Practice Imprvement Netwrk (PIN) The Practice Imprvement Netwrk (PIN) The PIN is the utpatient, ambulatry netwrk f the Quality Imprvement Innvatin Netwrks (QuIIN). As QuIIN evlved frm a netwrk f practicing pediatricians created in 2005 int a hme fr multiple pediatric netwrks in 2011, PIN was brn t huse the existing QuIIN membership. http://quiin.aap.rg PIN Missin The missin f the PIN, a netwrk f practicing pediatricians and their staff, is t imprve care and utcmes fr children and families by testing practical tls, measures, and strategies fr use in everyday pediatric practice, the child s medical hme, as well as by infrmal assessment that prvides practicing pediatrician perspective int evidenced based recmmendatins and tls fr implementatin. Wh makes up the Netwrk? The PIN cnsists f practicing pediatricians and their staff teams, the majrity f whm have sme experience with quality imprvement and like being n the cutting-edge f practice innvatins. Purpse f this Applicatin T determine the apprpriateness f the prject fr implementatin by the PIN as well as assist in determining funding needs fr the prject. We will d this by assisting yu in cmpleting this applicatin designed t develp the prtcl fr yur imprvement prject. Yur Imprvement Prject Funding maybe required fr the services prvided by the PIN. Fr internal AAP Staff, yu are requested t submit this applicatin and estimated grant budget (if available) t QuIIN staff prir t submitting yur final grant RFP. Allw 2 weeks fr review f this applicatin and discussin f yur specific needs. Fr individuals external t the AAP, please cmplete the applicatin t the best f yur ability and submit t quiin@aap.rg. Once received, a call between yurself and the PIN leadership will be arranged. Once an applicatin is apprved and funding is secured, a Prject Planning Team will be frmed cnsisting f QI and clinical cntent expert(s) t finalizing the verall prject prtcl. Upn finalizing the prtcl, an AAP IRB applicatin will be submitted if required. Upn apprval f IRB, recruitment f practices fr yur prject can begin.
PIN Page 2 Funding/Prject Cst The cmpnents f this applicatin and hw they are carried ut will determine the budget estimates fr using the services prvided by the PIN. Cmpnents include: Prject design including yur aim, gals, timeline, etc. Methdlgy QI Science: determine aim & measures; rapid cycle testing; systematic apprach Evaluatin: pre- and pst- interventin Data Cllectin (extent f training n the interventin; length f data cllectin perid) Implementatin Methds Breakthrugh learning cllabrative (3 face-t-face sessins) Mdified learning cllabrative (2 face-t-face sessins) Telecnferences; listservs; ther Recruitment f Teams (desired prfile and number f sites that will participate) Final prduct/spread expectatins (eg tlkit, EQIPP curse, ther) Fr a brief verview f quality imprvement prjects in general yu may visit http://www.ihi.rg/ihi/tpics/imprvement/imprvementmethds/hwtimprve/ Feel free t meet with QuIIN staff prir t starting yur applicatin shuld yu care fr mre directin. Hwever, we d encurage yu t discuss this applicatin with QuIIN staff prir t submitting a budget t yur funder. Please cntact Jill Healy jhealy@aap.rg r Keri Thiessen at kthiessen@aap.rg r fr mre infrmatin. Date f Applicatin: Quality Imprvement Prject Title: Yur Name and Email Address: AAP Sectin, Cmmittee, Other Represented: Prject Start Date (starts upn AAP IRB apprval): Prir t Obtaining Funding (1-2 mnths) 2 8 weeks PIN review f applicatin; discuss budget estimates; determine draft prtcl 2 weeks PIN and QuIIN Steering Cmmittee review and apprval Pst Funding (4 12 mnths) 2-5 mnths Prject Planning Team meets t finalize prtcl 2-4 weeks AAP IRB applicatin preparatin 1-2 mnths - AAP IRB apprval Prject Timeline IRB Apprval (implementatin begins when IRB is apprved) 4-6 weeks Recruit Practices 5-12 mnths Data Cllectin Perid 1-3 mnths Cmpile and Reprt Results AAP Practice Imprvement Netwrk 2
