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Quality Improvement

Where to Start

Introduction

Health Quality Ontario’s Quality Compass

Quality Improvement: Getting Started

The Quality Compass lists a variety of quality improvement tools and resources, including “how to” guides, tools and templates.

http://qualitycompass.hqontario.ca/portal/getting-started#.WfP-NWhSyM8

Institute for Healthcare Improvement

Open School: How to Improve with the Model for Improvement

This online course describes the Model for Improvement; the elements of an aim statement; process, outcome and balancing measures; change concepts and critical thinking tools; and small-scale testing using the Plan-Do-Study-Act cycle. Approximately 1 hour and 30 minutes to complete.

http://app.ihi.org/lmsspa/#/1431fa43-38e4-4e40-ab3b-7887d3254f72/41b3d74d-f418-4193-86a4-ac29c9565ff1

56 minute Video On Demand: An Introduction to the Model for Improvement
This tool provides a framework for organizing and guiding a team’s improvement journey.

http://www.ihi.org/education/WebTraining/OnDemand/ImprovementModelIntro/Pages/default.aspx

Safety Net Medical Home Initiative

Change Concepts: Quality Improvement Strategy

This guide provides an overview of quality improvement (QI) and detailed information and case studies on two common QI methods: the Model for Improvement and Lean. It also covers the role of measurement in PMH transformation and presents strategies for using data to drive and guide QI. Key changes for the Quality Improvement Strategy include the following:

  • Choose and use a formal model for QI.
  • Establish and monitor metrics to evaluate improvement efforts and outcome; ensure all staff members understand the metrics for success.
  • Ensure that patients, families, providers and care team members are involved in QI activities.
  • Optimize use of health information technology to meet meaningful use criteria.

http://www.safetynetmedicalhome.org/change-concepts/quality-improvement-strategy

Practice Reports

Health Quality Ontario

MyPractice: Primary Care

This resource provides customized confidential reports that give primary care physicians data about their practice and offer change ideas to help drive quality improvement. Reports include measures on access, continuity of care, chronic disease management, etc.

http://www.hqontario.ca/Quality-Improvement/Guides-Tools-and-Practice-Reports/Primary-Care

For patient enrolment model primary care physicians:

Cancer Care Ontario

Screening Activity Report

The Screening Activity Report (SAR) is an online tool available to primary care physicians who practice as part of a patient enrolment model. It provides screening data for breast, cervical and colorectal cancers to help physicians improve their cancer screening rates and appropriate follow-up. It also helps physicians better understand Cancer Care Ontario’s cancer screening guidelines. The report platform is interactive, allowing physicians to quickly find specific cancer screening information for each patient.

https://www.cancercareontario.ca/en/guidelines-advice/treatment-modality/primary-care/screening-activity-report

For existing teams:

Health Quality Ontario

Quality Improvement Plans

A Quality Improvement Plan (QIP) is a public commitment to meet quality improvement goals. By developing the plan, the organization outlines how it will improve the quality of care it provides to its patients, residents or clients. Hospitals, interprofessional primary care, LHIN home and community care, and long-term care homes submit QIPs. Find information on submitting QIPs at http://www.hqontario.ca/Quality-Improvement/Quality-Improvement-Plans

Quality Improvement Plan Reports

These reports summarize key findings from the previous year’s QIP and share successes and challenges.

http://www.hqontario.ca/Quality-Improvement/Quality-Improvement-Plans/Quality-Improvement-Plan-Reports

QIPs are publicly posted. To read individual QIPs or to search the QIP database, visit the QIP navigator website: https://qipnavigator.hqontario.ca/

For members only: Association of Family Health Teams of Ontario

Data to Decisions

Planning and Preparation Tool

Interactive Reports - For AFHTO members only

http://www.afhto.ca/members-only/d2d-interactive-report/

The AFHTO Data dictionary lists what indicators are being used by AFHTO and how they are defined - AHFTO F - Data-Dictionary-D2D-5.1-v1

