Implementing Daily Management Systems to Support Sustained Quality Improvement in Ambulatory Surgery Centers.

Quality improvement processes and management approaches that provide a foundation for continuous quality improvement can lead to improved patient care. The Institute for Healthcare Improvement developed a high-performance management system (HPMS) for health care leaders and staff members to effect continuous quality control, and then conducted a pilot of the system in several ambulatory surgery centers (ASCs). The primary focus of the pilot program in the ASC setting was to understand the applicability of the theory of quality control using related practices (eg, standardized daily huddles, visual management boards) included in the modified HPMS. After implementing the new program, pilot site leaders observed an improvement of approximately 10 percentage points in their Agency for Healthcare Research and Quality patient safety culture survey scores. At the end of the pilot, the researchers concluded that ASC leaders can improve patient care and sustain improvement in their organizations using the HPMS practices.

Improving The Oral Health Care Capacity Of Federally Qualified Health Centers.

Despite efforts that increased dental visits at federally qualified health centers (FQHCs) by 65 percent between 2007 and 2014, only 21 percent of FQHC patients received dental services in 2015-not altogether surprising, given that most such facilities do not offer dental services on site. Many of these facilities are part of multisite organizations that offer dental services at other locations; however, sites with co-located dental and medical services often serve only a fraction of their primary care patients. This article describes an initiative, funded by First 5 LA and led by the University of California, Los Angeles (UCLA), designed to improve access to and quality of oral health care for young children at twenty Los Angeles County FQHCs with co-located medical and dental services. The UCLA-First 5 LA Oral Health Program supported infrastructure enhancements, technical assistance, clinical training, quality improvement, health education for parents and caregivers, and related policy analyses. Findings demonstrate a twofold increase in diagnostic and treatment services capacity for young children and a threefold increase in preventive services capacity after two years. Investments in infrastructure, plus support for training and quality improvement focused on medical and dental integration, were crucial to these capacity increases.

Disease Management of Early Childhood Caries: ECC Collaborative Project.

Until recently, the standard of care for early childhood caries (ECC) has been primarily surgical and restorative treatment with little emphasis on preventing and managing the disease itself. It is now recognized that surgical treatment alone does not address the underlying etiology of the disease. Despite costly surgeries and reparative treatment, the onset and progression of caries are likely to continue. A successful rebalance of risk and protective factors may prevent, slow down, or even arrest dental caries and its progression. An 18-month risk-based chronic disease management (DM) approach to address ECC in preschool children was implemented as a quality improvement (QI) collaborative by seven teams of oral health care providers across the United States. In the aggregate, fewer DM children experienced new cavitation, pain, and referrals to the operating room (OR) for restorative treatment compared to baseline historical controls. The teams found that QI methods facilitated adoption of the DM approach and resulted in improved care to patients and better outcomes overall. Despite these successes, the wide scale adoption and spread of the DM approach may be limited unless health policy and payment reforms are enacted to compensate providers for implementing DM protocols in their practice.

Hemoglobinopathy Learning Collaborative: using quality improvement (QI) to achieve equity in health care quality, coordination, and outcomes for sickle cell disease.

Care and outcomes for individuals living with sickle cell disease (SCD) vary across institutions and communities. The Hemoglobinopathy Learning Collaborative (HLC) seeks to improve outcomes across the life course through improvement science. Faculty identified five key drivers of improved outcomes: a strong community network; knowledgeable, proactive individuals, families and providers; reliable identification and follow-up; seamless co-management between primary and specialty care; and appropriate treatment for acute episodes. Using a modified Delphi process, we selected improvement measures aligned with the drivers. Data are collected via a Web-based system linked to a reporting portal. Participating teams include consumers, community organizations and primary and specialty care providers. This commentary reviews the context of SCD in the U.S.; describes the framework, measures, and technology infrastructure already created for the HLC; reports on the early experience of teams; highlights the initiative's challenges and opportunities; and reflects on its implications in the setting of health reform.

Disease management of early childhood caries: results of a pilot quality improvement project.

OBJECTIVES: The purpose is to report findings of a quality improvement (QI) project implemented at two hospital-based dental clinics that care for children with early childhood caries (ECC). METHODS: We tested a disease management (DM) approach in children younger than age 60 months with ECC. RESULTS: After 30 months, for the 403 and 234 DM patients at Children's Hospital Boston (CHB) and Saint Joseph Hospital (SJH) who returned for at least two visits, rates of new cavitation, pain, and referrals to the OR were 26.1, 13.4 and 10.9% for CHB and 41.0, 7.3 and 14.9% for SJH. Rates of new cavitation, pain, and referrals to the OR for historical controls were 75.2, 21.7, and 20.9% for CHB and 71.3, 31.3, and 25.0% for SJH. CONCLUSIONS: A risk-based DM approach utilizing QI strategies to address ECC can be implemented into practice and has the potential to improve care and health outcomes.

Designing a large-scale multilevel improvement initiative: the improving performance in practice program.

Improving Performance in Practice (IPIP) is a large system intervention designed to align efforts and motivate the creation of a tiered system of improvement at the national, state, practice, and patient levels, assisting primary-care physicians and their practice teams to assess and measurably improve the quality of care for chronic illness and preventive services using a common approach across specialties. The long-term goal of IPIP is to create an ongoing, sustained system across multiple levels of the health care system to accelerate improvement. IPIP core program components include alignment of leadership and leadership accountability, promotion of partnerships to promote health care quality, development of attractive incentives and motivators, regular measurement and transparent sharing of performance data, participation in organized quality improvement efforts using a standardized model, development of enduring collaborative improvement networks, and practice-level support. A prototype of the program was tested in 2 states from March 2006 to February 2008. In 2008, IPIP began to spread to 5 additional states. IPIP uses the leadership of the medical profession to align efforts to achieve large-scale change and to catalyze the development of an infrastructure capable of testing, evaluating, and disseminating effective approaches directly into practice.

Can electronic medical record systems transform health care? Potential health benefits, savings, and costs.

To broadly examine the potential health and financial benefits of health information technology (HIT), this paper compares health care with the use of IT in other industries. It estimates potential savings and costs of widespread adoption of electronic medical record (EMR) systems, models important health and safety benefits, and concludes that effective EMR implementation and networking could eventually save more than $81 billion annually--by improving health care efficiency and safety--and that HIT-enabled prevention and management of chronic disease could eventually double those savings while increasing health and other social benefits. However, this is unlikely to be realized without related changes to the health care system.