Transcript IPIP Change Package Presentation

Improving Performance in Practice (IPIP)
Change Package
Coaching Practices
Improving Healthcare State by State
Martha Rome, RN, MPH
Milwaukee, WI
February 11, 2009
Aims of IPIP
•
To dramatically improve patient outcomes by
transforming the way we deliver primary care,
focusing initially on measurable improvement in
diabetes and asthma, but rapidly spreading to
preventive services and other conditions
•
To assist different types of practices in using
practice redesign strategies to improve efficiency
and implement best practices
•
To align efforts and motivate action at the national,
regional, state, practice and patient level
Aligning Across Policy Levels
National
State
Network
Practice
Patient
3
Build will on state level and create
state infrastructure
• National specialty societies work through state chapters
• Specialty Boards provide clear expectations for
maintenance of certification
• Partner with other organizations in the state
– AHEC, QIO, payers, businesses, state government
• Aligning state efforts creates the IPIP model
• National Team supports states with:
–
–
–
–
–
Standard protocols
Decision support tools
Access to other practices who’ve done this work successfully
Access to experts in the field
Data aggregation and reports
Model
• Improvement networks/collaboratives
• Quality Improvement Coaches: Support
individual practices and improvement
networks
– Onsite consulting
– Group meetings (in person and phone)
• Reporting: monthly submission of
performance measures
Schematic of IPIP Process
QIC
Enroll
in IPIP
Statewide primary
Care practices
Documentation of
knowledge and
performance
Activated physician
Starting point for QI
Collaborative
practice
Using shared data
Knowledge Management
Improved outcomes
with physicians and
practices expert
in QI
Role of Quality Improvement
Coaches
• Intensive (often) on-site work with the practice team
• Provide avenue to network activities and share best
practices
• Focused approach for implementation starting with key
process changes
– Move practices faster for basic implementation
– Create group momentum with regard to
implementation and standardization
• Help practices ensure that all IPIP changes are
implemented
• Assist practices in developing teams & standardized
work flow
• Provide examples of tools (standing orders) and roles
• Assist practices with regular monitoring of
implementation to ensure reliability
Living with chronic illness is like
piloting a small plane
8
To get safely to their destination
pilots need:
• Flight instruction
• Preventive
Maintenance
• Safe Flight Plan
• Air Traffic Control
Surveillance
• Self-Management
Support
• Effective Clinical
Management
• Treatment Plan
• Close Follow-up
9
Usual care works well if your
plane is about to crash
10
The IOM Quality Report:
Selected Quotes
• “The current care systems cannot do
the job.”
• “Trying harder will not work.”
• “Changing care systems will.”
11
The Watchword
Systems are perfectly
designed to get the
results they achieve
12
A Recipe for Improving Outcomes
Model for Improvement
What are we trying to
accomplish?
How will we know that a
change is an improvement?
What change can we make that
will result in improvement?
Evidence-based
Clinical Change
Concepts
Act
Plan
Study
Do
System change strategy
Participants
System Change
Concepts
Select
Topic
Prework
Planning
Group
P
Identify
Change
Concepts
A
P
D
A
S
LS 1
P
D
A
S
LS 2
D
S
LS 3
Event
Action Period Supports
(12 months time frame)
E-mail
Visits
Phone
Assessments
Web-site
Senior Leader Reports
Learning
Model
13
Advantages of a General System Change
Model
• Applicable to most preventive and
chronic care issues
• Once system changes in place,
accommodating new guideline or
innovation much easier
• Early participants in our collaboratives
using it comprehensively
14
Essential Element of Good Chronic
Illness Care
Informed,
Activated
Patient
Productive
Interactions
Prepared
Practice
Team
15
What characterizes a “prepared”
practice team?
Prepared
Practice
Team
At the time of the visit, they have the patient
information, decision support, people,
equipment, and time required to deliver
evidence-based clinical management and
self-management support
16
What characterizes a “informed,
activated” patient?
