Change Concepts

• Choose and use a formal model for quality improvement.
• Establish and monitor metrics to evaluate improvement efforts and outcome; ensure all staff members understand the metrics for success.
• Obtain feedback from patients/family about their healthcare experience and use this information for quality improvement.
• Ensure that patients, families, providers, and care team members are involved in quality improvement activities.
• Optimize use of health information technology to:
  

• Schedule appointments and monitor access to care.
• Define and understand their patient population, including subpopulations.
• Define and track care of individual patients and subpopulations, including referrals and abnormal lab/imaging results.
• Provide patient-specific educational materials.
• Provide individual care reminders.
• Provide patient summary data at time of visit.
• Enable feedback to team and for external reporting on processes of care and population outcomes.
• In addition, PCMH practices strive to use technology to improve communication between patients and practices through: 
• • Online/web-based interactive support for care.
  • A means of secure communication with patients and caregivers, allowing them to build personal health records.

The Quality Improvement (QI) Strategy Change Concept provides an infrastructure for achieving patient-centered medical homeness. The goal of this change concept is to establish a quality improvement methodology that engages and empowers all members of the care team, including patients and family members. 

Developing a QI strategy will require goal-setting around the other Change Concepts and will require regular measurement to indicate to the QI team whether the changes that they are putting in place are moving them closer to their goal. Measurement will also be used to demonstrate successful accomplishment of these goals to clinic and organizational leaders. Health information technology, e.g., electronic medical records, can support measurement and reporting, for example, demonstrating how frequently a patient population is receiving organized, evidence-based care.

The QI Strategy Change Concept is also linked to the Patient-Centered Interactions Change Concept, as forming a QI strategy necessitates asking patients and family members about their healthcare experience and taking actions to improve upon any identified opportunities.

• QI Strategy Implementation Guide Part I: Choosing and Using a QI Framework (August 2011)
  Choosing and using a Quality Improvement (QI) Strategy is fundamental to making system-wide changes and making those changes sustainable over time. The QI Strategy "Change Concept" supports all facets of the PCMH Model of care, and along with Engaged Leadership, is the driver of PCMH transformation. Part 1 of the QI Strategy Implementation Guide Series includes an overview of QI methods and provides detailed information and case studies on two methods commonly used in PCMH transformation: the Model for Improvement and Lean Methods. Also included in this guide are tips on measurement for quality improvement and strategies practices can use to engage staff, patients and families in QI work.
   Read Part 1
  
  
• QI Strategy Implementation Guide Part 2: Optimizing Health Information Technology for Patient-Centered Medical Homes (March 2011)
  A PCMH is defined by the way healthcare teams are organized and how they interact with their patients, but medicine is such an information-rich enterprise that many important features of the PCMH Model are difficult or impossible to implement without state-of-the-art information management tools. This guide describes how clinics can optimize health information technology to power medical home workflows. It also includes tips for clinics without electronic health records.
   Read Part 2
  
  
• Using Data for Quality Improvement (November 10, 2011)
  Moderator: Katie Coleman, MSPH, MacColl Center for Health Care Innovation, Group Health Research Institute
  Speakers: Lander Cooney, MS, Community Health Partners (Livingston, MT); Linda Hults, Community Health Partners (Livingston, MT)
   Audio & video program  Printable slides
  
  
• Building and Sustaining Momentum for PCMH Transformation (September 27, 2011)
  Moderator: Donna Daniel, PhD, Qualis Health
  Speakers: Regina Neal, MS, MPH, Qualis Health; Susan Crocetti, RN, BSN, CPHQ, HEM, Qualis Health
   Audio & video program    Printable slides
  
  
• QI 101: Tools for Understanding and Teaching PDSA Cycles (September 30, 2010)
  Speaker: Nicole Van Borkulo, MEd, Qualis Health
   Audio & video program    Viewable slides
  
  
• HIT and Meaningful Use (March 31, 2010)
  Moderator: Donna Daniel, PhD, Qualis Health
  Speaker: Jeff Hummel, MD, MPH, Qualis Health 
  Audio & video program   Printable slides
  
  
• Using EHR Tools to Support Medical Home Workflows (January 26, 2010)
  Speaker: Jeff Hummel, MD, MPH, Qualis Health
  Audio & video program (This program can be viewed only with Real Player  ).
  Printable Slides