Using the Plan, Do, Study, Act Model to Implement a Quality Improvement Program in Your Practice

Morelli, Michael

doi:10.1038/ajg.2016.321

Cited by 8 publications

(11 citation statements)

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“… 11 Process standardization can dramatically decrease variation and eventually improve performance. 22 , 23 Furthermore, the case mix of studied populations has little importance when interpreting variation results, which avoids some bias and makes benchmarking between physician easier. Our low impact on coefficient of variation reflects the challenge of changing clinician decision-making, particularly in the ambulatory setting.…”

Section: Discussionmentioning

confidence: 99%

Physician Assessment and Feedback During Quality Circle to Reduce Low-Value Services in Outpatients: a Pre-Post Quality Improvement Study

et al. 2021

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Background The impact of the Choosing Wisely (CW) campaign is debated as recommendations alone may not modify physician behavior. Objective The aim of this study was to assess whether behavioral interventions with physician assessment and feedback during quality circles (QCs) could reduce low-value services. Design and Participants Pre-post quality improvement intervention with a parallel comparison group involving outpatients followed in a Swiss-managed care network, including 700 general physicians (GPs) and 150,000 adult patients. Interventions Interventions included performance feedback about low-value activities and comparison with peers during QCs. We assessed individual physician behavior and healthcare use from laboratory and insurance claims files between August 1, 2016, and October 31, 2018. Main Measures Main outcomes were the change in prescription of three low-value services 6 months before and 6 months after each intervention: measurement of prostate-specific antigen (PSA) and prescription rates of proton pump inhibitors (PPIs) and statins. Key Results Among primary care practices, a QC intervention with physician feedback and peer comparison resulted in lower rates of PPI prescription (pre-post mean prescriptions per GP 25.5 ± 23.7 vs 22.9 ± 21.4, p value<0.01; coefficient of variation (Cov) 93.0% vs 91.0%, p=0.49), PSA measurement (6.5 ± 8.7 vs 5.3 ± 6.9 tests per GP, p<0.01; Cov 133.5% vs 130.7%, p=0.84), as well as statins (6.1 ± 6.8 vs 5.6 ± 5.4 prescriptions per GP, p<0.01; Cov 111.5% vs 96.4%, p=0.21). Changes in prescription of low-value services among GPs who did not attend QCs were not statistically significant over this time period. Conclusion Our results demonstrate a modest but statistically significant effect of QCs with educative feedback in reducing low-value services in outpatients with low impact on coefficient of variation. Limiting overuse in medicine is very challenging and dedicated discussion and real-time review of actionable data may help.

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Section: Discussionmentioning

confidence: 99%

Physician Assessment and Feedback During Quality Circle to Reduce Low-Value Services in Outpatients: a Pre-Post Quality Improvement Study

et al. 2021

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“…The Plan‐Do‐Study‐Act method of continuous quality improvement was used to develop and refine the program. 11 The team collaborated with affected hospital departments (ED, laboratory, informatics, billing, and leaders from infectious disease and hepatology). Literature and guideline reviews helped determine approaches; local epidemiology was reviewed, and the team planned and implemented the program.…”

Section: Methodsmentioning

confidence: 99%

“…The Plan‐Do‐Study‐Act method of continuous quality improvement was used to develop and refine the program 11 . The team collaborated with affected hospital departments (ED, laboratory, informatics, billing, and leaders from infectious disease and hepatology).…”

Section: Methodsmentioning

confidence: 99%

Aligning an emergency department hepatitis C and human immunodeficiency virus testing quality improvement initiative with universal screening recommendations

Cave

Laun

Sheahan³

et al. 2022

JACEP Open

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Objective The interactions among hepatitis C virus (HCV), human immunodeficiency virus (HIV), and the ongoing injection drug epidemic have created a syndemic that significantly affects the Appalachian region of the United States. The purpose of this work is to describe a successful Kentucky program that aimed to increase HCV and HIV testing for people visiting an urban emergency department (ED) who were screened, diagnosed, and linked to care after diagnosis with special consideration for substance use disorder. Methods The Plan‐Do‐Study‐Act model for quality improvement was used to create a streamlined process for testing, reporting results, and linking people to care. The program was refined and expanded across 3 phases. Results Across all phases, a total of 25,685 patients were eligible for testing and did not opt out. Of those, 17,090 had HCV antibody (Ab) testing; 3460 (20.2%) had HCV Ab; 1750 (50.8%) had HCV RNA, and an average of 31% of patients were linked to care within 30 days. The program found 54 new cases of HIV infection. Conclusions Universal HCV and HIV testing and linkage to care is possible within an ED. In areas affected by the syndemic, EDs may serve as a public health safety net to identify affected individuals and ensure they receive follow‐up care. Testing in this center uncovered an exceptionally high prevalence of HCV infection and new HIV case identification.

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“…Process standardization can dramatically decrease variability and can eventually improve performance [ [57], [58]]. Following the Less is More approach, process quality indicators are easier to fix than outcome indicators as this approach targets activities that clinicians control most directly.…”

Section: Monitoring and Data Reporting Using Variabilitymentioning

confidence: 99%

The challenge of implementing Less is More medicine: A European perspective

Kherad

Peiffer-Smadja

Karlafti

et al. 2020

European Journal of Internal Medicine

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The concept of Less is More medicine emerged in North America in 2010. It aims to serve as an invitation to recognize the potential risks of overuse of medical care that may result in harm rather than in better health, tackling the erroneous assumption that more care is always better. In response, several medical societies across the world launched quality-driven campaigns ("Choosing Wisely") and published "top-five lists" of low-value medical interventions that should be used to help make wise decisions in each clinical domain, by engaging patients in conversations about unnecessary tests, treatments and procedures.However, barriers and challenges for the implementation of Less is More medicine have been identified in several European countries, where overuse is rooted in the culture and demanded by a society that requests certainty at almost any cost. Patients' high expectations, physician's behavior, lack of monitoring and pernicious financial incentives have all indirect negative consequences for medical overuse. Multiple interventions and quality-measurement efforts are necessary to widely implement Less is More recommendations. These also consist of a top-five list of actions: (1) a novel cultural approach starting from medical graduation courses, up to (2) patient and society education, (3) physician behavior change with data feedback, (4) communication training

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Using the Plan, Do, Study, Act Model to Implement a Quality Improvement Program in Your Practice

Cited by 8 publications

References 0 publications

Physician Assessment and Feedback During Quality Circle to Reduce Low-Value Services in Outpatients: a Pre-Post Quality Improvement Study

Physician Assessment and Feedback During Quality Circle to Reduce Low-Value Services in Outpatients: a Pre-Post Quality Improvement Study

Aligning an emergency department hepatitis C and human immunodeficiency virus testing quality improvement initiative with universal screening recommendations

The challenge of implementing Less is More medicine: A European perspective

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