Informed,
Activated
Patient
Patient understands the disease process,
and realizes his/her role as the daily self manager.
Family and caregivers are engaged in the patient’s
self-management. The provider is viewed
as a guide on the side, not the sage on the stage!
17
How would I recognize a
productive interaction?
Informed,
Activated
Patient
Productive
Interactions
Prepared
Practice
Team
•Assessment of self-management skills and
confidence as well as clinical status
•Tailoring of clinical management by stepped
protocol
•Collaborative goal-setting and problem-solving
resulting in a shared care plan
•Active, sustained follow-up
18
Chronic Care Model
Community
Health System
Health Care Organization
Resources and
Policies
SelfManagement
Support
Informed,
Activated
Patient
Delivery
System
Design
Productive
Interactions
Decision
Support
Clinical
Information
Systems
Prepared,
Proactive
Practice Team
Improved Outcomes
19
Clinical Information System
• Provide reminders for providers and patients.
• Identify relevant patient subpopulations for
proactive care.
• Facilitate individual patient care planning.
• Share information with providers and
patients.
• Monitor performance of team and system.
20
Delivery System Design
• Define roles and distribute tasks amongst team
members.
• Use planned interactions to support evidencebased care.
• Provide clinical case management services.
• Ensure regular follow-up.
• Give care that patients understand and that fits
their culture
21
Self-management Support
• Emphasize the patient's central role.
• Use effective self-management support
strategies that include assessment, goalsetting, action planning, problem-solving
and follow-up.
• Organize resources to provide support
22
To Change Outcomes (e.g., HbA1c) Requires
Fundamental Practice Change
• Interventions focused on
guidelines, feedback, and
role changes can improve
processes
• Interventions that address
more than one area have
more impact
• Interventions that are patientcentered change outcomes.
Renders et al, Diabetes Care, 2001;24:1821
23
Templates Related to Better
Performance and Less Variation (IPIP
practices)
24
IPIP Change Package
• High-leverage Changes
– Implement Registry
– Use Template for Planned Care
– Use Protocols
– Adopt Self-management Support Strategies
25
Implement IPIP Changes in Steps
1.
Use Registry to identify asthmatics/diabetics prior to
visit (this requires the work of implementing a registry
or “fixing” the EHR)
Use condition-specific decision support tool (e.g., visit
planner)
Create customized flow diagram and protocols to
standardize the care process
2.
3.
•
•
•
4.
Nursing Standing Orders to increase reliable execution [examples]
Standard Protocol [example]
Specific Care Team roles: who does what in the protocol
Implement a self-management support system
Throughout: Frequent monitoring of reliability and investigation of failures for
ideas about how to improve standard performance
Detailed Changes: Registry
1) Select and install a registry tool
2) Determine staff workflow to support
registry use
3) Populate registry with patient data
4) Routinely maintain registry data
5) Use registry to manage patient care and
support population management
27
Detailed Changes: Templates
1) Select template tool from registry or create a
flow sheet
2) Determine staff workflow to support use of
template
3) Use template with all patients
4) Ensure registry updated each time template
used
5) Monitor use of template
28
Detailed Changes: Protocols
Step 3: Use Protocols
a. Select and customize evidence-based protocols to
office
b. Determine staff workflow to support protocols,
including standing orders
c. Use protocols with all patients
d. Monitor use of protocols
29
Protocols: Asthma-specific
• Assess and document asthma severity and
control
• Prescribe appropriate asthma medications and
monitor overuse of beta agonists
• Use Asthma Management plans
• Establish visit frequency protocol
• Assess and treat co-morbidities
• Assess, counsel, and prevent exposure to
environmental triggers
30
Protocols: Diabetes
Check and treat BP <130/80
Check and treat cholesterol
Check A1C and treat hyperglycemia
Assess aspirin and prescribe if not using
Assess need for eye exam and make referral if
needed
• Assess nephropathy risk
