Guiding your hypertension improvement journey A practical approach for busy healthcare teams engaged in quality improvement work Brant J Oliver PhD MS MPH FNPBC PMHNPBC Principal Scientist Healthcare Improvement Science DartmouthHitchcock Health Lebanon NH ID: 1043337
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1. CHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMGuiding your hypertension improvement journey: A practical approach for busy healthcare teams engaged in quality improvement workBrant J. Oliver, PhD, MS, MPH, FNP-BC, PMHNP-BCPrincipal Scientist (Healthcare Improvement Science), Dartmouth-Hitchcock Health, Lebanon, NHAssociate Professor, The Dartmouth Institute and Geisel School of Medicine at Dartmouth, Hanover, NHFaculty Senior Scholar, Veterans Affairs HPEER and VAQS National Fellowship ProgramsDirector, Chronic Health Improvement Research Program
2. Disclosure StatementNo real or perceived conflicts to disclose.CHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAM
3. Learning ObjectivesAfter completing this learning activity, participants will be able to:1) describe a basic approach to building and organizing an improvement effort using the "Improvement Passport" approach;2) discuss the use of various improvement tools to help facilitate your improvement work; and3) technically interpret run charts and advise improvement efforts based on run chart analyses.CHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAM
4. AcknowledgmentsThe Dartmouth Institute (TDI)VA National Quality Scholars Fellowship (VAQS)Institute for Healthcare Improvement Open School (IHI)CHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAM
5. AgendaCHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMPart IImprovement PassportPart IIImprovement ToolboxPart IIIImprovement Measurement
6. Part I: The Improvement PassportCHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMPurpose and RationaleContext and PopulationAimsMeasurement DefinitionsData Collection PlanTests of ChangeData AnalysisYour Passport can be a simple slide set with 7 slides, each addressing one of the 7 core domains…
7. Part I: The Improvement PassportCHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMPurpose and Rationale: What is the objective and focus of your work? Why is it important to do this work now? Context and PopulationAimsMeasurement DefinitionsData Collection PlanTests of ChangeData AnalysisSQUIRE 2.0 Format Rationale Statement Template: “IF… THEN … SO THAT … SO THAT…”Example: “If we can better understand drivers of uncontrolled HTN management in African American Men, then we can address these drivers to improve HTN for them, so that they will achieve improved HTN control, so that they can achieve better overall cardiovascular and general health outcomes.” http://www.squire-statement.org/
8. Part I: The Improvement PassportCHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMPurpose and RationaleContext and Population: What are the characteristics of your setting. Who are the people you are trying to help?AimsMeasurement DefinitionsData Collection PlanTests of ChangeData AnalysisDescribe your “5Ps”*PurposePeople (Patients)ProfessionalsProcesses (Process Maps-see Toolbox)PatternsCreate a process map (see Toolbox)*www.clinicalmicrosystem.org
9. Part I: The Improvement PassportCHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMPurpose and RationaleContext and Population: What are the characteristics of your setting. Who are the people you are trying to help?Aims: What will you improve (goal), and by when?Measurement DefinitionsData Collection PlanTests of ChangeData AnalysisAim Statement Template: “We aim to improve ______(target)_____ from _________(current baseline)_______ to ___________(goal)________ by __________(date)_______________.”Example: “We aim to improve monthly HTN monitoring follow up adherence rate from current baseline of 35% to initial goal of 75% by May 1, 2021.” Other Aim Statement Templates (see Toolbox)IHI Aim Statement WorksheetClinical Microsystems Global Aim Statement TemplateClinical Microsystems Specific Aim Template
10. Part I: The Improvement PassportCHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMPurpose and RationaleContext and Population: What are the characteristics of your setting. Who are the people you are trying to help?AimsMeasurement Definitions: How will you know that a change is an improvement? Define your measures and link to aims.Data Collection PlanTests of ChangeData AnalysisDefine your measures:Conceptual DefinitionOperational DefinitionLink to AimsTools:Definitions “Inverted Triangle” worksheetModified Driver Diagram“Clean Room Exercise” – improvement measures are context specific!Hospital Operating SuiteTeenager’s BedroomOperationally Define: “Clean”
11. Part I: The Improvement PassportCHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMPurpose and RationaleContext and Population: What are the characteristics of your setting. Who are the people you are trying to help?AimsMeasurement DefinitionsData Collection Plan: Describe the “who, what, where, when, and how.”Tests of ChangeData AnalysisDescribe the 5 Elements for Data Fidelity:What data will be collected?Who will collect and manage the data?Where will the data be collected (setting)?When will the data be collected (sampling frame)?How will the data be collected and validated?Tools (see Toolbox)Data Collection Plan WorksheetModified Driver Diagram
12. Part I: The Improvement PassportCHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMPurpose and RationaleContext and Population: What are the characteristics of your setting. Who are the people you are trying to help?AimsMeasurement DefinitionsData Collection PlanTests of Change: What changes (interventions, exposures) will you test? How will you implement and assess them?Data AnalysisDevelop a list of potential “change ideas” related to driversAlign with Aims and measuresAlign with process mapAlign with driversDevelop and conduct PDSA cyclesTools:Definitions WorksheetProcess mapDriver diagramPlan-Do-Study-Act (PDSA) CyclesDerived from Scientific MethodSequential Small ExperimentsSmall scale to start then can scale over timeRapidPDSA ComponentsPlan: Strategy and hypothesis for the test of changeDo: Conduct and assess the test of changeStudy: Analyze and review the resultsAct: “Adopt, Adapt, or Abandon”Tools (see Toolbox)PDSA WorksheetDefinitions WorksheetModified Driver DiagramThe IHI Model for Improvement. www.ihi.org.
