Your Medical Home:
Well Designed Using a Quality Improvement Process
The Patient- and Family-Centered Medical Home (PFCMH) and Quality Improvement (QI) go together like bricks and mortar, hammer and nail, petrol and vehicle — the medical home and making ongoing improvements are the journey and destination entwined.
Working through the 'Building Blocks' in this toolkit will result in the identification of practice strengths and needed developments. The fundamentals for solid practice improvement include forming a medical home improvement team who 1) has the will to change 2) gains ideas to help with changes and 3) has developed skills to execute tests of change in preparation for practice wide implementation. Implementation is most successful after small tests of change help "get it right".
Once the change areas are identified a method for testing and successfully implementing ideas will be needed. The Model for Improvement provides such a method, drawing upon a few simple steps to help with the adaptation of good ideas and tools and by creating the right practice environment by which to successfully implement them.
The Model for Improvement (See Graphic Below) poses three basic questions (Q.):
| Q: | What are you trying to accomplish? |
| A: | A high quality efficient and recognized medical home. |
| Q: | How will you know that a change is an improvement? |
| A: | By measuring tests of change (patient, practice, system) using patient questions or feedback; clinician and staff measures and utilization data |
| Q: | What changes can you make that will result in improvement? |
| A: | The toolkit suggests numerous change ideas and offers tools ready for use and /or adaptation in any practice. |
Why use a method for (testing and implementing) improvement? Because it will help to:
- Increase belief that the change will result in improvement
- Predict how much improvement can be expected from the change
- Learn how to adapt the change to conditions in the local environment
- Evaluate costs and side-effects of the change
- Minimize resistance upon implementation
Implementing the Model for Improvement
1. Step One: Write an Aim Statement
- Time spent by all team members crafting an aim is the highest predictor of team success. An aim keeps a team focused, helps to assess progress and provides a clear and unambiguous statement of the team's intent.
- Each aim statement includes the population (who) targeted, the intent (what) for improvement, a timeframe (by when) and goals (or stretch goals) to measure success.
2. Step Two: Create your first "test of change" using a Plan Do Study Act approach (PDSA)
Use the focus of the aim statement to design a PDSA cycle or test of change. The following sub steps can guide
the PDSA:
Plan a test of change, answering what:
Questions need to be answered?
Predictions can be made about what may happen?
Are the best details for the test (when, who, how many)?
Data can be collected
Predictions can be made about what may happen?
Are the best details for the test (when, who, how many)?
Data can be collected
Do it: Carry out the test
Study it: What happened?
Act on results: Improve/change the test and try again
| 3. Step Three: | After testing and determining that your change is the right one, implement it but continue to evaluate measuring improvement. |
Subsequent changes may have increasing levels of complexity. For example:
a) Begin by working out a method to identify a population of patients
b) Develop and test an assessment tool, and
c) Create intervention strategies based upon these assessments, such as individualized healthcare plans.
Additional Resources
Quality Improvement Innovation Network (QuIIN)
The mission of the Quality Improvement Innovation Network (QuIIN), a network of practicing pediatricians and their staff, is to improve care and outcomes for children and families. QuIIN does so by using quality improvement science to test practical tools, measures, and strategies for use in everyday pediatric practice, the child's medical home, as well as by informal assessment that provides practicing pediatrician perspective into evidenced based recommendations and tools for implementation. QuIIN quality improvement projects use QI science, including measurement.
National Center for Medical Home Implementaion Quality Improvement Resources
EQIPP: Medical Home for Pediatric Primary Care
The goal of the EQIPP: Medical Home for Pediatric Primary Care course is to help pediatric health care providers create plans for improvement to address gaps identified in key activities of the medical home. Using EQIPP, pediatric health care providers will collect baseline and follow-up data and work to improve their medical home through Plan, Do, Study, and Act (PDSA) cycles. This EQIPP course will focus on the following key activities related to medical home:
- Developing a highly functioning, multidisciplinary quality improvement team
- Knowing and manage your patient population
- Enhancing access to care
- Providing family-centered care
- Providing and document planned, proactive, comprehensive care
- Coordinating care across all settings