Further Resources

Quality Improvement Methods

Health Quality Ontario

Quorum

Quorum is an online community where users can share ideas, ask questions and search a database of quality improvement projects. It also offers space for communities of practice.

https://quorum.hqontario.ca/

Choosing Wisely Canada / College of Family Physicians of Canada

Family Medicine

Choosing Wisely Canada is a campaign to help clinicians and patients have conversations about unnecessary tests, treatments and procedures. These discussions help clinicians and patients make informed choices and help ensure high-quality care. The recommendations have broad applicability across primary care.

https://choosingwiselycanada.org/family-medicine/

Choosing Wisely in Primary Care

http://www.hqontario.ca/Quality-Improvement/Quality-Improvement-in-Action/choosing-wisely-canada/choosing-wisely-in-primary-care

Choosing Wisely and Prevention Through Primary Care

http://www.cfpc.ca/ProjectAssets/Templates/Resource.aspx?id=8732

Canadian Foundation for Healthcare Improvement

12 minute 24 second Video: CFHI Quality Improvement Primer: Plan-Do-Study-Act (PDSA)

Plan-Do-Study-Act is an approach to developing, testing and implementing change. The use of sequential PDSA cycles facilitates improvement by enabling changes to be shaped by practical experience in the context of implementation. PDSA cycles follow a pattern similar to the scientific method or to the learning, treatment or nursing process. Using quantitative and qualitative data is a requirement of effective improvement work; the PDSA cycle provides a practical guide to collecting and using these data.

http://www.cfhi-fcass.ca/sf-docs/default-source/on-call/primer-videos/qi-primer-pdsa-e.pdf?sfvrsn=2

11 minute 53 second Video: CFHI Quality Improvement Primer: Driver Diagrams: Improvement Theory

The driver diagram is a tool to facilitate the development, use, refinement and communication of improvement theory. Improvement theory reflects the best available evidence, experience and analysis of the current system and local organizational context. The driver diagram is a structure for learning and should be continually refined as new understanding emerges. Driver diagrams can serve as effective communication tools, engaging a shared understanding of the reason change is being planned, tested and implemented.

http://www.cfhi-fcass.ca/sf-docs/default-source/on-call/primer-videos/qi-primer-driver-diagrams-e.pdf?sfvrsn=2

16 minute Video: CFHI Quality Improvement Primer: Achieving Successful Improvement

A growing body of literature and tools is providing an understanding of what promotes success and sustainability with quality improvement initiatives. This video introduces a new consolidated tool to help guide quality improvement teams and organizations to achieving QI success.

http://www.cfhi-fcass.ca/sf-docs/default-source/on-call/primer-videos/qi-primer-achieving-successful-improvement-e.pdf?sfvrsn=2

12 minute 18 second Video: CFHI Quality Improvement Primer: Highly Adoptable Improvement

Research has contributed to the understanding of what makes change initiatives and interventions more adoptable. This video explains the impact of workload and perceived value on improvement initiatives and explores a model and toolkit that can help teams and organizations design more adoptable improvement.

http://www.cfhi-fcass.ca/sf-docs/default-source/on-call/primer-videos/qi-primer-highly-adoptable-improvement-e.pdf?sfvrsn=2

Institute for Healthcare Improvement

Quality Improvement Essentials Toolkit

This resource includes 11 documents with the tools and templates needed to launch a successful quality improvement project and manage performance improvement.

http://www.ihi.org/resources/Pages/Tools/Quality-Improvement-Essentials-Toolkit.aspx

Measurement

Agency for Healthcare Research and Quality

Practice Facilitation Handbook: Measuring and Benchmarking Clinical Performance

Performance measurement involves collecting and reporting data on practices’ clinical processes and outcomes. Measuring clinical performance can create buy-in for improvement work in the practice and enables the practice to track its improvements over time. Performance measurement can also be used to identify and prioritize improvement goals and to track progress toward those goals.