PIN Page 3 1. Ratinale (Hw will the prject imprve healthcare fr children? What is the evidence fr testing this imprvement?) 2. What is the QI Prject s Aim Statement? (Include the strategic imprtance t patients and participants and their rganizatin, target ppulatin, anticipated numerical imprvement (gals), and timeframe fr achieving gals.) 3. Define the Prject s Perfrmance Measures (Fr each measure, indicate the surce (NQF, HEDIS, etc,) and the specificatin. If nt using natinally endrsed measures, explain evidence base and develpment prcess fr measures.) Measures are indicatrs f change. They answer the questin, Hw will we knw that a change is an imprvement? Measures are directly linked t aims and gals and can be integrated int daily wrk. QuIIN staff are available t discuss pssible measures with yu. Measures will likely be fine-tuned at a later date by yur wn planning team fr this prject. 4. What changes will the Prject implement and test t achieve imprvements in care? 5. What are the minimum criteria fr participatin fr a physician? (What wuld the members f the Netwrk d (e.g. review tls, test feasibility f measures r implementatin strategies, etc.)? Describe wh is needed fr this testing (e.g. pediatricians nly, multidisciplinary team, practices with specific patient characteristics, etc.) 6. What are the surces f data fr the Prject? (E.g. charts, registry, surveys, administrative data, direct data cllectin, etc.) D yu have a data cllectin instrument selected? If yes, please attach. 7. What is yur planned mechanism t spread results f yur Prject? (eg, publicatin f results in jurnal, tlkit develped, revisins made t plicy statement, etc) AAP Practice Imprvement Netwrk 3
PIN Page 4 8. What are the funding surces fr the Prject, if any? Prir t submitting yur RFP fr funding, please cmplete this applicatin and submit t: Keri Thiessen, MEd Senir Health Plicy Analyst QuIIN kthiessen@aap.rg 847-434-4260 Thank yu! Attachments Cnsideratins fr s Sample Sample Data Cllectin Tl AAP Practice Imprvement Netwrk 4
PIN Page 5 American Academy f Pediatrics Quality Imprvement Innvatin Netwrks Cnsideratins fr s Criteria used t select prjects Prjects presented fr Netwrk cnsideratin will be assessed and priritized n the fllwing criteria: Will the prject directly imprve the quality f care fr children r child health utcmes? Des the prject address an imprtant gap in pediatric health care? Des the prject address a tpic with large variatin in practice? Will the result f this prject imprve practice prcesses r efficiency? Is the idea timely and imprtant (e.g. plicy, ecnmic, clinical) Is the data cllectin required easily implemented int practice rutine? Can the prject be cmpleted in a reasnable length f time? (i.e. 2 t 18 mnths) Des the prject require input frm a natinal quality imprvement pediatric netwrk such as PIN vs frm a smaller set f healthcare prfessinals? Des the prject have adequate funding fr its scpe? AAP Practice Imprvement Netwrk 5
PIN Page 6 SAMPLE Date f Applicatin fr Review: June 25, 2008 Quality Imprvement Prject Title: Safe and Healthy Beginnings Yur Name and Email Address: Jane De, jde@aap.rg Sectin, Cmmittee, Other: Sectin n Perinatal Care Prject Start Date (starts upn AAP IRB apprval): June 2009 Prir t btaining Funding (1-2 mnths) 2 8 weeks QuIIN review f applicatin; discuss budget estimates; determine draft prtcl 2 weeks QuIIN Steering Cmmittee review and apprval Pst Funding (4 12 mnths) 2-5 mnths Prject Planning Team meets t finalize prtcl 2-4 weeks AAP IRB applicatin preparatin 1-2 mnths - AAP IRB apprval Prject Timeline IRB Apprval (prject begins when IRB is apprved) 4-6 weeks Recruit Practices 5-12 mnths Data Cllectin 1-3 mnths Cmpile and Reprt Results 1. Ratinale (Hw will the prject imprve healthcare fr children? What is the evidence fr testing this imprvement?) Safe and Healthy Beginnings supprts the implementatin f the AAP guideline fr management f hyperbilirubinemia and addresses issues raised by the changes in perinatal care ver the last decade. One f the mst striking changes in peripartum care ver the last 10-15 years is the decreased duratin f pstpartum hspitalizatin. Other significant changes include increased prevalence f breastfeeding (smetimes withut adequate lactatin supprt), and the rutine care f pre-term infants in the newbrn nursery. Participating teams will evaluate hw effectively tls, strategies and measures help nurseries and practices imprve care prcesses. 2. What is the QI Prject s Aim Statement? (Include the strategic imprtance t patients and participants and their rganizatin, target ppulatin, anticipated numerical imprvement (gals), and timeframe fr achieving gals.) T develp and test specific changes in the care f newbrns based n the AAP Management f Hyperbilirubinemia in the Newbrn Infant 35 r Mre Weeks f Gestatin Clinical Practice Guidelines. Changes tested t imprve care prcesses are related t: Preventin, assessment, and management f hyperbilirubinemia AAP Practice Imprvement Netwrk 6
