Quality Improvement Kara Bischoff, MD Palliative Medicine Fellow - PowerPoint PPT Presentation

Using PCQN Data for Quality Improvement Kara Bischoff, MD Palliative Medicine Fellow UCSF

PCQN Data • Daily symptom scores – Pain: none, mild, moderate, severe • Data reports – Pain score Day 1 – Comparison to Day 2

Baseline Data • January – June 2013 45.5% of patients who had pain on the day of initial palliative care consult experienced an improvement in their pain by the next day

Other PCQN Hospitals 100 100 80 69.2 Frequency (%) 60 46.9 46.5 42.2 40 20 0 Network Hospital 1 Hospital 2 Hospital 3 Hospital 4 (n=100) (n=43) (n=9) (n=15) (n=4)

Choosing a Goal Specific • Measureable • Achievable • Relevant • Time-bound • 25% improvement in the proportion of patients whose pain improved from the day of initial palliative care consultation to the following day, during 3 of 4 quarters.

July – Sept: Map the Process

Plans for Improvement • Determined steps that are: 1. quality gaps and 2. directly actionable • Analyzed specific cases • Talked to providers who provided care during exceptional months • We welcome your input as well!

Plans for Improvement 1. Patient education cards “ As your palliative care team, we want to improve your pain and other symptoms. You have been prescribed an "as needed" pain medication, ___________, which you can ask for every ___ hours . If you have pain, push your call button to ask for this medicine . If that medicine does not work within 1 hour, please tell your nurse. It is generally easier to stay out of pain than to get out of pain once it is severe. Please let your nurse know early when your pain is worsening. If you want to talk with our team directly, ask your nurse to page the palliative care team. We are committed to working with your primary team to help you feel better.”

Plans for Improvement 1. Patient education cards 2. Solicit help from RNs 3. Communicate recommendations in a clear and timely fashion PLAN  DO  STUDY  ACT

Results 60% 55% 50% 47% 44% 45% 40% 35% 30% Jan-Mar April-June July-Sept October

Results 60% 55% 50% 47% 44% 45% 41% 40% 35% 30% Jan-Mar April-June July-Sept October

Results 60% Goal = 57% 55% 50% 50% 47% 44% 45% 41% 40% 35% 30% Jan-Mar April-June July-Sept October

Summary PCQN data provides baseline and • ongoing data for quality improvement • Helps identify goals for improvement and monitor progress Link to patient allows for chart review to • identify challenges and opportunities Improvement is hard and possible • Strategies from successful teams would • be greatly appreciated

Questions?