https://www.ahrq.gov/professionals/prevention-chronic-care/improve/system/pfhandbook/mod7.html

Institute for Healthcare Improvement

49 minute 59 second Video On Demand: Building Skills in Data Collection and Understanding Variation
This webinar is designed to help teams successfully manage the milestones along the quality measurement journey.

http://www.ihi.org/education/WebTraining/OnDemand/DataCollection_Variation/Pages/default.aspx

56 minute 3 second Video On Demand: Using Run and Control Charts to Understand Variation
This webinar addresses the application of statistical process control methods, with specific attention given to run and control charts.

http://www.ihi.org/education/WebTraining/OnDemand/Run_ControlCharts/Pages/default.aspx

Quality Improvement Support and Training Programs

Ontario College of Family Physicians

Practising Wisely: Reducing Unnecessary Testing and Treatments

Practising Wisely: Reducing Unnecessary Testing and Treatment is a Mainpro+ certified Continuing Professional Development program.  This initiative of the Ontario College of Family Physicians aligns closely with the Choosing Wisely Canada (CWC) campaign to implement good healthcare stewardship and avoid over-medicalization. This hands-on, interactive program is comprised of four modules, each with a different area of focus. Participants will identify opportunities on how to "practise wisely", with a focus on reducing over-prescribing, over-imaging, over-screening and over-monitoring using the latest evidence and tools from diverse sources.

http://ocfp.on.ca/cpd/practising-wisely

Transdisciplinary Understanding and Training on Research–Primary Health Care (TUTOR-PHC)

TUTOR–PHC is a one-year pan-Canadian interdisciplinary research capacity building program that has been training primary and integrated health care researchers and decision-makers from family medicine, nursing, psychology, epidemiology, social work, occupational therapy, education, policy and many other disciplines since 2003.

http://www.uwo.ca/fammed/csfm/tutor-phc/

Association of Family Health Teams of Ontario

Information to Action – Available for AFHTO only (that offers teams Lean training).

For AFHTO members only.

https://www.afhto.ca/members-only/library/member-news/translating-information-to-action/

Health Quality Ontario

Quality Improvement: IDEAS (Improving & Driving Excellence Across Sectors)

This training program focuses on quality improvement designed for all healthcare professionals in Ontario.

http://www.hqontario.ca/Quality-Improvement/E-Learning-and-Events/ideas

Cancer Screening

Cancer Care Ontario

Primary Care Cancer Screening Quality Improvement Toolkit

The Primary Care Cancer Screening Team leads strategies that support primary care efforts in cancer screening participation, appropriateness and coordinated follow-up. The Cancer Screening Toolkit for Quality Improvement Plans (QIPs) was developed for Family Health Teams in support of Ontario’s Action Plan for Health Care’s focus on quality in primary care.

https://www.cancercareontario.ca/en/cancer-care-ontario/programs/primary-care/cancer-screening

Physician-Linked Correspondence

Available to all patient enrolment model physicians. Physician-linked correspondence includes physicians’ names in their rostered patients’ cancer screening letters.

https://www.cancercareontario.ca/en/guidelines-advice/treatment-modality/primary-care/physician-linked-correspondence

Methods and Strategies for Leading and Facilitating Quality Improvement

Agency for Healthcare Research and Quality Patient-Centered Medical Home Resource Center

Engaging Primary Care Practices in Quality Improvement: Strategies for Practice Facilitators

This document supports practice facilitators in encouraging primary care practices to undertake quality improvement (QI) activities. It addresses these questions:

  • How can practice facilitators begin to engage clinicians and staff in QI initiatives?
  • How can practice facilitators assess a practice’s readiness for QI initiatives?
  • How can practice facilitators gain initial buy-in and then maintain it for meaningful and sustained QI initiatives?

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