Basics of Quality Improvement
MIPS: Explaining the Quality Performance Category
The Merit-based Incentive Payment System includes a category on quality performance. Read more to learn about how to report and how the category is scored.
Quality improvement (QI) is a systematic, formal approach to the analysis of practice performance and efforts to improve performance.
A variety of approaches—or QI models—exist to help you collect and analyze data and test change. While it’s important to choose a reputable QI model to guide your efforts, it’s more important that you fully commit to using the QI process and good QI practices.
Benefits of QI
Understanding and properly implementing QI is essential to a well-functioning practice, and is nonnegotiable for any practice interested in improving efficiency, patient safety, or clinical outcomes.
In addition, good QI practices and improved patient outcomes position your practice for success by:
- Helping you prepare for the transition to value-based payment models.
- Allowing you to participate in the public reporting of physician-quality data.
- Giving you the opportunity to participate in federal quality improvement incentive programs, such as Meaningful Use and the Physician Quality Reporting System (PQRS).
- Equipping you with the skills necessary to apply for and complete national recognition programs, such as National Committee for Quality Assurance’s Diabetes Recognition Program and Patient-Centered Medical Home Recognition.
- CME Opportunities: Performance in Practice
- Patient-Centered Medical Home (PCMH)
- Process Mapping: A How-to Primer(2 page PDF)
- Agency for Healthcare Research and Quality (AHRQ)(www.ahrq.gov)
- Institute for Healthcare Improvement (IHI)(www.ihi.org)
- Health Resources Services Administration (HRSA(www.hrsa.gov))
The QI Basics
The quality improvement process is grounded in the following basic concepts:
- Establish a culture of quality in your practice. Your practice’s organization, processes, and procedures should support and be integrated with your QI efforts. This “QI culture” looks different for every practice, but may include establishing dedicated QI teams, holding regular QI meetings, or creating policies around your QI goals.
- Determine and prioritize potential areas for improvement. You will need to identify and understand the ways in which your practice could improve. Examine your patient population (e.g., to identify barriers to care, frequently diagnosed chronic conditions, or groups of high-risk patients) and your practice operations (e.g., to identify management issues such as low morale, long patient wait times, or poor communication). Or, use already established QI measures, such as measures from the National Quality Forum(www.qualityforum.org), Agency for Healthcare Research and Quality(www.qualitymeasures.ahrq.gov), Meaningful Use(www.cms.gov), or PQRS(www.cms.gov), to guide your efforts.
- Collect and analyze data. Data collection and analysis lie at the heart of quality improvement. Your data will help you understand how well your systems work, identify potential areas for improvement, set measurable goals, and monitor the effectiveness of change. It’s important to collect baseline data before you begin a QI project, commit to regular data collection, carefully analyze your results at the end of the project, and make decisions based on your analysis.
- Communicate your results. Quality improvement does not exist in a bubble— your QI efforts will affect your staff members and your patients. As you plan and implement a QI project, communicate your project needs, priorities, actions, and results to the entire practice, including patients. When a project is successful, celebrate and acknowledge that success.
- Commit to ongoing evaluation. Quality improvement is an ongoing process. A high-functioning practice will strive to continually improve performance, revisit the effectiveness of interventions, and regularly solicit patient and staff feedback.
QI Models and Tools
Quality improvement models present a systematic, formal framework for establishing QI processes in your practice. Examples of common QI models include the following:
- Model for Improvement (Plan-Do-Study-Act [PDSA] cycles)(www.ihi.org): The Institute for Healthcare Improvement’s Model for Improvement combines two popular QI models: Total Quality Management (TQM) and Rapid-Cycle Improvement (RCI). The result is a framework that uses PDSA cycles to test interventions on a small scale.
- Lean Six Sigma(asq.org): Lean Six Sigma combines two popular QI models: Lean and Six Sigma. The result is a framework that provides a means for assessing value of potential QI efforts and an approach to executing QI projects, referred to as DMAIC, or Define, Measure, Analyze, Improve, and Control.
Quality improvement tools are standalone strategies or processes that can help you better understand, analyze, or communicate your QI efforts. Examples of QI tools include run charts(www.ihi.org), process maps, and fishbone diagrams.
AAFP Office Champions Projects
AAFP Office Champions is a series of QI demonstration projects in which participating family physician practices select staff and physician office champions to lead the implementation of an intervention. Read the results: