Improving Immunizations: A CQI Approach

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Improving Immunizations A CQI Approach
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(No Transcript)
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Last week we learned

• Why influenza is specifically harmful to
  dialysis patients, and
• Why it is important to immunize

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Today we will talk about

• How to use CQI to improve vaccination rates
• How to identify common barriers
• How to develop strategies for overcoming the
  barriers

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What is CQI?

• Improving quality through
• Proactive approach
• Optimal orientation
• Process focus

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What is CQI?

• Improvement comes from the application of
  knowledge.
• Any approach to improvement must be based on
  building and applying knowledge.
• Significant, long-term, positive impact occur
  only when someone takes the initiative.

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The CQI Cycle
PLAN
ACT
DO
STUDY
The Cycle Never Ends
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It just keeps going, and going, and going
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A Cycle for Learning and Improvement
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The IHI Model for Improvement

• What are we trying to
• accomplish?
• How will we know that a
• change is an improvement?
• What changes can we
• make that will result in
• an improvement?

Act
Plan
Study
Do
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Understanding the Problem

• Establishing a problem statement
• Defining the scope of the problem
• Refining the problem

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Immunizations for Influenza

• Where are we currently?
• - What does the data say?
• -What is the trend?
• Where do we want to be?
• - What knowledge do we have?
• - What is our goal?

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Where Are We Now?
ESRD patients initiating therapy at least 90 days
before September 1, 2005, alive on December 31,
2005 vaccinations tracked between September 1
December 31.
illi
illi
lla
lla
USRDS ADR 2007
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What Knowledge Do We Have?

• Increased susceptibility of CKD patients to
  pneumococcal and hepatitis B (CDC)
• Failure to increase rates of immunization over
  past 10 years (USRDS)

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Where do we want to be?

• Healthy People 2010 Goals
• Influenza 90
• Pneumococcal 90
• Hepatitis B 80
• Network Medical Review Board recommendations
• CDC Guidelines

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What Are the Barriers?
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How Will We Know a Change Is an Improvement?

• Identify the barriers
• How do we measure that barrier?
• What does improvement look like?

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Identifying the Causes

• Which root causes are are specific to this
  dialysis unit?
• What barriers create this cause?
• What strategies can be implemented to overcome
  the barriers?

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Root Cause Analysis
Low immunization rates
HP 2010 Goal
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PlanningKey Components of a CQI Team

• Multidisciplinary
• Common goal
• Day-to-day knowledge

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Planning for Improvement

• Thinking outside the box
• Establishing accountability
• Setting a timeframe
• Evaluating results
• Documenting change

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REMEMBER
All improvement requires change but Not all
change is improvement
Evaluate the results!
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Thinking Outside the Box
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Rules of Creativity

• Challenge the boundaries
• Rearrange the order of the steps
• Look for ways to smooth the flow
• Evaluate the purpose
• Visualize the idea
• Remove the current way of doing things as an
  option

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Establishing Accountability
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• From the top down
• Support
• resources

• From the ground up
• Problem identification
• Idea development

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Implementing Change

• When given a choice between two systems, one of
  which they understand, people will use what they
  know.
• If you want to truly make a change, you must
  present an expectation and put in place a
  structure to effect the change.
• People need information in order to change.

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Setting A Timeframe
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Evaluate the Results
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Document the Change
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Resources

• Immunization Tools
• www.cdc.gov/vaccines/pubs/downloads/b_dialysis_gui
  de.pdf
• www.esrdnetwork6.org/STICCoalition.htm
• www.esrdnet11.org/quality/immunization_coalition.a
  sp
• www.esrdnet15.org/QI.htmstic
• CQI Tools
• ANNA
• ESRD Networks
• www.ihi.org

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Questions?Lsauls_at_nw6.esrd.netjdeane_at_nw11.esrd.ne
tkstrott_at_nw15.esrd.net