Resident Longitudinal QI Project Instructions.

October - November. Background and Planning.

Goals:Learn about PDSA methodology(you will be expected to complete two cycles per year)

Define an area of interest

Research national standards and determine how your practice compares to them.

  1. Helpful 20 minute tutorial at

Contains tips and a simple outline for implementation of a QI project

Applicable to your future- Attending Physicians are often expected to do QI projects

Explains PDSA methodology

  1. Identify what guidelines you want to follow in your practice for the management of chronic diseases (DM at UNM, HTN at the VA). Identify an area of improvement.
  2. Check your clinic boxes for a list of your patients and their data (Alisha Parada at SWMesa and Your VA attending at the VA will be providing these to you)
  3. Identify a clinic attending* with which you can discuss the following-
  4. How the PDSA methodology can be applied to your clinic project.
  5. Which guidelines should be implemented?
  6. Example: ADA standards of Medical Care in Diabetes 2012, is there evidence of a better approach to prevention, detection, evaluation and treatment?
  7. What obstacles are keeping you from implementing guidelines or standards of care into your practice?
  8. Ensure that the change you are implementing is measurable.
  9. If you decide you will have your patient’s meet with a nutritionist, how do you know this was done (and in time to make a difference to the data you are collecting)
  10. Determine how your practice compares to national standards (data! Record it!)
  11. Fill out the ‘Plan’ section of the PDSA Worksheet (example PDSA included) and Panel Database worksheet

Check yourself

Do you have a basic understanding of the PDSA methodology (a nationally recognized improvement tool)?

Do you know where to find national practice guidelines and standards of care?

Do you know how to access your patient panel information to evaluate your management skills?

Did you record preliminary data on the Panel Database Worksheet?

Did you fill out the Plan & Do section of the PDSA Worksheet?

*If you are unable to find an attending to work with you, please email your clinic QI Chief for assistance.

Resident Longitudinal QI Project Instructions. October- April. (6 months)

October-March. DO!

  1. Implement your project into your practice
  2. Record observations, obstacles and complications on your PDSA sheet

March & April. STUDY & ACT!

Record 6 month data on the Panel Database worksheet (HbA1C, BP)

Evaluate baseline and 6month data

Summarize data and process on PDSA worksheet

Evaluate if your aim was met.

If No: Identify specific changes that need to be implemented to meet your aim

If Yes: Discuss how you can broaden the scope of your project (add additional guidelines/standards to your practice, expand to other providers)

Regardless: Identify obstacles/complications and discuss ways to avoid these for next cycle. Record your analysis & discussion on PDSA Worksheet.

Resident Longitudinal QI Project. April-October (6 months).

April-May. PLAN & DO!

Repeat PDSA Cycle with focus on improvement of your project or expanding its scope.

May-October. STUDY, ACT!

Look up HbA1C/BP information on the patients identified during cycle 1 and record on the Panel Database Worksheet.

Compare the new average to data from your baseline and first 6 months.

Summarize findings on PDSA Worksheet (should be full now!).

Turn in PDSA worksheet to the QI Chief for credit (PROJECT DUE IN OCTOBER,Two PDSA cycles should be complete).

After completing this project, you will have

Increased awareness of health care systems and how to incorporate resources to optimize patient care (system based practice)

Experience in investigation evaluation ofyour patient care

Experience problem solving to improve the care you provide (Problem based learning and improvement)

Improved knowledge of guideline/standard of care based practice (JNC7 or ADA guidelines)

Knowledge, experience, and exposure to QI methodology

Evaluation of data derived outcome measures and continuous process improvement (PDSA)

Experience in translating guidelines into practice

Improved management of chronic diseases

Experience with implementation of Evidence Based Medicine into practice

PDSA WorksheetPDSA cycle dates (start through 2 cycles):

Resident name: Attending/Advisor:

PDSA Cycle Outline / Plan
1. What is the identified problem?
2. What is the aim?
3. What is the specific component of the guidelines used?
4. What is your current improvement process? / Do
Carry out small scale test of change with the goal of meeting the aim by implementing the chosen standard of care component into practice.
Implement plan into clinic practice for those identified patients
Briefly describe your plan for the implementation of the intervention. / Study
Gather data and analyze impact of change / Act
How do you interpret these results?
Was your goal met?
If not why?
If your goal was met, then are you meeting national standards?
What can you add to or improve to help meet your goal or meet national standards?
Cycle 1 / 1.
2.
3.
4. / Baseline data:
1st 6 months data:
Cycle 2 / 1.
2.
3.
4. / 2nd 6 months data:

