Quality Improvement Organizations Qios Use Peer Review Data Analysis and Other Tools to
External Supports for Practices
Past Erin Chips Taylor, Deborah Peikes, Kristin Geonnotti, Robert McNellis, Janice Genevro, and David Meyers
Why is quality comeback important for primary care practices?
Engaging primary intendance practices in quality comeback (QI) activities is essential to achieving the triple aim of improving the health of the population, enhancing patient experiences and outcomes, and reducing the per capita toll of intendance, and to improving provider experience. In an try to create a high-value wellness care system in the United states, many providers, insurers, delivery systems, and quality improvement organizations are focused on improving the performance and prophylactic of main intendance. 1 prominent approach to redesigning principal care, the patient-centered medical home (PCMH), requires master care practices to have a systematic focus on QI and rubber. (Please access the Bureau for Healthcare Enquiry and Quality'south definition of the PCMH).
Primary intendance practices with a stiff QI orientation continually seek to improve their own performance and the outcomes of their patients. This QI orientation guides practices to set priorities for areas to ameliorate and the work needed to achieve these goals. The specific areas that practices cull to address through ongoing QI efforts, and the methods they use to address them, are likely to vary based on the practice's concerns, circumstances, and resources. Some examples of specific areas that might be priorities for practices include improving the identification, monitoring, and followup of patients with diabetes, or improving the delivery of recommended preventive services for all of their patients.
Engaging in ongoing QI is likely to be a new activity for many primary care practices, and even the most determined practice is likely to need new skills to meet its improvement goals. These skills include identifying areas for improvement, understanding and using data, planning and making changes, and tracking performance over time. External supports—defined hither as the diverse forms of technical assistance, learning activities, and tools and resources provided by organizations outside the practice—can assist practices in undertaking QI.
What external supports tin help practices with quality comeback?
Four categories of external supports, which tin can exist used alone or in combination, can assist practices with QI:
- Information feedback and benchmarking provide practices with information on their performance, as compared to external benchmarks (such as regional or national averages), and aid target areas for improvement.
- Do facilitation (or coaching) by external organizations helps practices develop skills and organize their approach to QI, provides QI tools and expertise, and helps them troubleshoot challenges or barriers.
- Good consultation (also called peer-to-peer mentoring) provides practices with specific show-based knowledge from clinicians and staff outside the practice.
- Shared learning or learning collaboratives provide a community in which practices tin can share challenges, lessons learned, and all-time practices and draw motivation and inspiration.
Table 1 at the end of this brief provides more than information on these supports and links to resources.
What types of organizations provide QI support to primary care practices?
Although there is currently no nationwide system to back up QI by practices, surface area health education centers (AHECs), health information technology regional extension centers (RECs), quality comeback organizations (QIOs/QINs), practice-based inquiry networks (PBRNs), public and private insurers, primary care professional person organizations, and others provide these types of supports to some master care practices in some geographic areas. These supports are currently typically financed past Federal grants and contracts, State programs, multipayer and single payer initiatives, and foundations.
Example: AHRQ IMPaCT Grantees' Work to Support Quality Improvement in Master Care
In 2011, AHRQ launched the Infrastructure for Maintaining Primary Intendance Transformation (IMPaCT) initiative, awarding iv cooperative grants to support State-level QI efforts. Grants were awarded to projects in New Mexico, North Carolina, Oklahoma, and Pennsylvania. These programs used principal care extension agents to assist small and medium-sized primary care practices with chief care redesign, and also provided technical assistance to 13 other States to support their transformation efforts. Select for more information about the projects.
Selected examples of Impact'south work to back up practices with QI activities:
- New Mexico deployed practise coaches to add together new do comeback strategies targeted toward pocket-size and medium-sized primary care practices. This approach complemented its existing Information technology component of chief intendance practice transformation, which the State-designated REC provides. In addition to exercise transformation, the program also promoted collaborations to improve community health, with a focus on addressing social determinants of health. Select for more information.
- North Carolina launched two learning collaboratives, among other activities, to heighten its infrastructure to support chief intendance practices. The regional leadership collaborative helped regional teams develop skills to: (1) lead successful QI initiatives, and (2) increment coordination and collaboration among local medical home care networks and AHEC's working toward shared objectives. Select for more than information (PDF, 80 KB) on North Carolina's range of activities.
- Oklahoma created the infrastructure for a statewide primary intendance extension system, intended to support local primary intendance needs. With counties and local partners as the foundation, the infrastructure now supports continuous QI, connects practices and communities to resources, and encourages innovative master care delivery models. Select for more data.
- Pennsylvania conducted a survey of primary intendance providers across the Land about what support they most needed. Elevation-ranked needs included identifying and analogous behavioral health services, improving office efficiency, and implementing evidence-based guidelines, amongst others. Pennsylvania also convened a large cadre of partner organizations to collaborate on practice transformation, focusing on how to attain more than practices in the State. Select for more information.
