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QUALITY …… the final frontier
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Quality in Family Practice
Purpose:
“To recommend and pilot test a programme in Ontario which promotes and celebrates
a culture of continuous quality improvement (CQI) in family practice.”
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QIFP – The Basics
• McMaster Project ( 2000 ) • Programme Development –Phase 1
– September 2003 to March 2005
• Demonstration Pilot Project -Phase 2– April 2005 to July 2007
• Implementation – Phase 3– 2007-2008
• Quality In the Units – Phase 4 – 2008 - ???
• Next steps?
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Quality in Family Practice
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The Quality Process
• Get the whole practice team involved• Identify projects in each area• Identify project leaders• Allocate tasks• Agree to meet regularly to work on projects • Complete the on-line assessment tool • External assessment visit• The Quality Report • Next steps?
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QIIP – The Basics
• MOHLTC Initiative ( 2007 ) • To assist the Family Health Team
Initiative– Linking FHT’s and staff from the same discipline– Regional workshops– Resources / tools for FHT’s– Improvement agenda
• Learning Collaboratives• FHT facilitators for on-site support
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Learning Collaborative• Quality improvement teams from different FHT’s • Joint learning sessions, action periods• 12 – 15 month period• Plan Do Study Act (PDSA) cycles• Results are measured and reported monthly• Three areas of focus ( within a pilot practice ):
– Chronic Disease Management – Prevention – Office Practice Redesign ( Access / Efficiency )
• “Spread initiative”
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Chronic Disease Management
Diabetes: - Increasing the percentage of diabetic patients
registered in the Disease Registry - Increasing the percentage of DM patients with
- A1C measurements / at-target A1C results- documented self-management goals- at-target BP readings- treatment with ACE-I or ARB- at-target LDL levels- retinopathy screening- foot examination- ACR screening re nephropathy
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Prevention
Colorectal cancer screening:
- Increasing the rate of FOBT screening or colonoscopy
- Increasing the efficiency of follow-up of FOBT + patients
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Office Practice Redesign
Access:
- Increasing availability of appointment times for patients
- Increasing continuity within practice teams, defined as supervising physician / residents
- Decreasing patient waiting time / increased efficiency at the office visit
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QIIP and the Quality Project