Document PDSA cycle and outcomes on this sheet. Turn in to the QI Chief by the end of the 12 month cycle. The completed worksheet needs to be approved by the attending advisor prior to submitting. This worksheet can be emailed to

PDSA Worksheet (Example)PDSA cycle dates (start through 2 cycles):

Resident name: Attending/Advisor:

PDSA Cycle Outline / Plan
1. What is the identified problem?
2. What is the Aim?
3. What is the specific component of the guidelines used?
4. What is your current improvement process? / Do
Carry out small scale test of change with goal of meeting the Aim by implementing the chosen standard of care component into practice.
Implement plan into clinic practice for those identified patients
Briefly describe your plan for the implementation of the intervention. / Study
Gather data and analyze impact of change / Act
How do you interpret these results?
Was your goal met?
If not why?
If your goal was met, then are you meeting national standards?
What can you add to or improve to help meet your goal or meet national standards?
Cycle 1 / 1. I identified 7 patients with poorly controlled DMII (A1c>9) that have not had adequate follow up. I will use these patients in my PDSA project.
2. Improve the average of the identified patient panel A1c by 20% over the next 6 six months.
3. According to Standards of Medical Care in Diabetes – 2012 (page s18), uncontrolled DMII needs follow up at least quarterly
4. I will ensure quarterly follow visits and call the identified patients to ensure awareness of next appointment (the 7 patients with A1c >9%) / For my PDSA project, I will ensure quarterly follow up appointments and personally call these patients to inform them of their appointment. I will assess my baseline average A1c values for these 7 patients and compare results every six months. My goal is to lower the average A1c of these 7 patients by 20% in six months. (September/October through March/April) / Baseline data:
Average A1c for the identified 7 patients in my panel was 11.8%
1st 6 months data:
After six months, the average A1c was 10.0%, the goal average A1c was 9.4%. / My aim was not met.
I identified medication compliance and lack of time during clinic visit to educate patients as a barrier for improvement.
I will add a follow up phone call one week after each quarterly visit and discuss, encourage, and educate these patients to improve med compliance.
Cycle 2 / 1. Poorly controlled DMII, A1c not at goal, I identified lack of quarterly follow up and educational time about medication compliance as barriers for me not meeting my aim.
2. Goal A1c 9.4 (20% decrease form baseline A1c)
3. Implementation of quarterly follow up (page S18) and education (page S16)
4. I will ensure quarterly follow up with a reminder phone call for these patients, and I will add a follow up phone call after each quarterly visit to educate and encourage medication compliance / For the second PDSA cycle, I will ensure quarterly follow up and a follow up phone call dedicated to discuss DM education on medication compliance. My aim will be to decrease A1c by an average of 20% in these 7 identified patients from their average baseline average A1c of 11.8%. (April/May through September/October) / 2nd 6 months data:
After 2 PDSA cycles (12months) the average A1c was 9.1%. / My aim was met. I plan to discuss ways to enact this project on a larger scale and problem solve ways for this to be sustainable on a large scale.
I plan to continue this PDSA cycle for the next 12 months and complete 2 more cycles.

Resident Longitudinal Continuity Clinic Quality Improvement ProjectUNM Clinics

Panel database sheet: Please record which patients you are following and their HgA1c at baseline, 6 months, and 12 months and then calculate the average HgA1c of the panel.

Resident Name: Attending Advisor Name:

Project Title/Description:

Date Project started: Date Project ended (2 Cycles)

Patient
Name / Patient
MRN / Baseline
HgA1c / 6 months
HgA1c / 12 months
HgA1c / 18 month HgA1c / Notes

Average HgA1C at baseline:_____Average HgA1C at 6 months: _____Average HgA1C at 12 months:_____

Resident Longitudinal Continuity Clinic Quality Improvement ProjectVA Clinics

Panel database sheet: Please record which patients you are following and their BP at baseline, 6 months, and 12 months and then calculate the average BP of the panel.

Resident Name: Attending Advisor Name:

Project Title/Description:

Date Project started: Date Project ended (2 Cycles)

Patient
Name / Patient
MRN / Baseline
BP / 6 months
BP / 12 months
BP / 18 months BP / Notes

Average BP at baseline:_____Average BP at 6 months: _____Average BP at 12 months:_____