Transcript A step-by-step review of implementing Phases I and II of

AAIM-ABIM PIM Project
Quality Improvement in a Resident
Practice
“The Devil is in the Details”
Why bother…….
 Critical physician skill
 Satisfies numerous requirements:
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ACGME Core Competencies
JCAHO QI requirements
CME credit for faculty
PIM Process
 Phase I
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Create a Learning Community
Data Collection
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Chart Reviews
Patient Surveys
Practice Survey
 Phase II
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Expand the Learning Community
Data Analysis
Intervention
Ongoing Assessment
PIM Basic Requirements
 Internet access for residents
 Core faculty preceptors committed to education and
quality improvement
 Mechanism to identify residents’ primary care
patients and access medical records
 “Research assistant” to collect patient surveys
 Willingness to make this process part of the culture
Micro-systems
 Clinical
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A small group of people who work together on a
regular basis to provide care to discrete
subpopulations of patients
 Educational
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A small group of people who work together on a
regular basis to ensure high-quality education for
a group of housestaff
PDSA Cycle for Implementing
the Project
 Project Micro-systems
Phase I: “Plan and Do”
Educational Micro-system
Resident Development
Faculty Development
Phase II: “Study and Act
PIM
Data Collection
Intervention
Clinical Micro-system
Staff Development
System Development
Assessment
 Beyond Phase II: How will you sustain this process?
Phase I
 Education
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Residents
Faculty
 Data Collection
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Chart audits – 5/resident
Patient surveys – minimum of 25/site
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“research assistant”
Practice survey for each site
Example Template
Phase I: Implementation Template
 What?
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Over what time period will you conduct this project?
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Phase I?
Phase II?
 Where?
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Will you conduct the project at all resident practice sites?
Where will the resident and faculty preceptor work
together to complete chart reviews?
Where will internet access be located and how many
computers will be available?
Example Template
Phase I: Implementation Template
 When?
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Will Phase I be conducted during block or longitudinal
time?
When will time be carved out for faculty and residents to
perform chart reviews and the practice analysis survey?
 How?
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How will a resident’s primary care patients be identified?
How will medical records be accessed?
How will the faculty and housestaff work together?
How will you ensure faculty supervision?
How will you monitor compliance?
Example Template
Phase I: Patient Survey Template
 Who?
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Who will invite patients to participate?
Who will be available to help patients?
 What?
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What will be said to patients to invite them to participate
and to explain the process?
 Where?
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Where will a private space with telephone access be
located?
Example Template
Phase I: Patient Survey Template
 When?
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When will patients be approached and invited to
participate?
 How?
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How and when will the “research assistant” be trained?
How will appropriate patients be identified?
How will the process differ at different sites?
How will you deal with patients who have language
barriers or difficulty with the phone survey?
How will you monitor the process?
PIM Process
 Phase I
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Create a Learning Community
Data Collection
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Chart Reviews
Patient Surveys
Practice Survey
 Phase II
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Expand the Learning Community
Data Analysis
Intervention
Ongoing Assessment
Phase II
 Education
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Residents
Faculty
Practice Staff
 Data Analysis
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PIM Report
 Intervention
 Assessment
Staff Development
Principles of Adult Learning
 Goals realistic and relevant
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Improvement in patient care
Improved efficiency
 Respect for the current system
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Change does not reflect incompetence
Link to professional development
Capitalize on diverse talents
Encourage group leadership
Use collaborative, authentic problem-solving
activities
Adapted from John Goodlad, Best Practice Resources
Phase II: PIM Report
Example Template
Phase II: Intervention Template
 Reviewing the Data
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When will you meet with the practice staff, housestaff
and faculty to present and review the findings of Phase I?
What will be content of your presentation?
How will you reach consensus regarding an intervention?
 Writing an AIM Statement
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What is the target population?
What is the target goal?
Within what time period do you expect to reach the goal?
Example: AIM Statement
 “Improve blood pressure control in hypertensive
patients”
VERSUS
 “Within the next 12 months, 80% of our
hypertensive patients will have documented blood
pressures less than 140/90”
Example Template
Phase II: Intervention Template
 Planning the Intervention
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What?
What intervention are you planning?
 How do your data support this decision?
 What is the target goal for your intervention?
 What will you follow on an ongoing basis to measure
an impact?
 Carefully design a clinic flowchart and indicate every
step in the intervention process.
 Do you plan to pilot the intervention, and, if so, when
and with what group?
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Flowcharting
Pt makes appt
Pt processed
by checkout staff
Pt checks in
MD completes
papers
Pt brought
to room
Pt examined
by MD
 Who are the
key individuals
involved in each
area?
Where will all
the steps of your
intervention
occur?
Rudd, Stanford Contemporary Practice, 2004
AAIM- ABIM PIM Project
Quality Improvement in a Resident Practice
 Resources
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PIM Coaches:
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Eric Holmboe: [email protected]
Eric Scher: [email protected]
Linda Lesky: [email protected]
IHI Website: www.ihi.org
Clinical Microsystems Website: www.clinicalmicrosystem.org
The Improvement Guide: A Practical Approach to
Enhancing Organizational Performance. Jossey-Bass
Business and Management Series. 1996
AAIM-ABIM PIM Project
Quality Improvement in a Resident Practice
“We are what we repeatedly do.
Excellence then, is not an act, but a
habit."
~ Aristotle (384-322 BC)