QUALITY …… the final frontier

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.”

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?

Quality in Family Practice

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?

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

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”

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

Prevention

Colorectal cancer screening:

- Increasing the rate of FOBT screening or colonoscopy

- Increasing the efficiency of follow-up of FOBT + patients

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

QIIP and the Quality Project