Driving Quality Improvement in Family Practices

The New Mexico Coalition for Healthcare Quality launched its ambulatory quality improvement (AQI) learning collaborative Quality Transformation in Practice (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 practice. The coalition teamed with Envision New Mexico to utilize its practice coaching expertise for this program.

 

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, more than 40 onsite visits were conducted, and nearly 100 plan-do-study-acts (PDSAs) were captured. PDSA cycles help teams 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. The QTIP program developed quality tools specific to addressing QI key drivers to create a sustainable model for ongoing improvement linked to the chronic care model. These tools are now being used by other communities. This included a focus on standardizing and developing patient-centered medical homes.

 

Both qualitative and quantitative results from the practice coaching interventions illustrate success in moving toward data-driven interventions for diabetes and cardiovascular care and promote primary care practice redesign for increased quality for patient populations. “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.