1. HEALTHCARE QUALITY IMPROVEMENT Stephen E. Muething, MD April 6 th, 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 CHASM Institute of Medicine 2001 TIMELY EVIDENCE-BASED EQUITABLE PATIENT/FAMILY-CENTERED EFFICIENT SAFE

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

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

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

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

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

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

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. 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

14. 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

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

16. 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

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

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

24. Improving Outcomes: Hbg A1c after Family Choice

26. Time of Day Patients Are Discharged

28. ANY COMMENTS? ANY QUESTIONS?

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