This study provided evidence on the effectiveness of a diabetes quality improvement initiative to achieve better patient outcomes by delivering evidence-based care.
Premier® engaged with Billings Clinic, an integrated delivery network (IDN) in Billings, Montana, in 2018 to determine if a package of training materials, peer to peer discussions and a quality measure dashboard could improve nine National Quality Forum (NQF) measures in a clinical population of patients with diabetes. These measures included blood sugar control, cardiovascular health, vaccines and preventive screenings.
The objective of the study included developing and providing training for an online application aimed at supporting a diabetes quality improvement initiative in an IDN and evaluating the impact of the initiative using a pre-post design.
As the Premier Applied Sciences® team began engaging with the site to launch the initiative, they determined that the initiative had the potential to improve population care quality measures (e.g., percent of patients with poorly controlled diabetes, influenza vaccination) and improve the healthcare utilization of patients with diabetes. The team also believed that the program would result in clinicians and staff attaining an improved knowledge and attitude toward diabetes care (Figure 1).
Figure 1. Study model for Quality Improvement to Improve Diabetes Care and Patient Outcomes with data collection tools, study measures and outcome measures.
Using a four-part learning strategy, the Billings Clinic team walked through the following components of understanding their measure rates and where to focus improvement strategies:
- The NQF definitions for each measure, with an emphasis on the codes that define the denominator and numerator.
- A screen shot of where the data was recorded in the site’s electronic medical record (EMR).
- A copy of the query built to extract the data.
- Data files for two patients who met the measure and two patients who did not meet the measure.
With these learning components, the Premier Applied Sciences team was able to work with the site to identify gaps in data and strategize workflow solutions to close those data gaps. After repeating this process for each of the nine study measures and using coaching calls to bring clinicians into the solutions discussions, the site felt confident they could continue this methodology after the intervention period was completed.
At the start of the initiative, the Billings Clinic team was slightly discouraged with their depression screening rates of about 2 percent and asked to prioritize work on that particular measure at the launch of the project. After examining their documentation and workflow, changes were made to roles and responsibilities, documentation, and necessary referrals, as it is well known that patients with diabetes have a higher than average rate of depression. As changes were implemented, the site saw their depression screening measure improve almost immediately, and by the end of the intervention, the rate had risen 1,400 percent.
This quality improvement intervention was the first time that Billings Clinic had participated in a targeted and monitored quality improvement initiative. By the end of this initiative, they stated that they planned to continue employing strategies learned during the study period in addition to continuously monitoring many of the nine study measures as well as new quality improvement measures.
When asked, site administrators said the most valuable lessons learned from the initiative were to take a deep dive into the measures, ask the right questions and dialogue with the larger team in order to facilitate workflow changes. Given the tools to better understand quality measures and how to target improvements, this team felt well-equipped and intended to continue identifying and improving their quality metrics and the health of their patients.
Given that this was the first quality improvement project for Billings Clinic, this study was successful in addressing measurement issues with workflow changes. While the measure changes were a mixed bag of improvements, the study site learned and implemented skills needed to continue practicing monitored quality improvement.
For more on Premier Applied Sciences and how you can put the Premier Applied Sciences team to work for you, visit: www.Premierinc.com/PAS