1. MOQC Current State Douglas Blayney, MD Physician Lead, MOQC

2. MOQC RECOGNITION

3. MOQC QOPI CERTIFIED PRACTICES MOQC QOPI CERTIFIED PRACTICES

4. MOQC Palliative Care Demonstration Project Participants

5. MOQC OVERALL PERFORMANCE

6. O RAL C HEMOTHERAPY QOPI M EASURES MOQC S PRING 2012 R ESULTS Oral chemotherapy monitored on visit/contact following start of therapy Documented Plan / Education prior to Start of Therapy O PPORTUNITIES FOR I MPROVEMENT S TRONG P ERFORMANCE n = 20 sites

7. PALLIATIVE CARE DEMONSTRATION PROJECT:

8. Palliative Care Demonstration Project Overview  8 Teams  8 Months  Compelling Reason to Change  Clinical Framework: Integrated Palliative Care  Measure of Performance: MOQC Dashboard  Validated Tool: ESAS  Quality Improvement Model: Institute of Healthcare Improvement

9. Framework: Integrated Palliative Care Palliative Care Disease Modifying Treatments Hospice Diagnosis Treatments to Relieve Suffering/Improve QOL 6MoDeath Bereavement

12. Measure of Performance MOQC Palliative Care Dashboard

13. W HAT IS A D ASHBOARD ? A dashboard is a visual display of the most important information needed to achieve one or more objectives; consolidated and arranged on a single screen so the information can be monitored at a glance Like the one in your car, a business dashboard keeps your eye on key measures so you can prioritize appropriate actions It is used by both those in leadership/ management and the general workforce as they are easy to understand and are a call to action

14. W HY U SE A D ASHBOARD ? Quick and Easy – Provides a quick, easy to understand look at how you are doing as a practice Focused – Concentrates on measures of top importance Accountability – Uses goals to interpret results

15. W HAT IS THE MOQC P ALLIATIVE C ARE D ASHBOARD ? It is an oncology practice management tool that presents performance on key palliative care QOPI measures in a summarized manner Measures were selected from over 80 QOPI measures that were deemed most important for an oncology practice to assess their palliative care processes MOQC- participating practices will receive an updated dashboard with every round of QOPI data

16. MOQC P ALLIATIVE C ARE D ASHBOARD

17. MOQC M EASURE S ELECTION The corresponding QOPI # for each measure

18. P ALLIATIVE C ARE C URRENT S TATE A SSESSMENT

19. E XPLANATION OF C URRENT S TATE CURRENT – Your practice’s score for from the most current QOPI data (Or the most recent time period you submitted data) TREND ARROWS – Whether you improved, decreased or stayed the same from the previously reported time period for that measure GOAL – Target for each measure set by MOQC

20. C URRENT S TATE : S TATUS I NTERPRETATION Green > 85% performance exceeding target Yellow = 60-84% performance approaching goal Red < 60 % performance – requiring attention NOTE: Thresholds for # 7 (Chemo in last 2 weeks of life) are Green- 30%

21. n= 41 sites and ~2,800 charts in Spring 2012

22. Chemo last 2 weeks

23. P ERFORMANCE I MPROVEMENT P LAN 1. Check Current Performance 2.Determine WHY Issue 3. Establish Improvement Plan

24. VALIDATED TOOL EDMONTON SYMPTOM ASSESSMENT SYSTEM

26. IMPROVEMENT MODEL Kevin DeHority Quality Improvement Specialist University of Michigan

27. Adopted from: Langley GL, Nolan KM, Nolan TW, Norman CL, and Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. Jossey-Bass, 1996. Institute for Healthcare Improvement (IHI) web site, “How to Improve,”

28. Foundations of Quality Improvement Rapid Cycle QI requires teams to set aims, try out changes, and measure the effects… What are we trying to accomplish? (Aim) How will we know that the change is an improvement? (Measures) What can we do to improve things? (Change)

29. How will I know if an idea will work? PDCA ( Plan Do Check Act) Step 1: Plan Decide with your team how you will implement this change on a small scale (plan it step by step) Identify who will do what and when they will accomplish the task Make some predictions about what you expect to happen after the change is implemented Set deadlines for key steps Identify data you will need to see what effect this change has made during the test period

30. How will I know if an idea will work? PDCA (Plan Do Check Act) Step 2: Do Try it Document problems and unexpected observations Collect and monitor the data

31. How will I know if an idea will work? PDCA (Plan Do Check Act) Step 3: Check Analyze what happened, look at what the data says about the change Summarize what you learned from the test. Did your data and observations match what you had predicted for this change? – If yes, what else happened? – If not, then why not? Even failed tests teach teams a great deal about their care system.

32. How will I know if an idea will work? PDCA (Plan Do Check Act ) Step 4: Act By now, you know whether the change you tested is working If it is working... – You can plan to standardize and implement on a larger scale If it is not working… – Evaluate what happened so as to get ideas on how to modify the change – Determine whether to try something else Either way the cycle moves back to step 1 (Plan)

33. Displaying the Data Two primary ways to display your data… Time Series Graphs — Collecting and plotting data over time Storyboards — Helps you display your project to others — Helps the team to understand its own progress — Show your results in a simple and structured way to patients, families, senior leaders, other staff, and other organizations

34. Root Cause / Problem Solving Waste / Problems are symptoms We need to identify the root causes of waste / problems We must get to actionable, measurable, processes in the future state that: – Eliminate root causes of waste / problems – Prevent similar problems from reoccurring – Make future reoccurrences visual PDCA ( Plan Do Check Act)

36. PUTTING IT ALL TOGETHER : GETTING RESULTS

39. Average ESAS Scores for 8 Demonstration Participants n= 730 ESAS forms / 8 practices

40. LESSONS LEARNED FROM KARMANOS Michael Stellini, MD Palliative Care Specialist Larmender Davis, MSW, LMSW Director Social Work & Support Services Karmanos Cancer Institute

41. + + Michigan Oncology Quality Consortium Transforming Oncology Care Together Improving Symptom Management Exercise

42. FUTURE STATE: OPPORTUNITIES TO GET ENGAGED Transforming Oncology Care Together

43. MOQC P ALLIATIVE C ARE N EEDS A SSESSMENT 1. Foundational (Advanced Directives) 8. Inter-disciplinary team approach availability 2. Access 6. Communication w/ Patients/Families 7. Documentation (Goals of Care & Social Needs) 5. Communication w/in Care System 3. Symptom Management 4. Patient & Caregiver Education Adapted from National Quality Forum Complete The Survey

44. Helpful Resources Group Email Email distribution where you can reach all MOQC members interested in sharing best practices MOQCshare@umich.edu Thumb drives in your folder Includes tools, slides and other info to help your quality improvement and Palliative Care efforts Website www.MOQC.org

45. MOQC Working Groups Annual Infusion Staff Competency Review checklist development Extravasation Management process and checklist development Commitment? ~4 hours of webinar participation and conference calls, from July to September Who? Infusion nurses, pharmacists, educators, or anyone interested in improving the infusion process

46. Mock Survey We offer help in achieving QOPI Certification! Assess your performance against the current safety standards, prior to QOPI Certification site visit You will receive site-specific feedback, including a report with recommended improvements and resources Commitment? ~4 hours during the site visit