• Perform foot exam
• Provide appropriate vaccines
•
•
•
•
•
31
Self-management Support
• Obtain patient education materials (e.g.,
asthma action plans)
• Determine staff workflow to support SMS
• Provide training to staff in SMS techniques
• Set patient goals collaboratively
• Document and monitor patient progress
toward goals
• Link with community resources (schools,
service organizations)
32
IPIP System Diagram
Outcomes
Key Drivers
Intervention/Change Concepts
Implement Registry
Use Registry to Manage Population
Improved clinical outcomes for
patients with diabetes and asthma
Measures of success:
Diabetes:
 >70% BP < 130/80
 >70% LDL < 100 mg/dl
 <5% A1c greater than 9.0%
 >80% received dilated eye exam
 >90% tested (or treated) for
nephropathy
 >90% counseled to stop tobacco
use
Asthma:
 >90% control assessed
 >90% with persistent asthma on
anti-inflammatory medication
 >90% with influenza vaccination
 >75% with: assessment of control
+ anti-inflammatory + influenza
vaccination
 Identify each affected patient at every visit
 Identify needed services for each patient
 Recall patients for follow-up
 Determine staff workflow to support
registry
 Populate registry with patient data
 Routinely maintain registry data
 Use registry to manage patient care &
support population management
Planned Care
Care Team is aware of patient needs and
work together to ensure all needed
services are completed
Standardized Care Processes
Practice-wide guidelines implemented per
condition (asthma, diabetes
Self Management Support
Realized patient and care team partnership
Use Templates for Planned Care
 Select template tool from registry or
create a flow sheet
 Determine staff workflow to support
template
 Use template with all patients
 Ensure registry updated each time
template used
 Monitor use of template
Employ Protocols
 Select & customize evidence-based
protocols for asthma and diabetes
 Determine staff workflow to support
protocol, including standing orders
 Use protocols with all patients
 Monitor use of protocols
Provide Self-Management Support
 Obtain patient education materials
 Determine staff workflow to support SMS
 Provide training to staff in SMS
 Set patient goals collaboratively
 Document & monitor patient progress
33
toward goals
 Link with community resources
Cincinnati Children’s Hospital PHO
• 44 geographically dispersed, sites
• Individual models and styles of practice
• “First Wins”
– Early adoption of registry
– Concurrent data collection: written parent
symptom review and clinical interview
34
Cumulative Percent of Network Asthma Population Receiving "Perfect Care"
100%
90%
80%
10/03
Project
Inception
Registry
Established
70%
BMF Included
60%
3/05
Self
1/05 Pay for
10/04
M anagement
Desktop PC Performance
Collaborative
Rewards
Registry
Determined
Installed at
Practices
5/04
1/04
Reliability
Performance Improvement
Feedback Collaborative
Reports
50%
40%
8/05
Web Site
with Registry
Launched
PHO practices
achieve > 80%
reliability (“perfect
care”)
3/ 31/ 06
"Perf ect Care"
WITH Flu Shot
30%
End 05-06 Season
8/04
Pay for
3/ 31/ 05
Performance "Perf ect Care"
Program
WITH Flu Shot
Announced End 04-05 Season
20%
10%
Jun 07
Apr 07
Feb 07
Dec 06
Oct 06
Aug 06
Jun 06
Apr 06
Feb 06
Dec 05
Oct 05
Aug 05
Jun 05
Apr 05
Feb 05
Dec 04
Oct 04
Aug 04
Jun 04
Apr 04
Feb 04
Dec 03
Oct 03
0%
35
Relationship between changing
process and changing outcome
Percent of asthma population with 1 or more
CCHMC asthma related admissions ( Monthly )
0.4%
Center Line has been recalculated based on data from
11/05 through 12/06.
10/03 project initiation
0.3%
0.2%
0.1%
Percent
Center Line
08/07
06/07 n=12723
04/07 n=12720
02/07 n=12582
12/06 n=12643
10/06 n=12631
08/06 n=12443
06/06 n=12401
04/06 n=12153
02/06 n=11925
12/05 n=11925
10/05 n=11925
08/05 n=11925
06/05 n=11925
04/05 n=11925
02/05 n=11925
12/04 n=11925
10/04 n=11925
08/04 n=11925
06/04 n=11925
04/04 n=11925
02/04 n=11925
12/03 n=11925
10/03 n=11925
0.0%
Control Limits
80% of Patients Receive
“Perfect Care”
36
Impact of PHO Asthma Initiative
Asthma Admissions per 10,000 Children
Admissions/10,000
10
8
6
4
Comparison
2
PHO
0
Baseline
Improvement Period
ED Visits per 1,000
3
ED Visits
2.5
2
1.5
1
Comparison
0.5
PHO
0
Baseline
Improvement Period
37
UNITE HERE Health Center

