Post on 25-Dec-2015
Leading Quality Improvements in Pediatric Rheumatology Care
A Learning Network Approach
Movement Toward Learning Networks
Are all children with JIA receiving the best care possible according to recommended guidelines?
Are pediatric rheumatologists working in systems that allow us to do the best by our patients?
Are patients and families getting all the information they need to understand JIA, make decisions about treatments, and effectively care for their child at home?
Are JIA Patients Achieving Desired Outcomes?
Research is Not Quickly Implemented
Research IS important but application lags
Average of 17 years for new evidence-based findings to reach clinical practice1
People talking to people is how norms and standards quickly change 2
What is needed are systems and a cultures where doing the right thing is what people do, day in and day out, even when no one is watching 2
1. http://www.ihi.org/resources/Pages/Publications/Managingclinicalknowledgeforhealthcareimprovement.aspx
2. http://www.newyorker.com/magazine/2013/07/29/slow-ideas
Healthcare Improvement
Needs a QI System • In current U.S healthcare system, patients often receive less than half of clinically indicated standard of care http://www.iom.edu/Reports/2001/Crossing-the-Quality-Chasm-A-New-Health-System-for-the-21st-Century.aspx).
• Improvement research requires a large base of data and instances to test improvement tools.
• Limitations - small numbers of pediatric patients at each clinic site.
Learning Networks Movement to Address
Needs• Multi-site, practice-based clinical networks.
• Combine engaged patients and families, multidisciplinary clinicians and staff, researchers and communities.
• By combining patients and practices across a Learning Network, improvement is enhanced and accelerated.*
• Provides foundation for QI research, testing and implementation.
Sample Learning Networks – Big and
Small• American Board of Pediatrics (ABP)
• Agency Healthcare Research and Quality (AHRQ)
• Patient-Centered Outcomes Research Institute (PCORI) is acclaimed for engaging patients and clinicians to improve health outcomes
• PR-COIN is 1of 9 Learning Networks coordinated by the Anderson Center of Health Systems Excellence at Cincinnati Children’s Hospital Medical Center.
QI systems are needed to support improvement
*http://www.cincinnatichildrens.org/service/j/anderson-center/learning-networks/default/
“It takes an average of 17 years for new knowledge generated by randomized controlled trails to be incorporated into practice, and even then application is highly uneven.“ Institute of Medicine reports (2001)
The Case for a JIA Learning Network
JIA:
• Chronic childhood painful, inflammatory joint condition
• Affects 1:1000 children• Can lead to long term
disability, pain and reduced quality of life
• Associated eye inflammation (uveitis) can cause vision loss
• Early diagnosis and proper treatment improves long term outcomes
Challenge:Variation• Variation exists in
treatment patterns by providers, medical centers and geographic locations
• Challenge: Patients are not reaching optimal outcomes (inactive disease, low pain score)
Opportunity: PR-COIN• Network of experts• Developed tools and
successful processes• Learning from peers
and share best practices
• Maintenance of Certification
• Outcomes:• Improve care• Increase family
engagement in process
PR-COIN Uses QI to Improve Care
Launched in 2011 as sustainable collaborative of pediatric rheumatologists with focus on quality improvement initiatives
16 Sites -2 Canada, 14 in US, and growing*
Over 2,260 unique patients registered in database and growing monthly*
*As of April 2015
International, quality improvement Learning Network working to improve care for children with Juvenile Idiopathic Arthritis
Learning Networks are Successful – ImproveCareNow example
Learning Network Success in Other Chronic Diseases
The successful Improve Care Now network is a stellar example of the power of learning networks. No new medications were introduced, yet by sharing insights, tools, documents and processes 66 teams standardized their site’s practice and reached 77% remission rates in 5 years. That is much better than the usual 17 years! There is power in collaborating.
Remission rate: 60% to 77%
66 Care Sites>500 physicians>15,000 patientsStandardized care
PR-COIN Structure, Approach and Achievements
PR-COIN teams learn from others, avoiding their mistakes and applying successful tools, concepts and practices to improve safe use of therapeutics and achieve improved outcomes.
QI Methods
Improve Inactive Disease RateReduce drug toxicity
Catch uveitis early and treat
Physical function measure
Toxicity Lab
monitoring
Uveitis Screening
Improved
Outcomes
Improved
Processes
Lead to
PR COIN Approach for Transforming Care Delivery in JIA Population
Proven QI methodolo
gy
Growing data
repository
Shared Tools
Tracking performance over time
Performance tracking of team
and network outcome and
process measures
10 sites submitting data
into Registry
1,850 unique patients in
database as of September 2014
IHIBreakthroug
h Series Model
QI tools to test small changes to
improve clinic
processes
Share best practices to reduce cost
& time
Shared Decision Making
Population Managemen
tPre-Visit Planning
Improved Care,
Processes and
Outcomes
A D
P
S
Percent of patients in remission on medications
for 6 months
0
20
40
60
80
100
PR-COIN Achievements: Examples of Statistically Significant Progress
As of October 2014
Percent of patients on DMARDs who had medication
counseling within the last 12 months
0
20
40
60
80
100
Parent Engagement Supports Improvement
Our Parent Working Group raises awareness about PR-COIN, advises and participates in network QI activities, and collaborates with local care teams by sharing insight about patient and family needs
Families representing 13 teams participate
The Facebook Group is growing and currently has 91 family members from across the nation
PR-COIN’s value is recognized through Grant Awards
PR-COIN and partners awarded PCORnet grant funded by PCORI (partners include the Arthritis Foundation, CARRA, Friends of CARRA and the Lupus Foundation)
STUDY ENDORSED BY
Independent Education Grant
Membership Benefits and Participation Expectations
Membership Benefits Maintenance of Certification credit (upon meeting
requirements) and serves as a quality improvement platform for Fellows
Monthly team and network level data reports Access to PR-COIN aggregate data for approved research
projects (teams also have access to their submitted data) Training in Quality Improvement methods and tools Quality Improvement consultation Twice yearly Learning Sessions and monthly informational
webinars Access to Member Only websites including use of the
Population Management Tool and Pre-Visit Planning Report PR-COIN materials, documents, presentations, and tools Web-based data submission Support with IRB and legal processes Your team is listed on public website
Benefits at Every Institutional Level
- Improve patient outcomes and engagement - Access to QI
tools and broad network of peers- Maintenance of Certification Part
IV - Learn best
practices
- Recognized as a leader in improving health care- Increased visibility and branding potential as members of international collaborative for outcomes excellence
- Exemplar for other divisional
QI efforts- Join a growing
international network of recognized institutions- Receive QI
initiative support aligned with
organizational priorities
Benefits to Pediatrics Department
Benefits to Our EntireOrganization
Benefits toRheumatology Division
Participation Expectations
Attendance at two Learning Session Conferences/year and at monthly informational webinars
Active conduct and reporting of local improvement activities to improve clinic processes and care by applying improvement science concepts and tools
Resources to test process improvements, manage data entry, and human subjects requirements (IRB, patient consent and legal agreements)
Annual site participation fee (fiscal year July – June)
Contact PR-COIN for additional details
PR-COIN SPONSORS (all)
An Anonymous Family Foundation
CCRF Place Outcomes Award
STUDY ENDORSED BY
independent grant for learning &
change
Find out how your team can improve outcomes for your patients with JIA.
Join PR-COIN today!
Contact PR-COIN coordinating center for further information at pr-coin@cchmc.org
Learn more at www.PR-COIN.org