The Institute of Medicine has identified six dimensions of quality which include care that is effective, efficient, equitable, timely, patient-centered, and safe. Quality can be viewed from both a clinical and operational perspective:
- Clinical quality improvement focuses on the scope of improvement of clinical outcomes.
- Operational quality improvement includes the business operational aspects of healthcare delivery in practices.
- Other dimensions such as equitable care, patient access, and patient-centered care further expand the scope of quality.
The Model for Improvement, the Plan Do Study Act (PDSA) model, is extensively utilized by the Institute of Healthcare Improvement (IHI). The PDSA model has been successfully applied in several inpatient and outpatient healthcare settings to improve clinical quality and patient outcomes.
*Adapted from: Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd edition). San Francisco: Jossey-Bass Publishers; 2009.
Further, quality improvement results occur as a product of teamwork. Teamwork involves a set of skilled cross-disciplinary interactions that are learned, practiced and refined to provide better care delivery management, promote safety, and enhance outcomes.
The commitment to quality improvement is implicit in the Academy's mission of promoting the health and well-being of all children. The Academy has enhanced its range of programs, resources, and tools, as well as its relationship with external agencies and organizations to decrease the quality gap and provide optimal health care quality to all children.
One quality improvement initiative of the Academy is the QuIIN. Multiple studies document that the development and publication of guidelines alone do not translate into improved care. Practical tools and strategies have been identified as important components to assist pediatricians in making a change in practice. QuIIN was developed to provide a standard Academy mechanism for developing these "change packages" of measures, tools, and strategies for the practicing pediatrician in a primary care practice as well as the pediatric hospitalist in the inpatient setting.
The mission of the QuIIN, a network of practicing pediatricians an 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 evidence based recommendations and tools for implementation. QuIIN quality improvement projects use QI science, including measurement.
The GPCI Quality Improvement Project (QIP) is currently underway to develop, implement, and evaluate strategies to enhance PCP knowledge, practice, and attitudes regarding the provision of genetic related services.
Visit the AAP Quality Improvement page for more information on additional quality improvement initiatives at the Academy.
Purpose of the GPCI-QIP
In order to deliver high quality care for children, primary care provider knowledge of medical genetics and the PCP role in providing genomic services are essential. Family history provides a basis for identifying potential areas of risk and/or concern based on the interplay between a child's genetics and the environment, and is a core component of preventive care. Ongoing care and management of patients with identified genetic conditions is equally important.
The purpose of the GPCI-QIP was to improve the provision of genetic services in primary care. Thirteen clinical teams worked to implement tools, strategies, and measures designed to improve the assessment and identification of genetic conditions for all patients age 0-21 years, as part of the health supervision visit, and to improve the care and management of patients age 0-21 years with known genetic conditions. Over the course of 6 months, teams used quality improvement science to test, implement, and evaluate strategies to enhance knowledge, practice, and attitudes regarding the provision of genetic-related services.
The AAP worked with 13 primary care providers and their staff to integrate genetic medicine into their clinical care practices, as well as test strategies and tools. The main goals of this project included:
- Improving the assessment and identification of genetic conditions for all patients age 0-21 years old, as part of the health supervision visit.
- Improve the care and management of patients aged 0-21 years with defined genetic conditions through the use of a practice registry of genetic conditions.
- Improve systems that track children with genetic conditions in order to ensure appropriate follow-up, communication, and care coordination takes place.
Pre-work: December 2013 through January 2013
Learning Session 1: March 8 and 9, 2013
Action Period: April through September 2013
Learning Session 2: November 2014
Learn more about the GPCI QIP on the AAP QuIIN Website
. View measurement tools, educational resources, and data summaries.
Archived Webinar: Successful QI Strategies for Integrating Genetics into a Pediatric Primary Care Practice
A webinar was held to discuss the project accomplishments, as well as best practices learned regarding how to integrate genetics into a pediatric primary care practice. You may access the archived webinar presentation here.
1. Amy Driscoll, MD, FAAP - Co-Chairperson
2. Beth A. Tarini, MD, MS, FAAP - Co-Chairperson
3. Michael L. Rinke, MD, PhD - QI Expert
4. Ruth S. Gubernick, MPH, PhD - QI Advisor
The Academy provides a free course on QI basics. The course, "Hot Topics: Getting Started with Quality Improvement" is sponsored by the AAP and can be accessed through PediaLink
. The free, 15 minute course includes slides and a brief evaluation component for each section to test user comprehension. (Note: If you are not an AAP member, you will need to create an AAP username and password in order to register).
Learning objectives for this course include:
- Explain the current quality problems of overuse, underuse and misuse in children healthcare
- Improve quality of healthcare provided to children using a series of Plan-Do-Study-Act cycles
- Use one or a combination of approaches like process mapping, evidence-based medicine, best-practices benchmarking and brainstorming session to improve healthcare quality in the workplace.
Another quality improvement initiative at the Academy is the Education in Quality Improvement in Pediatrics Practice (EQIPP) -- a unique online learning program that weaves improvement principles and concepts with pediatric-specific clinical content in order to help you deliver high quality care to every child in your practice and improve office efficiencies.
The EQIPP: Newborn Screening: Evaluate and Improve Your Practice course was produced by the American Academy of Pediatrics and supported by the CDC’s National Center on Birth Defects and Developmental Disabilities (NCBDDD). The goal of this course is to help pediatric primary care providers to create plans for improvement to address gaps identified in key activities of newborn DBS and hearing screening. The EQIPP course was developed using lessons learned from a project conducted by the QuIIN.
The AAP is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This enduring material (EQIPP) is designated for AMA PRA Category 1 Credit(s)™ and will fulfill American Board of Pediatrics Maintenance of Certification Performance in Practice requirements.
- National Quality Strategy
This strategy, issued by the US Department of Health and Human Services (HHS), was called for under the Affordable Care Act and is the first effort to create national aims and priorities to guide local, state, and national efforts to improve the quality of health care in the US. Priority areas include effective care coordination and person-and-family centered care for all children and adults.
- Health Resources and Services Administration (HRSA) Quality Improvement Web Site
This Web site aggregates QI resources, as well as QI information from HRSA federal and non-federal partners, including patient safety tools, quality indicators, and a health measure inventory.
- Institute for Healthcare Improvement (IHI)'s Knowledge Center
To help you with your improvement efforts, the Knowledge Center offers tools, change ideas, measures to guide improvement, IHI white papers, audio and video, improvement stories, and more.
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