Quality Improvement Techniques for Public Health: Useful in - - PowerPoint PPT Presentation

Angela Carman, DrPH

March 2020

Quality Improvement Techniques for Public Health:

Useful in Addressing the Substance Use Disorder Crisis?

What is Quality Improvement?

“Systematic problem solving required to develop and improve products”

• Dr. W. Edwards Deming

“Big QI vs little qi”

The Opioid Epidemic in the United States

• From 1999 to 2017, more than 700,000 people have died from a

drug overdose.

• Around 68% of the more than 70,200 drug overdose deaths in

2017 involved an opioid.

• In 2017, the number of overdose deaths involving opioids

(including prescription opioids and illegal opioids like heroin and illicitly manufactured fentanyl) was 6 times higher than in 1999.

• On average, 130 Americans die every day from an opioid
• verdose.

https://www.cdc.gov/drugoverdose/epidemic/index.html

Plan

1. Identify and Prioritize Opportunities

• 2. Develop AIM

Statement

• 3. Describe the Current

Process

• 4. Collect Data on

Current Process

• 5. Identify All Possible

Causes

• 6. Identify Potential

Improvements

• 7. Develop Improvement

Theory/Idea

• 8. Develop Action Plan
• 1. Implement the

Improvement

Do

• 2. Collect and Document

the Data

• 3. Document Problems,

Observations, and Lessons Learned

Check/ Study

• 1. Reflect on the Analysis

Act

• 2. Document Problems,

Observation, and Lessons learned

Adopt Adapt Abandon

Standardize

Do Plan

The ABC’s of PDCA, G. Gorenflo and J. Moran

PDCA/PDSA Process

Identify all Possible Causes

Cause & Effect Diagrams – Construction

 Write the issue as a problem

statement on the right hand side

• f the page and draw a box

around it with an arrow running to it.

 This issue is now the effect

Effect

 Generate ideasas to

whatare the main causesof theeffect

 Label theseas the main

branch headers

 Organizesgroup

knowledgeaboutcauses

• f a problem and display

the information graphically

Effect Header Header Header Header

Cause & Effect Diagrams – Construction:

 Foreach main cause

category brainstorm ideas as towhatare the related sub-causes that might effectour issue

 Use the 5 Why techniques

when acause is identified

 Keep repeating the

question until noother causescan be identified

 List thesub-cause using

arrows

Effect Header Header Header Header

why why why why

Cause and Effect Diagrams – Construction:

Fishbone (Cause & Effect) Diagrams:

 6 Common categories of causes

Practice

• Step One:

– By table groups - Brainstorm risk factors/causes of Substance Use Disorder Mortality and Morbidity using a T-Chart

Mortality Morbidity

Practice

• Step Two:

– Select the list from either side

• f the T-Chart

(mortality or morbidity) – Organize information into a fishbone diagram

Mortality Morbidity OR

What we think vs What we know

Evidence-based Literature Review – Causes/Risk Factors

• Peer-reviewed literature
• CDC
• SAMHSA

Risk Factors/Effect – Substance Use Disorder

Uses of the Fishbone (Cause and Effect)

• Assessing membership

in the consortium

• Focusing on the specific

risk factor

• Selecting evidence-based

intervention(s) to target a specific risk factor

What is Working Around the Country?

CDC – What’s Working in the United States

1. Targeted Naloxone Distribution 2. Medication Assisted Treatment 3. Academic Detailing 4. Eliminating Prior-Authorization Requirements for Medications for Opioid Use Disorder 5. Screening for Fentanyl in Routine Clinical Toxicology Settings 6. 911 Good Samaritan Laws 7. Naloxone Distribution in Treatment Centers and Criminal Justice Settings 8. MAT in Criminal Justice Settings and Upon Release 9. Initiating Buprenorphine-based MAT in Emergency Departments

• 10. Syringe Services Programs

Evidence Based Strategies for Preventing Opioid Overdose

https://stacks.cdc.gov/view/cdc/59393

Plan

1. Identify and Prioritize Opportunities

• 2. Develop AIM

Statement

• 3. Describe the Current

Process

• 4. Collect Data on

Current Process

• 5. Identify All Possible

Causes

• 6. Identify Potential

Improvements

• 7. Develop Improvement

Theory/Idea

• 8. Develop Action Plan
• 1. Implement the

Improvement

Do

• 2. Collect and Document

the Data

• 3. Document Problems,

Observations, and Lessons Learned

Check/ Study

• 1. Reflect on the Analysis

Act

• 2. Document Problems,

Observation, and Lessons learned

Adopt Adapt Abandon

Standardize

Do Plan

The ABC’s of PDCA, G. Gorenflo and J. Moran

PDCA/PDSA Process

NEXT STEPS?