Tabular array 1. External Supports for Helping Practices with Quality Improvement Work
| External Support | Description | Role in Supporting QI Work | Sample of Bachelor Resource |
|---|---|---|---|
| Data Feedback and Benchmarking | Data feedback gives practices and teams information on primal indicators of processes and outcomes (patient quality of intendance, service utilise, toll, and feel), which are tracked over time to assess improvement. Benchmarking allows practices and teams to compare their functioning on selected measures to the performance of other practices and providers, or to national targets (e.1000., 90 percent compliance with a standard). | √ Provides motivation and direction for QI goals. √ Helps identify gaps in services or overuse of services and potential areas for improvement. √ Allows practices and teams to track changes in operation over time. | Hysong S, Best R, Pugh J. Audit and feedback and clinical practise guideline adherence: making feedback actionable. Implement Sci 2006;1(9). Available at: Audit and feedback and clinical practice guideline adherence: Making feedback actionable. Jamtvedt 1000, Young JM, Kristoffersen DT, et al. Audit and feedback: Furnishings on professional practice and wellness care outcomes. Cochrane Database Syst Rev 2006(two):CD000259. |
| Practice Facilitation / Coaching | Supportive services are provided to a primary care practice by an external facilitator or coach, with the goal of building internal capacity for QI activities and, ultimately, primary intendance redesign and transformation. Facilitators help practices identify means to implement an innovation or improvement activeness within the practice's context. | √ Helps practices learn how to amend by providing training in use of data and QI skills, sharing tools and resources, and lending QI expertise. √ Provides a customized arroyo through 1 on one work with practices. √ Supports practices in identifying and achieving improvement goals; helps practices prioritize and sequence QI activities and approaches (including use of information feedback and benchmarking, academic detailing/skilful consultation, and learning collaboratives, every bit needed). | Baskerville BN, Liddy C, Hogg West. Systematic review and meta-analysis of practice facilitation inside chief care settings. Ann Fam Med 2012;ten(i):63-74. Bachelor at: Systematic Review and Meta-Assay of Practice Facilitation Within Primary Care Settings. Grumbach One thousand, Bainbridge E, Bodenheimer T. Facilitating comeback in master care: The promise of do coaching. New York, NY: The Republic Fund; June 2012. Available at: Facilitating Improvement in Primary Intendance: The Promise of Practice Coaching Knox L, Taylor EF, Geonnotti One thousand, et al. Developing and running a primary care exercise facilitation programme: a how-to guide. (Prepared by Mathematica Policy Research under Contract No. HHSA290200900019I TO 5.) AHRQ Publication No. 12-0011. Rockville, Physician: Bureau for Healthcare Research and Quality; Dec 2011. Available at: Developing and Running a Master Intendance Do Facilitation Program: A How-to Guide (PDF File, 49 KB) |
| Expert Consultation | External clinician or other expert provides bear witness-based knowledge to the practice team (oft clinicians), with the aim of changing behaviors through sharing best practices. | √ Provides evidence and education through a apparent external source and relates that evidence to the practice context. √ Can assist develop practices' interest in QI work, often past relating peer to peer. | AHRQ's Academic Detailing Project. Available at: Former Projects |
| Shared Learning / Learning Collaboratives | Practice clinicians and staff come together, either in person or virtually, to receive grooming, share lessons and best practices, evaluate operation, and work individually and collaboratively to implement exercise changes over time. | √ Provides motivation and inspiration by creating a customs for sharing challenges and successes peer to peer, and learning how others approach change and improvement. √ Creates positive peer pressure level to spur change beyond participating practices; an efficient way of reaching many practices at once. √ Promotes civilisation of continuous QI (to the extent that learning is ongoing and broad based). | AHRQ'due south PBRN Peer Learning Groups. Bricker PL, Baron RJ, Scheirer JJ, et al. Collaboration in Pennsylvania: rapidly spreading improved chronic treat patients to practices. J Contin Educ Health Prof 2010;30(2):114-25. Available at: Collaboration in Pennsylvania: rapidly spreading improved chronic care for patients to practices Fleischfresser S. Wisconsin Medical Home Learning Collaborative: a model for implementing do alter. Wisconsin Med J 2004;103(5). Goeschel CA, Pronovost PJ. Harnessing the potential of health care collaboratives: lessons from the Keystone ICU Project. In: Henriksen Chiliad, Battles JB, Keyes MA, et al., eds. Advances in patient condom: new directions and alternative approaches. Vol. two, Culture and redesign. Rockville, Dr.: Agency for Healthcare Inquiry and Quality; August 2008. Bachelor at: Advances in Patient Safety: New Directions and Culling Approaches (PDF File, 19 KB) |
Page last reviewed November 2020
Page originally created June 2014
Cyberspace Commendation: Quality Improvement in Main Care. Content concluding reviewed November 2020. Agency for Healthcare Research and Quality, Rockville, MD.
https://www.ahrq.gov/research/findings/factsheets/quality/qipc/index.html
Source: https://www.ahrq.gov/research/findings/factsheets/quality/qipc/index.html
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