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. I am already focused on Clinical Care, Teaching and Research. I guess, otherwise you wouldn’t be giving this talk.

What does Quality Improvement have to do with Clinical Care

CROSSING THE QUALITY CHASM Institute of Medicine 2001 TIMELY EVIDENCE-BASED EQUITABLE PATIENT/FAMILY-CENTERED EFFICIENT SAFE

Percent of Diabetic Medicare Enrollees Receiving Annual Eye Examinations ( ) Percent of Diabetic Enrollees Receiving Annual Eye Examinations ( )

Percent of Diabetic Medicare Enrollees Receiving Annual Eye Examinations ( ) 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 HgbA1c Testing ( ) Percent of Diabetic Enrollees Receiving Annual HgbA1c Testing ( )

Percent of Diabetic Medicare Enrollees Receiving Annual HgbA1c Testing ( ) 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 At Least One LDL Blood Lipids Test in a Two-Year Period ( ) Percent of Diabetic Enrollees Receiving At Least One Blood Lipids Test ( )

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

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?

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

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

 Plan  Always includes a prediction  Do  Study  Did my prediction hold?  What assumptions need revision?  Act  Adapt  Adopt  Abandon PDSAPDSA

Changes That Result in Improvement AP SD A P S D AP SD D S P A DATA Very Small Scale Test Follow-up Tests Wide-Scale Tests of Change Implementation of Change Evidence Best Practice Testable Ideas Use of PDSA cycles

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

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

Improving Outcomes: Hbg A1c after Family Choice

Time of Day Patients Are Discharged

ANY COMMENTS? ANY QUESTIONS?

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