1. G. Dean Cleghorn, EdD Lawrence Family Practice Residency Lawrence, MA
Practice-based Learning and Improvement & Brent James’ “Essential Infrastructure for Improvement” An Introduction
G. Dean Cleghorn, EdD Lawrence Family Practice Residency Lawrence, MA
July 27, 2006

2. Objectives—PBLI Participants will:
review six elements of Practice-based Learning and Improvement.
learn how the Lawrence Family Practice Residency is addressing the elements of the Practice-based Learning and Improvement and Systems-based Practice competencies.
review essential infrastructure for health improvement.
discuss questions about how to implement PBLI.

3. ACGME Competency: Practice-based Learning and Improvement
Residents must be able to
investigate and evaluate their patient care practices,
appraise and assimilate scientific evidence,
and improve their patient care practices.

4. PBLI 1-Residents are expected to:
Analyze practice experience and
perform practice-based improvement activities
using a systematic methodology

5. PBLI 2-Residents are expected to:
Locate,
appraise,
and assimilate
evidence from scientific studies related to their patients’ health problems

6. PBLI 3-Residents are expected to:
Obtain and use information
about their own population of patients
and the larger population from which their patients are drawn

7. PBLI 4-Residents are expected to:
Apply knowledge of study designs and statistical methods to
the appraisal of clinical studies
and other information on diagnostic and therapeutic effectiveness

8. PBLI 5-Residents are expected to:
Use information technology to
manage information,
access on-line medical information;
and support their own education

9. PBLI 6-Residents are expected to:
Facilitate the learning of students
and other health care professionals

10. Essential Infrastructure Elements For Health Care Delivery Improvement
Culture of quality
Aligned Strategies (prioritization of improvement goals)
Measurement Systems
Organizational Structure
Creative payment mechanisms to cover costs of improvement
From “Essential Infrastructure for Health Care Delivery Improvement.” Pre-conference workshop, 15th Annual National Forum on Quality Improvement in Health Care, Orlando, FL, December 13, Brent C. James, M.D., M.Stat.

11. Essential Infrastructure Elements-1
Culture of quality
Training for medical directors, nursing directors, administrators
Team training
Site-based
Ten-week course, hours
Front-line staff involvement

12. Essential Infrastructure Elements-2
Aligned Strategies (prioritization of improvement goals)
Based on clinical outcomes data
Selected from the largest opportunities for improvement
Likelihood of success

13. Essential Infrastructure Elements-3
Measurement Systems
Available expertise in information systems, measurement, statistics
Capacity for data ware housing
Capacity for online reporting available to all employees and perhaps to patients

14. Essential Infrastructure Elements-4
Organizational Structure
Explicit duties to manage improvement for Medical Site Directors, Medical Directors, Practice Managers
Shared goals for improvement including with the Board, Executive Leaders, and Local Sites

15. Essential Infrastructure Elements-5
Creative payment mechanisms to cover costs of improvement
Grants
Payers
Increased margin from results

16. Implementation Questions
How can improvement be embedded in the daily work of caring for patients?
In addition to an “embedded improvement process” how can residents learn about PBLI given the limits on their time?
How can we limit the need for residents to learn a new vocabulary in order to gain the needed improvement knowledge?

17. Implementation Questions
How do we create a culture of data-based decision making?
What resources are available to give point-of-care access to national and local medical data and information?
How do we create a culture of openness about clinical outcomes?
How do we measure competence as a result of educational events?