AAIM-ABIM PIM Project

1. AAIM-ABIM PIM Project Quality Improvement in a Resident Practice “The Devil is in the Details”

2. Why bother……. • Critical physician skill • Satisfies numerous requirements: • ACGME Core Competencies • JCAHO QI requirements • CME credit for faculty

3. PIM Process • Phase I • Create a Learning Community • Data Collection • Chart Reviews • Patient Surveys • Practice Survey • Phase II • Expand the Learning Community • Data Analysis • Intervention • Ongoing Assessment

4. PIM Basic Requirements • Internet access for residents • Core faculty preceptors committed to education and quality improvement • Mechanism to identify residents’ primary care patients and access medical records • “Research assistant” to collect patient surveys • Willingness to make this process part of the culture

5. Micro-systems • Clinical • A small group of people who work together on a regular basis to provide care to discrete subpopulations of patients • Educational • A small group of people who work together on a regular basis to ensure high-quality education for a group of housestaff

6. PDSA Cycle for Implementing the Project • Project Micro-systems Phase I: “Plan and Do” Phase II: “Study and Act PIM Data Collection Intervention Assessment Educational Micro-system Resident Development Faculty Development Clinical Micro-system Staff Development System Development • Beyond Phase II:How will you sustain this process?

7. Phase I • Education • Residents • Faculty • Data Collection • Chart audits – 5/resident • Patient surveys – minimum of 25/site • “research assistant” • Practice survey for each site

8. Example TemplatePhase I: Implementation Template • What? • Over what time period will you conduct this project? • Phase I? • Phase II? • Where? • Will you conduct the project at all resident practice sites? • Where will the resident and faculty preceptor work together to complete chart reviews? • Where will internet access be located and how many computers will be available?

9. Example TemplatePhase I: Implementation Template • When? • Will Phase I be conducted during block or longitudinal time? • When will time be carved out for faculty and residents to perform chart reviews and the practice analysis survey? • How? • How will a resident’s primary care patients be identified? • How will medical records be accessed? • How will the faculty and housestaff work together? • How will you ensure faculty supervision? • How will you monitor compliance?

10. Example TemplatePhase I: Patient Survey Template • Who? • Who will invite patients to participate? • Who will be available to help patients? • What? • What will be said to patients to invite them to participate and to explain the process? • Where? • Where will a private space with telephone access be located?

11. Example TemplatePhase I: Patient Survey Template • When? • When will patients be approached and invited to participate? • How? • How and when will the “research assistant” be trained? • How will appropriate patients be identified? • How will the process differ at different sites? • How will you deal with patients who have language barriers or difficulty with the phone survey? • How will you monitor the process?

12. PIM Process • Phase I • Create a Learning Community • Data Collection • Chart Reviews • Patient Surveys • Practice Survey • Phase II • Expand the Learning Community • Data Analysis • Intervention • Ongoing Assessment

13. Phase II • Education • Residents • Faculty • Practice Staff • Data Analysis • PIM Report • Intervention • Assessment

14. Staff DevelopmentPrinciples of Adult Learning • Goals realistic and relevant • Improvement in patient care • Improved efficiency • Respect for the current system • Change does not reflect incompetence • Link to professional development • Capitalize on diverse talents • Encourage group leadership • Use collaborative, authentic problem-solving activities Adapted from John Goodlad, Best Practice Resources

15. Phase II: PIM Report

16. Example TemplatePhase II: Intervention Template • Reviewing the Data • When will you meet with the practice staff, housestaff and faculty to present and review the findings of Phase I? • What will be content of your presentation? • How will you reach consensus regarding an intervention? • Writing an AIM Statement • What is the target population? • What is the target goal? • Within what time period do you expect to reach the goal?

17. Example: AIM Statement • “Improve blood pressure control in hypertensive patients” VERSUS • “Within the next 12 months, 80% of our hypertensive patients will have documented blood pressures less than 140/90”

18. Example TemplatePhase II: Intervention Template • Planning the Intervention • What? • What intervention are you planning? • How do your data support this decision? • What is the target goal for your intervention? • What will you follow on an ongoing basis to measure an impact? • Carefully design a clinic flowchart and indicate every step in the intervention process. • Do you plan to pilot the intervention, and, if so, when and with what group?

19. Flowcharting Pt makes appt Pt checks in Pt brought to room • Who are the key individuals involved in each area? • Where will all the steps of your intervention occur? Pt examined by MD Pt processed by checkout staff MD completes papers Rudd, Stanford Contemporary Practice, 2004

20. AAIM- ABIM PIM ProjectQuality Improvement in a Resident Practice • Resources • PIM Coaches: • Eric Holmboe: EHolmboe@ABIM.org • Eric Scher: EScher1@HFHS.org • Linda Lesky: LLesky@AAMC.org • IHI Website: www.ihi.org • Clinical Microsystems Website: www.clinicalmicrosystem.org • The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. Jossey-Bass Business and Management Series. 1996

21. AAIM-ABIM PIM ProjectQuality Improvement in a Resident Practice “We are what we repeatedly do. Excellence then, is not an act, but a habit." ~ Aristotle (384-322 BC)