Plan-Do-Study-Act! Using the PDSA Cycle to Improve Your Performance Improvement Projects

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Plan-Do-Study-Act!Using the PDSA Cycle to
Improve Your Performance Improvement Projects
March 18, 2014
Presenter Christi Melendez, RN, CPHQAssociate
Director, Performance Improvement ProjectsHealth
Services Advisory Group, Inc.
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Performance Improvement Principle

• Your current systems and improvement strategies
  have resulted in your current outcomes.
• What youre doing is getting you the results you
  have.
• To GET different results, you have to DO
  something different.

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Selecting Changes

• While all changes do not lead to improvement, all
  improvement requires change.
• What changes can you make that will
• result in improvement?

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PDSA Cycle

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Identifying Barriers

• Conduct an initial barrier analysis to identify
  possible barriers.
• Brainstorming and the Five Whys
• Fishbone Diagram
• Key Driver Diagram

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Prioritizing Barriers

• Request data related to identified barriers.
• Evaluate whether data support barriers
  relevance.
• Rank barriersfrom highest to lowest priority.

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Plan Interventions

• Development of Interventions
• Avoid Passive Interventions
• Mailers
• Reminder letters
• Newsletter articles
• Postcards, flyers, and brochures
• Updating Web site/portals
• Robot calls

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Plan Interventions (cont.)

• Develop Active intervention(s) that directly
  address prioritized barriers and will impact
  indicator outcomes.
• Face-to-face education efforts (enrollee and
  provider)
• Outreach eventsboots on the ground
• Policy/process changes
• Performance report cards
• Incentive programs (enrollee and provider)

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PDSA Cycle

• Develop a strategy to implement the
  interventions.
• Develop a plan to test the intervention (Who?
  What? When? Where? What data need to be
  collected?)

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PDSA Cycle (cont.)

• Try the intervention on a small scale.
• Carry out the intervention as designed.
• Its better to do a few interventions well!

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PDSA Cycle (cont.)

• Evaluate the effectiveness of the intervention.
• Analyze your results.
• What did you learn?
• What were the results compared to your prediction?

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PDSA Cycle (cont.)

• Use what you learned from the evaluation/analysis.
  
• Refine or revise.
• Determine next steps.
• If successful, how will the intervention be
  rolled out on a larger scale?
• If unsuccessful, repeat the cycle.

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What It Takes to Get Improvement

• Improvement will not happen without these
  components
• Will
• Ideas
• Execution

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Setting Goals

• What are you trying to accomplish?
• The goal should be S-M-A-R-T.
• Specific
• Measurable
• Attainable
• Relevant
• Time-bound

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Managed Medical Assistance (MMA) Statewide PIPs

• There are two statewide PIPs
• Preventive Dental Services for Children
• Improving Prenatal Care and Well-Child Visits in
  the First Fifteen Months of LifeSix or More
  Visits

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Preventive Dental Indicator PIP

• Title The percentage of enrollees 1 to 20 years
  of age who had at least one preventive dental
  service during the measurement year.
• Numerator Total number of unduplicated enrollees
  1 to 20 years of age who had at least one
  preventive dental service under the supervision
  of a dentist. Codes D1000D1999.
• Denominator Eligible enrollees 1 to 20 years of
  age who have been continuously enrolled in
  Medicaid or Childrens Health Insurance Program
  (CHIP) Medicaid Expansion programs for at least
  90 days and are eligible to receive Early and
  Periodic Screening, Diagnosis, and Treatment
  (EPSDT) services.

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Prenatal/WCV PIP

• Four Potential Study Indicators
• Potential Study Indicator 1
• Title The percentage of women who had a live
  birth and received a prenatal care visit as an
  enrollee of the MMA plan in the first trimester
  or within 42 days of enrollment in the health
  plan.
• Numerator Total number of women who had a live
  birth and received a prenatal visit in the first
  trimester or within 42 days of enrollment.
• Denominator Eligible women who delivered a live
  birth on or between November 6 of the year prior
  to the measurement year and November 5 of the
  measurement year.

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Prenatal/WCV PIP (cont.)

• Potential Study Indicator 2
• Title The percentage of women who had a live
  birth and received greater than or equal to 81
  percent of expected prenatal visits.
• Numerator Total number of women who had an
  unduplicated count of greater than or equal to 81
  percent of the number of expected prenatal visits
  (adjusted for the month of pregnancy at time of
  enrollment and gestational age).
• Denominator Eligible women who delivered a live
  birth on or between November 6 of the year prior
  to the measurement year and November 5 of the
  measurement year.

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Prenatal/WCV PIP (cont.)

• Potential Study Indicator 3
• Title The percentage of women who received a
  full course of antenatal steroids completed prior
  to delivering a live, preterm newborn(s).
• Numerator Total number of women who received a
  full course of antenatal steroids completed prior
  to delivering a live, preterm newborn(s). Course
  of steroids must be completed prior to date of
  delivery.
• Denominator Women enrolled in the MMA plan
  delivering a live, preterm newborn(s) with gt24
  and lt32 weeks gestation completed.

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Prenatal/WCV PIP (cont.)

• Potential Study Indicator 4
• Title The percentage of children 0-15 months of
  age who received six or more well-child visits
  with a Primary Care Physician (PCP) during the
  measurement year.
• Numerator Total number of children who received
  six or more well-child visits with a PCP during
  their first 15 months of life.
• Denominator Eligible children 0-15 months of age
  during the measurement year.

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Measurement Periods

• Baseline January 1, 2014, through December 31,
  2014
• R1 January 1, 2015, through December 31, 2015
• R2 January 1, 2016, through December 31, 2016
• The eligible population size will be smaller for
  baseline than subsequent years due to the
  transition.

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Important Dates
DATE TASK
April 2, 2014 Comments and/or feedback on statewide PIP methodologies due to contract managers
April 15, 2014 Remaining two PIP proposals due to the Agency for Health Care Administration (AHCA)
May 20, 2014 Quarterly MeetingTallahassee
May 21, 2014 On-site, one-on-one technical assistance, as requested
August 1, 2014 PIPs due to AHCA with first six activities completed (Study Design)
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Questions