QUALITY IMPROVEMENT:

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QUALITY IMPROVEMENT Clinic Initiatives in
Diabetic Care Fred Romm, MD, MPH Sandy Olsen,
MS Judy Payne, MS CURE Conference MCW
DFCM October 15, 2003
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QI in Healthcare

• DEMAND
• Payers
• Regulators
• CONTENT
• Health Outcomes
• Patient Access
• Patient Interaction/Satisfaction
• Practice Vitality

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Session Goals

• Understand five features about quality
  improvement.
• Understand a basic Q.I. cycle.
• Develop three components of a proposed Q.I.
  Initiative.
• Understand common strategies for improving
  outcomes.

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Quality Improvement

• Minimizes variation from performance standard.
• Differs from Quality Assurance.
• Links process to outcome.
• Engages those involved in the planning and
  decision-making.
• Employs cyclical steps.

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PDSA Cycle

PLAN
ACT
DO
STUDY
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PLAN

• Goal
• Process focus
• Plan (short-term)
• Intervention
• Measurement
• Physician roles

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DO

• Implement the Plan
• ...both the Intervention as well as the
  Measurement components
• Physician roles

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STUDY

• What did the intervention achieve?
• Is the intervention sustainable?
• Other lessons learned?
• Physician roles

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ACT

• Next steps
• ... What changes are to be made re this process
• ... Next PDSA cycle
• Physician roles

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St. Mikes Example
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Plan St Mikes example

• Goal To improve pneumovax rates
• Target To improve to 60 initially
• Process Evaluated point in process which
  might be open to change
• Plan Who? Using crystal reports, define our
  diabetic patient population
• What? Where? How long? Key variables,
  length of study and cycle defined by MCW
  DFCM Clinical Division

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Do St Mikes example

• Determined that we would use a combination of
  disease management strategy combined with access
  to crystal reports.
• Used nursing personnel in key roles to analyze
  reports for compliance with ADA recommendations
  and contact patients when not in compliance
• Developed templates, reports and documents in the
  EMR to facilitate easy access to patient specific
  information

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Study St Mikes example

• Interventions achieved significant improvement in
  pneumovax rates
• Subsequent studies indicate that change has been
  sustainable

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Act St Mikes example

• Next steps are to further extend success to other
  areas of diabetic care
• Have seen significant improvement in LDL, HgbA1c
• Working to improve diabetic foot care, eye exams,
  mammograms

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The P of PDSA your assignment

• Groups of 2-3 where you are sitting
• One of the following (from WI guideline)
• Foot Care
• Eye Care
• Self-Management training

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You comprise a PDSA team ....

• Identify one potential process issue needing
  improvement
• Identify one indicator to track
  - what, who, how, how often
• Identify one improvement strategy to implement
  - what, who, resources, how long

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In conclusion ...

• Challenge the process.
• You manage what you measure.
• QI is about doing the right thing for the
  patient.