Founded 1914 by ILGWU

Union mergers over the years, now UNITE HERE

Comprehensive Primary and Specialty Care

Serves predominantly UNITE HERE members,
their families and retirees and SEIU 32BJ members

1000 office visits/week

12 PCP’s, 40 specialists, all staff bilingual

On Site Physical Therapy, Radiology and
Pharmacy
38
Primary Care Teams

High functioning multidisciplinary teams with 2
hours protected meeting time every other week

Huddles
–Led by MA who does chart reviews day before
–First 20 minute appointment blocked
–Identify patients for health coach interventions

Cell phones and walkie-talkies

Protocols developed & incorporated into EMR
templates
39
Teamwork
• PCAs trained in monofilament testing,
glucose diaries and ABC cards
• Standing orders for Pneumovax and
ophthalmology appointments
• Pharmacy gets A1C lists for medication
review
• Health Coaches for DM education, self
management goal setting, BP checks and
blood glucose checks
40
Transforming Medical Assistants into
Health Coaches

Curriculum developed for in-house training

Didactic and observational testing
Promotion to “Health Coach” after
competency evaluation

Supervision by Nurse Practitioner and RN
coordinator

41
Evidence Based Care
• All providers use the DM template
• Review and discussion of data at provider
meetings
• DM always on the agenda
• Provider educational seminars
• Provider chart reviews
42
Challenges
% of patients with BP <130/80
Percentage .
90
80
70
60
50
40
May- Aug- Nov- Feb- May- Aug- Nov- Feb- May- Aug- Nov- Feb- May- Aug- Nov05 05
05 06 06 06
06 07 07 07 07 08 08 08 08
Months
43
Focus on Hypertension
• Reinforced
•
•
•
•
use of BP check visit –
patient sees RN or Health Coach
New protocol and training for MA to
recheck BP if high prior to seeing PCP
BP Loan Program
Chart Reviews
Discussion with PCPs at monthly
meeting
44
CHART REVIEW FOR UNCONTROLLED
HYPERTENSION IN PEOPLE WITH DIABETES
Number of patients: 122
BP at last PCP visit: <140/90  72 (59%) >140/90  50 (41%)
Was BP rechecked after first reading:
(70%)
Yes 37 (30%)
Number of medications for HTN:
0- 14 (11%)
1- 28 (23%)
2- 34 (28%)
4- 13 (11%)
>4- 6 (5%)
2 or fewer 76 (62%)
3 or fewer 102 (84%)
No 86
3- 26 (21%)
Was uncontrolled HTN identified as a problem:
Yes 82 (67%) No 40 (33%)
Took medications for HTN on day of visit:
Yes 33 (27%)
No 24 (20%)
Not in note 51 ( 42%) N/A 8 (7%)
45
PCP Discussions
• Monthly PCP meetings
• Results of chart reviews drive PCP
•
•
•
discussion
Discuss clinical management of HTN
Ask PCP with best results – what do you
do?
Share best practices - start with
combination drugs
46
PCP Discussions
• Identifies common misconceptions –
•
“uncontrolled patients are already on
maximal doses of medications”
Identifies target for improvement –
importance of rechecking BP if
uncontrolled and asking if patients took
their medications on the day of the visit
47
The Multidisciplinary Team:
The key to successful planned
diabetes care and quality
improvement in our practice
Robb Malone, PharmD
UNC General Internal Medicine
January 20, 2009
48
Water cooler discussions
hard
Change
is necessary
requires
scary
complicated
leadership
an
opportunity
Successful
change
requires
towell
improve
a
designed, active
team
49
We assessed root causes and actions
Root Causes
Actions
Continuity of care is poor because
providers have limited clinical time
Make clinical pharmacists available to
patients daily
Patients often miss follow-up
appointments
Call patients to remind them of
appointments
Transportation barriers can hinder care
Increase phone management; 1-800
number; transportation program
Physicians lack time and skill to provide
proper diabetes education
Pharmacists provide individualized
education
