The Quality Improvement Project MODULE 4: A FRAMEWORK FOR QI: THE MODEL FOR IMPROVEMENT October 2015

Objectives 1. Introduce different QI methods 2. Describe in details the Model For Improvement and learn: 1. How to write an AIM statement 2. How to identify a “family of measures” 3. Learn how to make a measurement plan October 2015

Many definitions and models for QI: They share common goal – to improve October σ LEAN

Why do we use the Model for Improvement from the Institute for Healthcare Improvement (IHI) ?  Centered in health care  Lots of online support from the IHI  Used by Health Quality Ontario  Focus is on:  System thinking and root cause  Strategic Leadership and physician leadership  Importance of teamwork October 2015

Model for Improvement: How does it fit in to the practice gap? October 2015 Start with a gap in care & exploring root cause for gap THEN…

Step 1 of the Model for Improvement Develop your AIM statement Answers the question: What are we trying to accomplish It is NOT THE “HOW” will we accomplish this Should be from the patient perspective (meaningful to the patient) Should have a clear target and timeline Should be easy to understand by everyone in the system (including patients) October 2015

AIM statement - examples The Primrose FHT will improve cervical cancer screening by increasing by 15% the pap testing rates in eligible women by May. The Melrose FHT will increase to 80% the proportion of adult patients who report that their overall experience in the FHT was excellent by next year. October 2015

Write an AIM statement - exercize Take 5 minutes to write an AIM statement based on the gap in care you identified in your Practice Audit. The discuss as a group What is to be improved ? Who is the population of focus? What is expected to happen? What is the timeframe? What is the goal? October 2015

Step 2 of the Model for Improvement: Establish measures of improvement (How will we know that an improvement has occurred?) OUTCOME MEASURE  Key measure for your project  Should capture what is important to the patient  ie: adverse events, seeing your preferred provider, patient experience of care PROCESS MEASURE  Focuses on the steps in the system that are involved  Are we doing the things we need to do to get an improvement?  ie: number of same days appts available, % time patient spends in waiting room, number of times something is charted correctly, number of times something is ordered correctly BALANCE MEASURE  Looks at potential negative impacts  ie: unnecessary appointments, longer appointment times, October 2015 These are your “family of measures”

Step 2: Establish measures of improvement – many types of data Clinical Chronic Disease Care (A1C test is done) Preventive Care (immunization rates) Administrative Access to care (same day, third next available) Continuity of Care (seeing the most responsible provider) System integration (% seen within 7 days post discharge) Patient Experience Were you satisfied with your care Did your provider communicate a care plan Did you feel your provider listened to you October 2015

“Just enough” data is all you need! October 2015

Step 2: Establish measures of improvement - SOME TIPS on SELECTING MEASURES:  Outcomes that occur frequently  Easy to measure  Avoid doing only pre/post measure, measure all along improvement  Don’t involve the EMR  Avoid patient survey (for this project)  Previously validated measures are good – LOOK TO THE LITERATURE  Gather “just enough” (15-20 data points can be ok) October 2015

Sharing your data with your clinic “Use data to generate light, not heat” October 2015

Data Visualization- exercize 1. Think of an outcome measure for your project 2. Draw a sample of the data results as you imagine they will be displayed 3. Reflect on how effective you think this data will be to explain to your clinic team the impact of your project October 2015

Data example #1: How well does this data get your message across? October 2015

Data example #2: How well does this data get your message across? October 2015

Data example #3: A Run Chart – how well does this get your message across? October 2015

Run charts  A good way to measure variability and change with a QI project  Repeated measurements over time  Method/Rules for Run charts: Good video from IHI esources/Pages/AudioandVideo/Whiteboard 7.aspx October 2015

Measurement Plan for the QI Project  You need to plan for your data collection  Who will collect the data?  What data will you be collecting?  What patients/encounters will be sampled?  How will you collect the data?  When and for how long will you collect the data? October 2015

Excercize: MEASUREMENT PLAN ON YOUR OWN OR IN GROUPS: 1. Select one of each measure: OUTCOME, PROCESS, BALANCE 2. Pick a target for the OUTCOME measure 3. Identify the WHAT, WHO, HOW, WHEN for your data collection for that measure October 2015

Resources: An 8 minute video from the IHI that reviews the Model for Improvement from a physician perspective October 2015

Resources: Health Quality Ontario or October 2015

Resources: Institute for Healthcare Improvement (IHI) – Look within the IHI “Open School” October 2015