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HEALTHCARE QUALITY IMPROVEMENT

HEALTHCARE QUALITY IMPROVEMENT. Stephen E. Muething, MD April 6 th , 2006. As an Academic Physician, is it important for me to become knowledgeable about quality improvement?. It’s interesting, but not necessary. QI is for the administrative folks, not for academics.

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HEALTHCARE QUALITY IMPROVEMENT

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  1. HEALTHCARE QUALITY IMPROVEMENT Stephen E. Muething, MD April 6th, 2006

  2. As an Academic Physician, is it important for me to become knowledgeable about quality improvement? • It’s interesting, but not necessary. • QI is for the administrative folks, not for academics. • I am already focused on Clinical Care, Teaching and Research. • I guess, otherwise you wouldn’t be giving this talk.

  3. What does Quality Improvement have to do with Clinical Care

  4. CROSSING THE QUALITY CHASMInstitute of Medicine 2001 TIMELY EVIDENCE-BASED EQUITABLE PATIENT/FAMILY-CENTERED EFFICIENT SAFE

  5. Percent of Diabetic Medicare Enrollees Receiving Annual Eye Examinations (1995-96) 70.0 60.0 50.0 Percent of Diabetic Enrollees Receiving Annual Eye Examinations (1995-96) 40.0 30.0 20.0

  6. 80 or More (0) 60 to < 80 (3) 40 to < 60 (232) 20 to < 40 (71) Less than 20 (0) Not Populated Percent of Diabetic Medicare Enrollees Receiving Annual Eye Examinations (1995-96)

  7. Percent of Diabetic Medicare Enrollees Receiving Annual HgbA1c Testing (1995-96) 80.0 70.0 60.0 50.0 Percent of Diabetic Enrollees Receiving Annual HgbA1c Testing (1995-96) 40.0 30.0 20.0 10.0 0.0

  8. 80 or More (0) 60 to < 80 (6) 40 to < 60 (104) 20 to < 40 (177) Less than 20 (19) Not Populated Percent of Diabetic Medicare Enrollees Receiving Annual HgbA1c Testing (1995-96)

  9. Percent of Diabetic Medicare Enrollees Receiving At Least One LDL Blood Lipids Test in a Two-Year Period (1995-96) 80.0 70.0 60.0 50.0 Percent of Diabetic Enrollees Receiving At Least One Blood Lipids Test (1995-96) 40.0 30.0 20.0 10.0 0.0

  10. 80 or More (0) 60 to < 80 (8) 40 to < 60 (52) 20 to < 40 (193) Less than 20 (53) Not Populated Percent of Diabetic Medicare Enrollees Receiving Blood Lipids Testing (1995-96)

  11. Nutritional status in CF • What is the variation across CF centers in the US? • How long have we known that it’s worth working on?

  12. Urgent Intervention Need/Failure Risk of Same High-Risk Pediatric Patients Pediatric Patients in “Urgent Nutritional Need”/“Failure”or at Riskof “Urgent Intervention Need”/“Failure” by Center 100% 80% 60% 40% 20% 0%

  13. What are we trying to accomplish? What changes can we make that will result in improvement? Act Plan Study Do The Improvement Model How will we know that a change is an improvement?

  14. PDSA • Plan • Always includes a prediction • Do • Study • Did my prediction hold? • What assumptions need revision? • Act • Adapt • Adopt • Abandon

  15. Changes That Result in Improvement A P DATA Implementation of Change S D D S P A Wide-Scale Tests of Change A P S D Follow-up Tests A P EvidenceBest PracticeTestable Ideas S D Very Small Scale Test Use of PDSA cycles

  16. Charter Aim • S - Specific • M - Measurable • A – Actionable • R – Reliable • T – Time bounded

  17. Example • We will reduce central venous catheter infection rates throughout the hospital from 3/1000 device days to 0.8/1000 device days.

  18. Improving Outcomes:Hbg A1c after Family Choice

  19. Time of Day Patients Are Discharged

  20. ANY COMMENTS?ANY QUESTIONS?

  21. THANK YOU! Stephen E. Muething, M.D.

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