Patients have low education and literacy
Design interventions that do not rely on
literacy
Physicians contribute to clinical inertia
by failing to escalate therapy
Need agreement on evidence-based
treatment algorithms; Pharmacists use
algorithms to escalate therapy with
physician sign-off
Tracking of patient outcomes is poor
Design registry to allow better tracking
50
of patients
Everything tipped in late 2007:
How did we hit ‘The Tipping Point’?
• “The level at which the momentum for change
becomes unstoppable.“
• "Ideas and products and messages and
behaviors spread like viruses do.“
– The Tipping Point: How Little Things Can Make a Big
Difference. Malcolm Gladwell
Consensus driven growth that focused on the teamwork,
contribution from all, and leadership development in QI
Acceptance from the late majority and laggards 51
What did we learn from
the first 3 years?
• ‘Every system is perfectly designed to get
the results it gets’
• If we don't like the results we have to
change the system- basically and radically
• Providers responded to data and information
at the point of care
– Addressed unanswered questions
• We must build consensus and standardize
• We must diversify
• We need to move more quickly
52
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A1c (%)
An epiphany: The run chart ,
reporting AVG A1c for our clinic
2004
Average A1c
8
7.9
7.8
7.7
7.6
7.5
7.4
7.3
7.2
7.1
7
Month
53
Diabetes planned care
• Patient registry
• Robust decision support
• Prompting and stratification of patients by risk
– Stepped care approach
•
•
•
•
•
•
All patients eligible and recruited for care
Patient-centered education
Care coordination
Expanded standardization and algorithmic care
Extensive quality reporting
Adoption of the Model for Improvement (MFI)
54
What we learned from 2003 to 2006
• A successful program includes:
– A multidisciplinary team
– A registry with decision support for proactive care
– Consensus backed by evidence-based algorithms and
standards
• Persistence and leadership are key
• Appropriately designed interventions or systems
can overcome patient vulnerability
• We continually evolve, change is necessary and
represents opportunity
– Embrace rapid cycle change and the MFI
55
An example of our stepped care
approach: Green Zone
Stepped-Care Stratification
~ 40% of our patients
Low Risk
A patient with any of the following:
A1C < 7.5% AND BP < 140/85
AND
Global Assessment Good
Patient Care Plan
All new or recent onset patients are encouraged to attend our group
class.
1. CDE visits per request (Medical Intervention).
2. Assistance and care coordination at PCP visit per request only.
3. RD MNT‡ as needed.
4. Passive medication management.
5. Phone follow-up as needed.
6. Toll-Free telephone access and after hours nurse support.
7. Automated lab ordering
Continuous Clinical Reassessment
56
An example of our stepped care
approach: Yellow Zone
~ 35% of our patients
Stepped-Care Stratification
Moderate Risk**
A patient with any of the following:
A1C 7.5 to 8.5% AND BP 140-160/85-90
AND
Global Assessment Fair
Patient Care Plan
All new or recent onset patients are encouraged to attend our group class.
Quarterly CDE visits (Medical Intervention).
1. Intense medication management.
If not on ASA, start.
If not on Statin, start.
2. Assistance and care coordination at most PCP visits.
3. Target 3 RD MNT‡ visits per year.
4. Phone follow-up as needed.
5. Toll-Free telephone access and after hours nurse support.
6. Automated lab ordering and interpretation
Continuous Clinical Reassessment
57
An example of our stepped care
approach: Red Zone
Stepped-Care Stratification
~ 25% of our patients
High Risk**
A patient with any of the following:
A1C > 8.5% OR BP > 160/90 OR
