The key elements of a quality plan include a quality statement that describes the purpose and goals of the QI program, priorities of the program, a description of the organizational systems needed to implement the program, including committee structure and functions, definitions of accountability, roles and responsibilities, the process for obtaining consumer input, core measures, data collection processes, and a description of how the plan will be evaluated.
KEY POINTS
Providers play an active role in the activities of QI and can lead these efforts by asking questions to determine how improvements can be made. Although the QI program may require extra work from busy providers, the opportunities to systematically measure clinical performance will provide useful information that leads to better care for the patients they serve.
QI includes regular measurement of care processes, analysis of processes and systems of care, and implementation of solutions to improve care and monitor their effectiveness. The goal of QI is to achieve optimal health outcomes for patients. QI teams identify areas of change, implement pilots to test the change, review data assessing the change, and ultimately make recommendations about improvements. When staff members from the systems being assessed work together in teams and are engaged in the QI process, they are more likely to generate ideas and to accept changes.
Indicators, measurable aspects of care that evaluate the extent to which a facility provides a certain element of care, should be based on standards or guidelines, meet the primary goals of QI, and reflect priorities specific to the community and the clinic.
Once data have been reviewed by the team and the process for improvement identified, the next step is to decide where opportunities for improvement exist. This process is described as the PDSA (Plan- Do-Study-Act) process. The first step is to investigate this care process in greater detail. Once a change in a particular step of the process has been selected, a pilot test of the change can be quickly implemented and evaluated. If the pilot is successful, the change can be adopted widely. If the pilot is not successful, another change can be selected and tested.
Sustainability is probably the biggest challenge that clinics face in the field of QI. The key to sustaining QI in the clinic is development of an infrastructure that supports ongoing QI activities.
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SUGGESTED RESOURCES
AETC National Resource Center and New York State Department of Health AIDS Institute.
Measuring Clinical Performance: A Guide for HIV Healthcare Providers. Available at http: //www.hivguidelines.org/public_html/center/ quality-of-care/perform_guide/perform-guide- intro.htm Accessed 1/04.
Berwick D, Godfrey AB, Roessner J. Curing
Health Care. San Francisco: Jossey-Bass; 1990.
HIV/AIDS Bureau. Quality Management
Technical Assistance Manual. Rockville, MD:
Health Resources and Services Administration; 2003. Available at http://hab.hrsa.gov.
Institute for Healthcare Improvement. HIV/
AIDS Bureau Collaborations: Improving Care for People Living with HIV/AIDS Disease. Boston:
Institute for Healthcare Improvement; 2002. Available at http://www.ihi.org/collaboratives/ breakthroughseries/HIV/ChronicCare.pdf. Institute of Medicine Committee on Quality of Health Care in America. Crossing the Quality
Chasm: A New Health System for the 21st Century. Washington DC: National Academy
Press: 2001.
Langley GJ, Nolan KM, Norman CL, Provost LP, Nolan TW. The Improvement Guide: A
Practical Approach to Enhancing Organizational Performance. San Francisco: Jossey-Bass; 1996.
McGlynn EA, Asch SM. Developing a Clinical
Performance Measure. Am J Prev Med.
1998;14(3 Suppl):14-21.
New York State Department of Health AIDS Institute. HIVQUAL Group Learning
Guide: Interactive Quality Improvement Exercises for HIV Healthcare Providers. http:
//www.hivguidelines.org/public_html/center/ quality-of-care/performance_measurement_ materials/glg/group_learning_guide.
Scholtes PR, Joiner BL, Streibel BJ. The Team
Handbook (3rd Ed). Madison: Oriel,
Inc; 2003.
WEBSITES*
HIV-Specific Examples http://hab.hrsa.gov/special/qualitycare.htm http://hab.hrsa.gov/tools/QM http://www.hivguidelines.org Quality of Care Section.http://www.qualityhealthcare.org/QHC/ Topics/HIVAIDS http://www.ihi.org/collaboratives/ breakthroughseries/hiv http://www.qaproject.org General QI Websites http://www.qualityhealthcare.org/qhc http://www.ihi.org
(Institute for Healthcare Improvement) http://www.isqua.org.au (International Society for Quality in Health Care) http://www.asq.org
(American Society for Quality) http://www.mytapestry.com
(contains many links to other websites) http://www.ahrq.gov (Agency for Healthcare Research and Quality)
http://www.jcaho.org (Joint Commission on Accreditation of Healthcare Organizations) http://www.nahq.org
(National Association of Healthcare Quality) http://www.musc.edu/fm_ruralclerkship/ (Family Medicine/Rural Clerkship CQI) * Websites accessed 1/04.
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REFERENCES
Institute for Healthcare Improvement. HIV/AIDS Bureau Collaborations: Improving Care for People Living with HIV/AIDS Disease. Boston: Institute for Healthcare Improvement; 2002.
Institute of Medicine. Medicare: A Strategy for Quality Assurance. Vol.1. Washington: National Academy Press; 1990.
Institute of Medicine. Crossing the Quality Chasm. Washington: National Academy Press; 2001.
Institute of Medicine. Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act. Washington, DC: The National Academies Press; 2004.
New York State Department of Health AIDS Institute. HIVQUAL Group Learning Guide: Interactive Quality Improvement Exercises for HIV Health Care Providers. New York,
NY: New York State Department of Health AIDS Institute.
New York State Department of Health AIDS Institute. Measuring Clinical Performance: A Guide for HIV Health Care Providers. New York, NY: New York State Department of Health AIDS Institute; April 2002.