management

Achieving Health Equity Engagement of new Medicaid Patients Leveraging a QCDR Use of standard questionnaires Patients reported outcomes tools Standardize processes for screening

Behavioral & Mental Health Depression screening Diabetes Screening EHR enhancements for BH data capture Implementation of PCP and BH Implementation of PCBH model Major Depressive Disorder: prevention and treatment Tobacco/Alcohol screening

Beneficiary Engagement Collection, follow up on patient experience & satisfaction data Engagement of patients, caregivers & families in developing care plans Engaging with QIN-QIOs (HSAG) to implement self management programs Engaging patients and families to help with improvements in the systems of care Practice website enhancements / tools for patients with cognitive disabilities Using EHRs to capture PROs Group visits QCDRs Advisory Councils Self-management Evidence based techniques to promote SM Condition specific chronic disease SM programs Improvement in practices that disseminate SM materials Tools that assist SM SM decision aids

Care Coordination Patient tracking across settings Communication test results Specialty referrals Engaging community resources Training in care coordination Participation in TCPI

Emergency Preparedness and Response Disaster Medication Assisted Treatment Teams Participation in 60 day or greater effort to support domestic/International humanitarian needs

Expanded Access Participation in QIN/QIO Technical assistance Patient experiences data – collection & use to improve access 24/7 access to physicians / groups that have access to records Telehealth

Patient Safety Prescription Drug Monitoring Program ( PMP) Registration Query AMA Steps Forward Program AHRQ Culture of Safety Survey Analysis of total costs of care Antibiotic Stewardship Fall prevention Improvement at practice & panel level

Population Management Anticoagulation Management Improvements Glycemic Control Chronic Care & Preventative Care Management for empaneled patients Implementation of Medication Management practice improvements Participation in CMMI Models like Million Hearts RHC, IHS, FQHC QI activities Use of QCDR for feedback reports Participating in Population health Research Need examples for this category

Putting Together a QI Team: Engage Everyone! Champion/team member who rallies others and gets things done Knows population/issue Experience with QI & tools Enthusiasm Providers, Front line staff, MA, Nurse, EHR/HIT, Lab, Diabetes Educator, Care coordinator, Specialists

Choose Your Method: Make it Systematic Lean Six Sigma Goal: improve process flow – add value from customer perspective Reduce process variation - Also customer focused Process: analyze processes, gaps, delays Process: analyze variation Tools: flow charts, check sheets, cause-effect diagrams, etc Many of the same tools; strong data/statistical focus; uses statistical process control PDSA Plan Do Check Act Possible to provide handouts with overview of each method?

What Will You Measure? Critical Part of QI Three types of measures Outcome measures Process measures Balancing Measures

Outcome Measure Examples Anticoagulation Program Management Improvements Depression Screening Glycemic Management services Tobacco Use

Process Measure Examples Administration of AHRQ Survey of Patient Safety Culture Care Transition documentation practice improvements Chronic & Preventive Care for empaneled patients Collection and use of patient experience and satisfaction data on access Prescription Drug Monitoring program Participation in MOC Participation in TCPI **Practice Innovation Institute STEPS forward program completion -Patient Safety & Practice Assessment module

Balancing Measures Do the changes cause new problems elsewhere? More frequent A1C measurements – causing hypoglycemia

QI EXERCISE What do you want to improve? Who should make up the QI team? Which QI process makes sense for your practice/resources? 4. What are meaningful/feasible measures of success?

Report back Will we have time for this?

Questions?

Resources American College of Physicians https://www.qualitypaymentadvisor.org/ Practice Innovation institute - http://piiaz.org/ Health Services Advisory Group https://www.hsag.com/en/medicare-providers/physician-offices/macra/hsag-qpp-service-center/ Agency for Health care and research https://www.ahrq.gov/professionals/quality-patient-safety/index.html Patient Centered Primary Care Collaborative https://www.pcpcc.org/publications https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Quality-Measure-and-Quality-Improvement-.html https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/MACRA/QPP_2017_Improvement_Activities_Fact_Sheet.pdf?la=en