1. QUALITY … … the final frontier

4. Quality in Family Practice Purpose: “To recommend and pilot test a programme in Ontario which promotes and celebrates a culture of continuous quality improvement (CQI) in family practice.”

5. QIFP – The Basics McMaster Project ( 2000 ) Programme Development –Phase 1 –September 2003 to March 2005 Demonstration Pilot Project -Phase 2 –April 2005 to July 2007 Implementation – Phase 3 –2007-2008 Quality In the Units – Phase 4 –2008 - ??? Next steps?

6. Quality in Family Practice

7. The Quality Process Get the whole practice team involved Identify projects in each area Identify project leaders Allocate tasks Agree to meet regularly to work on projects Complete the on-line assessment tool External assessment visit The Quality Report Next steps?

9. QIIP – The Basics MOHLTC Initiative ( 2007 ) To assist the Family Health Team Initiative –Linking FHT’s and staff from the same discipline –Regional workshops –Resources / tools for FHT’s –Improvement agenda Learning Collaboratives FHT facilitators for on-site support

10. Learning Collaborative Quality improvement teams from different FHT’s Joint learning sessions, action periods 12 – 15 month period Plan Do Study Act (PDSA) cycles Results are measured and reported monthly Three areas of focus ( within a pilot practice ): –Chronic Disease Management –Prevention –Office Practice Redesign ( Access / Efficiency ) “Spread initiative”

11. Chronic Disease Management  Diabetes: - Increasing the percentage of diabetic patients registered in the Disease Registry - Increasing the percentage of DM patients with - A1C measurements / at-target A1C results - documented self-management goals - at-target BP readings - treatment with ACE-I or ARB - at-target LDL levels - retinopathy screening - foot examination - ACR screening re nephropathy

12. Prevention  Colorectal cancer screening: - Increasing the rate of FOBT screening or colonoscopy - Increasing the efficiency of follow-up of FOBT + patients

13. Office Practice Redesign  Access: - Increasing availability of appointment times for patients - Increasing continuity within practice teams, defined as supervising physician / residents - Decreasing patient waiting time / increased efficiency at the office visit

14. QIIP and the Quality Project

16. QIIP - A few personal reflections … Provided structure and focus to the work of the teams … Increased inter-disciplinary and inter-team discussions and problem-solving … Involvement of learners – Resident QA audits of the clinic using QIIP parameters ( Diabetes Management, Open Access ) Sometimes outcomes are REALLY hard to change! Sometimes change will sweep you away!