Global Assessment Poor
OR No ASA or Statin
Patient Care Plan
All new or recent onset patients are encouraged to attend our group class.
1.
2.
3.
4.
5.
6.
7.
8.
Bimonthly CDE visits (Medical Intervention).
intense medication management.
If not on ASA, start.
If not on Statin, start.
Assistance and care coordination at every PCP visit.
Target 3 RD MNT‡ visits per year.
Yearly Nutrition class referral.
Monthly to biweekly phone follow-up.
Toll-Free telephone access and after hours nurse support.
Automated lab ordering and interpretation
58
Continuous Clinical Reassessment
Role of The Care Assistants
• Consists of 4 care assistants
• Care assistants see patients during
provider visits
– Patient education
– Utilize the tools created by the database
– Assist the physician
– Facilitate proactive care, encourage
intervention
– Address barriers, adherence, glucose
monitoring, provide smoking cessation
counseling, screen for depression
59
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A1c (%)
Average A1c in our clinic now
Average A1c
8
7.9
7.8
7.7
7.6
7.5
7.4
7.3
7.2
7.1
7
Month
60
Example 1
Lipid screening & management:
A front desk intervention
61
Status of Lipid Management
September 2004
• 55% of patients had total cholesterol tested
annually
• Approximately 68% were prescribed statins
• Average total cholesterol = 185 mg/dl
• Average LDL = 99 mg/dl
• We set a goal that 90% of patients would be
screened annually and prescribed a statin
62
Front Desk Process
• List of patients with diabetes
• Whether or not labs need to be drawn
Plan/Do
• We had patients that needed labs
that were not getting triaged
appropriately
Study
• Looked at front desk logs and
process
63
Front Desk Logs
• About 60 patients with diabetes/week
• 30 needed a lab drawn
Study
• Only 15 had it drawn (50%)
64
Pizza for 90% Fidelity
• 25/33 = 75% No pizza
• 34/36 = 94% PIZZA
Act-Plan
Study
65
40
0
Sep-04
Oct-04
Nov-04
Dec-04
Jan-05
Feb-05
Mar-05
Apr-05
May-05
Jun-05
Jul-05
Aug-05
Sep-05
Oct-05
Nov-05
Dec-05
Jan-06
Feb-06
Mar-06
Apr-06
May-06
Jun-06
Jul-06
Aug-06
Sep-06
Oct-06
Nov-06
Dec-06
Jan-07
Feb-07
Mar-07
Apr-07
May-07
Jun-07
Jul-07
Aug-07
Sep-07
Oct-07
Nov-07
% Total Cholesterol Tested
Percent of Patients with Total Cholesterol Tested Yearly
100
Start
Automated
80
Re-Start
Automated
60
Stop
Automated
Front desk
fidelity
20
66
200
Jul-05
Aug-05
Sep-05
Oct-05
Nov-05
Dec-05
Jan-06
Feb-06
Mar-06
Apr-06
May-06
Jun-06
Jul-06
Aug-06
Sep-06
Oct-06
Nov-06
Dec-06
Jan-07
Feb-07
Mar-07
Apr-07
May-07
Jun-07
Jul-07
Aug-07
Sep-07
Oct-07
Nov-07
Results (mg/dl)
Focus on testing and utilization led
to improved lipids
Average Lipid Results
Total Chol
LDL
175
150
125
100
75
67
Example 2
Process measure improvement:
Nurse-directed interventions,
improving the prompts
68
Process to engage nurses
• Solidified divisional support for utilization
of the intervention
• Developed educational session with nurses
– Meeting introduction by medical director
– Revisited intent of the yellow sheets
– Reiterated the role of the nurse as an integral
member of our team
– Reviewed evidence behind recommendations
– Listened to nurses’ concerns
• Developed rapid means of feedback
69
Items to be included in
nurse assessment
• Assess as indicated on the prompt
– Depression screening
– Smoking assessment and intervention
– Eye referrals
– Monofilament testing
– Pneumococcal vaccination
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Modified Intervention (version 3)
Feedback and
change in clinical
focus led to
significant revision
of the yellow sheets
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Simple procedure for tracking
daily progress- Excel spreadsheet
Completed by ancillary staff
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Progress with mixed results