13. Part I: The Improvement PassportCHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMPurpose and RationaleContext and Population: What are the characteristics of your setting. Who are the people you are trying to help?AimsMeasurement DefinitionsData Collection PlanTests of Change: What changes (interventions, exposures) will you test? How will you implement and assess them?Data Analysis: How will you know that a change is an improvement?Improvement Measurement = Study of Variation (not Inference)Great for “small data”Real-time capabilityIdentifies patterns of variation to inform improvementEven simple approaches (Run Charts) can be very effectiveTools:Run chart templateAdvising improvement based on assessment of variation algorithm
14. Part II: The Improvement ToolboxCHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMProcess MapDefinitions WorksheetData Collection PlanDriver DiagramModified Driver DiagramPDSA WorksheetRun chart templateUsing variation to inform improvement algorithmUse these tools to help develop your Improvement Passport and empower and inform your improvement work…
15. Part II: The Improvement ToolboxCHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMProcess Map: Describes the sequence of events in the process of care your population is engaged in.Definitions WorksheetData Collection PlanDriver DiagramModified Driver DiagramPDSA WorksheetRun chart templateSoftware!Lucid ChartsVisioPowerPoint (Insert “shapes”)MS Word (Insert “shapes”)Others (QI Macros, etc.)
16. Part II: The Improvement ToolboxCHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMProcess Map: Describes the sequence of events in the process of care your population is engaged in.Definitions WorksheetData Collection PlanDriver DiagramModified Driver DiagramPDSA WorksheetRun chart template
17. Part II: The Improvement ToolboxCHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMProcess Map: Describes the sequence of events in the process of care your population is engaged in.Definitions WorksheetData Collection PlanDriver DiagramModified Driver DiagramPDSA WorksheetRun chart template
18. Part II: The Improvement ToolboxCHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMProcess Map: Describes the sequence of events in the process of care your population is engaged in.Definitions WorksheetData Collection PlanDriver DiagramModified Driver DiagramPDSA WorksheetRun chart templatewww.ihi.org
19. Part II: The Improvement ToolboxCHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMProcess Map: Describes the sequence of events in the process of care your population is engaged in.Definitions WorksheetData Collection PlanDriver DiagramModified Driver DiagramPDSA WorksheetRun chart template
20. Part II: The Improvement ToolboxCHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMProcess Map: Describes the sequence of events in the process of care your population is engaged in.Definitions WorksheetData Collection PlanDriver DiagramModified Driver DiagramPDSA WorksheetRun chart template
21. Part II: The Improvement ToolboxCHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMProcess Map: Describes the sequence of events in the process of care your population is engaged in.Definitions WorksheetData Collection PlanDriver DiagramModified Driver DiagramPDSA WorksheetRun chart templateSoftware!Excel templates (see Toolbox)QI MacrosSPC XLMinitabOthers
22. Part III: Improvement MeasurementCHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMTypes of MeasurementStudy of VariationUsing Variation to Inform ImprovementRun ChartsRun Chart Practice!
23. Part III: Improvement MeasurementCHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMTypes of MeasurementStudy of VariationUsing Variation to Inform ImprovementRun ChartsRun Chart Practice!Three Faces of Improvement Measurement (article)
24. Part III: Improvement MeasurementCHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMTypes of MeasurementStudy of VariationUsing Variation to Inform ImprovementRun ChartsRun Chart Practice!Precision & Accuracy
25. Part III: Improvement MeasurementCHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMTypes of MeasurementStudy of VariationUsing Variation to Inform ImprovementRun ChartsRun Chart Practice!
26. Part III: Improvement MeasurementCHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMTypes of MeasurementStudy of VariationUsing Variation to Inform ImprovementRun ChartsRun Chart Practice!
27. Part III: Improvement MeasurementCHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMTypes of MeasurementStudy of VariationUsing Variation to Inform ImprovementRun ChartsRun Chart Practice!Poll QuestionsWhat is the median performance level?What is the precision?How many SHIFTS are there?How many TRENDS are there?What type of variation is present?
28. SummaryCHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMImprovement PassportImprovement ToolboxImprovement Measurement
29. Recommended ResourcesCHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMToolbox (Worksheets and Templates)Brief VideosFlowcharts TutorialDriver Diagrams (IHI)Defining Measures (Dartmouth Institute)Data Collection Plan (Dartmouth Institute)Intro to Variation and Run Charts (VAQS)
30. Thank You!CHRONIC HEALTH IMPROVEMENT RESEARCH PROGRAMBest wishes for success in your improvement work!e-mail: brant.j.oliver@dartmouth.edu | Dartmouth profile