Quality Teams Making Quality Improvements

An ambulatory quality improvement (AQI) learning collaborative in New Mexico, Quality Transformation in Practice (QTIP), is helping primary care practices (PCPs) bring about improvements in overall diabetes care, including checking blood pressure, blood sugar levels, and tobacco use assessments. The program also contributed to a 21 percent increase in flu vaccinations administered to diabetic patients.

The New Mexico Coalition for Healthcare Quality, AF4Q’s initiative in the state, launched QTIP in spring 2012. This was the first community AQI initiative in New Mexico, and it used coaching and facilitation tools to drive quality improvement in family practices. The coalition teamed with Envision New Mexico to use its practice coaching expertise for this program.

“The focus was using the chronic care model. The idea was to teach the sites and their providers how to use the quality improvement methodology to get practices where they want to be,” said Dr. Jane McGrath, director of Envision New Mexico.

Dr. McGrath was recruited to the project and authored the methods and processes. 

“We had to identify how the chronic care model would meet the needs of all patients. We centered on the theme of teamwork. We were thoughtful about recruiting diverse team members and setting priorities. A key factor was having strong internal leadership to support the quality improvement work.”

Four practices completed the pilot in April 2013. Three practices worked on diabetes management, and one focused on advanced pediatric overweight medical management. During the project, coaches conducted more than 40 onsite visits, and nearly 100 plan-do-study-acts (PDSAs) were captured. PDSA cycles helped the QTIP teams of nurses, doctors, community health workers, and others track changes and ideas and assess impact. These practices, with the help of their practice coaches, focused on delivery system redesign. Redesign themes included team practice (implementing a team huddle, forming an improvement team, creating “care teams”); care management (new roles and responsibilities for non-MDs, proactive follow-up with patients); visit system changes (streamlined appointments, open scheduling, group visits); and planned visits intended to help with improving the ambulatory patient experience domain of better communication.

“QTIP focused on clinical quality measures for chronic conditions, and there were improvements seen in the measures over the year that the project was in place at both of the sites I worked with. These improvements allow us to move forward with the monumental clinical changes in which we are currently engaged, which will positively impact the accountable quality care that we provide to our patients,” said Marsha Souers, NP, patient-centered medical home coordinator at First Choice Community Health Care, a participant in the program.

Souers worked as a coach with several QTIP sites. She said the practices that were most successful had everyone on board. A large change for several of the participating practices was converting from paper charts to electronic medical records.

“This project created a real change culture focused on redesigning the delivery of care in the participating practices,” said Patricia Montoya, Project Director of the New Mexico AF4Q Alliance. “The next step is to identify how to continue to expand and spread this work. “