PURPOSE:Quality Improvement (QI) measures are often cited as goals for individual practices and medical centers, and may someday form a component of reimbursement guidelines. To date, there have been relatively few QI metrics relevant to ambulatory pulmonary medicine published. Using a team-based approach, pulmonary faculty collaborated with QI experts to design and implement a QI dashboard for ambulatory care. Clinicians were encouraged to participate in this QI process to improve outcomes. These activities were linked with other ongoing QI activities, thereby creating a “Culture of Quality” within an academic Pulmonary Division.
METHODS:Pulmonary Division faculty and QI experts reviewed current literature and developed metrics for the Pulmonary Medicine QI “dashboard.” Patients were identified through ICD-based billing databases, and QI results data were obtained from both manual and automated review of the EMR (electronic medical record). The Division’s performance was monitored and presented in regular faculty meetings. Quarterly confidential individual scorecards gave each clinician feedback regarding their performance as compared to that of the entire Division’s faculty.
RESULTS:There were improvements in many QI measures over 18 months, approaching the 100% goal in several domains. Chest CT results follow-up improved (77% to 100%), as did methacholine challenge and cardiopulmonary exercise results follow-up (74% to 100%). Documentation of prescriptions for inhaled corticosteroids for all asthmatic patients improved (76% to 98%). GOLD-based care for COPD patients consistently improved with successive measurements, and documentation of smoking history and cessation counseling goals were consistently met. Results were presented regularly at faculty meetings and quarterly to individual clinicians. Clinicians assisted in the QI process with iterative improvements in data collection and results presentation.
CONCLUSION:QI measures for an academic Pulmonary Division can be designed, implemented, and monitored. Key components included a well-structured EMR, measureable outcomes, strong QI leadership, and specific interventions such as monthly QI review meetings and quarterly individual “report cards” with collaborative and non-punitive language.
CLINICAL IMPLICATIONS:Vigorous efforts to create a “Culture of Quality” can lead to numerous improvements in ambulatory pulmonary care.
DISCLOSURE:David Roberts, No Financial Disclosure Information; No Product/Research Disclosure Information