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

2. 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

3. 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

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

6. 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

7. 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

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

9. 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

10. 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

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

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

13. 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

14. 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

15. 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

16. 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

17. 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?

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

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

20. 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

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

22. 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?

23. Report back
Will we have time for this?

24. Questions?

25. Resources
American College of Physicians
Practice Innovation institute -
Health Services Advisory Group
Agency for Health care and research
Patient Centered Primary Care Collaborative