QI Measures for Clinical Practice:
A Practical Guide to Improve Your QI IQ
By Rob Bednar, PA-C and Tanya Darrow, PA-C
With the new changes in healthcare involving Patient-Centered Medical Home, Accountable Care Organizations, and the implementation of Meaningful Use, healthcare providers are looking more at how to efficiently and effectively deliver quality care. For PAs this has, and should always be, an essential part of how we practice. In fact, Quality Improvement Meetings are a job requirement.
Per the North Carolina Medical Board:
“…PAs in a new practice arrangement, meetings with the primary supervising physician must occur monthly for the first six months to discuss clinical matters and quality improvement (QI). After the first six months, such meetings must take place at least every six months. All meetings must be documented.”
So what exactly should this QI meeting entail? The essence of these meetings should involve ways to look at how one is practicing compared to current standards of care as well as looking at patient outcomes and determining where improvements can be made. Because the PA profession covers such a wide array of specialties and subspecialties these meetings are often tailored to one’s own practice. For example, PAs in Primary Care may focus more on long-term outcomes relevant to disease management, while PAs in surgery may focus more on honing surgical techniques or procedures within their scope of practice. The following items should be documented for review, if needed:
- Clinical Issue Presented (standard of care for specific disease states, improvements for techniques, etc.)
- Improvements/Recommendations to improve current clinical practice measures discussed
- Signature of both Supervising Physician (NOT back-up supervising physicians) and PA (or PAs)
There are various tools available, as well, that can serve as a modifiable template:
- PLAN—plan a change or test how something works.
- DO—carry out the plan.
- STUDY—look at the results. What did you find out?
- ACT—decide what actions should be taken to improve.
- FOCUS—define the process to be improved.
- ANALYZE—collect and analyze data to form a baseline.
- DEVELOP—based on data, develop action plan for improvement, including tool to measure/monitor.
- EXECUTE/EVALUATE—implement and measure improvement.
DMAIC Tool. For those familiar with Six Sigma, the DMAIC tool can be used.
One thing to keep in mind is QI meetings should not focus on the PA as simply an employee. For example, a simple statement such as, “[PA] has shown great improvement in efficiency and punctuality over the past few months. There are no concerns regarding current clinical practice so nothing was reviewed” is not an acceptable statement. If there were no concerns identified in the six months there are constant changes in medication and techniques that could serve as the clinical issue to be evaluated.
As a practicing PA in the same practice for even a time as brief as a few years, it can be very tempting to oversimplify required QI Meetings in order to save time and “get back to work.” This is especially true for those in practice with a good rapport with their supervising physician. For new graduates, a QI meeting may make you feel as though you’re being sent “to the Principal’s Office,” as one of my colleagues put it. Still, these meetings are essential not only for improving patient care but also for maintaining the integrity of the PA profession. In fact, starting in 2014, QI measures will be required for PAs as part of maintenance of certification (more information regarding these changes can be found at the NCCPA website: http://www.nccpa.net/CertMain.aspx).
Another important point for the practicing PA to remember: these QI meetings need to be done with each supervising physician (not back-up supervisors). If a PA has more than one supervising physician registered with the Board (example: part-time jobs) these meetings must take place with each.