Bring on
the pizza
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Widespread, significant
improvement noted
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Provider satisfaction has improved:
How has this affected the
life of a physician?
• Delegating processes frees up time to
focus on diagnostic and therapeutic issues
• A weight has been lifted
• Excellent to know how the practice
performs
• Data has changed our conversations
• It is satisfying to show improved care
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Diabetes Improvement
Across the Practice--Lessons
• Just working harder doesn’t lead to better
outcomes
• Just making a policy doesn’t mean the
process gets done
• Doctors in our system don’t follow
algorithms or policies very well
– Other members of the health care team are
better…and that is OK
• Each member must function at their highest
level of skill
• Distractions will arise, challenges will occur
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In Summary: Change Package
• Includes details about making changes,
measures, assessment scales and tools
• A resource for practices and QICs
• Offers guidance and resources
• Remember: Teams’ testing helps adapt
and adopt strategies in their office
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IPIP Expectations
• Practices work on redesign of systems of care
delivery
• Target improvement in diabetes or asthma
• This becomes how we practice healthcare —
continuously tracking, sharing, and improving
• Participation in IPIP meets one requirement for
maintenance of certification and qualifies for
Continuing Medical Education (CME) credit
Expectations re: Data
• Collect data on performance measures
(required)
• Submit numerators and denominators to
IPIP via QIC, state program or directly
• Reliable, quality care is provided to the
entire population by using registry (or EHR
with population management functions)
What do we mean by data?
•
Aggregate measures of quality
– Based on national standards
(NCQA,AQA,HEDIS)
– Physician or practice-based
– Additional details enhance understanding of
context and meaning (levels of data quality)
– Range of data sources (paper -> Electronic
Health Record)
Rely Upon Nationally Endorsed
Measures
• Early in IPIP development, it became clear
that the scope of determining “ideal”
measures was beyond IPIP
• Other organizations exist to do this:
NCQA, Physicians Consortium, National
Quality Forum, Ambulatory Care Quality
Alliance
• IPIP decided to only require measures that
had been endorsed by a one or more of
the above organizations
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Benefits and Downsides
• Mitigates the debate about individual
opinions
• Dramatically improves our ability to align
• Reduces flexibility
• Often leaves us with more “clunky” measures
(less sensitive to changes)
• Measures sometimes change slower than we
would like (concerns about obsolete)
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Required IPIP measures are not the only
measures practices should be using
Use other measures to help ensure reliable
processes and do small PDSAs
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• The complete IPIP Change Package is in
Word format on the Extranet. Look under
Resources and then in the Change
Package folder.
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References
• www.improvingchroniccare.org
• http://www.med.unc.edu/medicine/general
m/documents/DiabetesResearch.pdf
• www.ihi/org/extranet.
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• http://www.med.unc.edu/medicine/general
m/documents/DiabetesResearch.pdf
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