PIN Page 7 Assessment and supprt f exclusive breastfeeding Crdinatin f care ensuring safe transitin f infants medical care frm hspital t medical hme Teams frm bth primary care practices and hspital nurseries will test a draft tlkit ver ver 11 mnths (March 2007 Feb 2008). A final set f measures, tls and strategies will be the prduct f this prject. This prduct will be packaged and disseminated thrugh the AAP s Marketing Department s all newbrn nurseries and primary care practices will have access t the tls, strategies and measures develped and tested frm this prject. 7. Define the Prject s Perfrmance Measures (Fr each measure, indicate the surce (NQF, HEDIS, etc,) and the specificatin. If nt using natinally endrsed measures, explain evidence base and develpment prcess fr measures.) Measure Surce Measure & Hw Calculated Gals AAP Management f Hyperbilirubinemia in the Newbrn Infant 35 r Mre Weeks f Gestatin Clinical Practice Guideline Recmmendatin Clinicians shuld advise mthers t nurse their infants at least 8 t 12 times per day fr the first several days 12 (evidence quality C: benefits exceed harms). Descriptin % f infants breastfed at time f initial visit t primary care practice Target Ppulatin: All newbrn infants attending target practice fr initial visit Numeratr: # infants wh are breastfeeding at time f initial visit t primary care practice Denminatr: All breastfeeding newbrn infants attending target practice fr initial visit whse charts are reviewed 100 % f infants breastfed at time f initial visit t primary care practice 8. What changes will the Prject implement and test t achieve imprvements in care? Each team will chse the changes that they implement r test, specific t their needs. All changes will be related t the prject measures. Changes ffered t teams fr testing include changes in: the timeframe fr assessment f risk fr severe hyperbilirubinemia and fllw-up related t same; changes in the way breastfeeding supprt is prvided t mthers; and changes in cmmunicatin and fllw-up with the infant s medical hme; adapting r implementing plicies, using new frms and tls, changing prcesses, etc. Specific changes TBD. 9. What are the minimum criteria fr participatin fr a physician? (What wuld the members f the Netwrk d (e.g. review tls, test feasibility f measures r implementatin strategies, etc.)? Describe wh is needed fr this testing (e.g. pediatricians nly, multidisciplinary team, practices with specific patient characteristics, etc.) Pediatricians and nurses frm bth primary care practices and newbrn nurseries. Participants will need t spend time t learn abut: the interventins t be tested; quality imprvement methds; hw t cllect and reprt data (ideally dne in a face-t-face sessin). Practices will be AAP Practice Imprvement Netwrk 7
PIN Page 8 asked t cllect baseline data, implement the interventin, make changes and cllect data again ver a 5 mnth perid f time t track changes in perfrmance f care prcesses related t hyperbilirubinemia, exclusive breastfeeding and transitin f care frm hspital t medical hme. Participants will use patient chart reviews fr the surce f data cllectin, cllect data mnthly, and attend mnthly cnference calls t discuss barriers and successes with the teams. 10. What are the surces f data fr the Prject? (E.g. charts, registry, surveys, administrative data, direct data cllectin, etc.) D yu have a data cllectin instrument selected? If yes, please attach. Chart Review. Draft chart review tl attached. Baseline data initially cllected. Interventin (draft tlkit) intrduced and tested ver 5 mnths. Data cllected mnthly during this perid using chart review. (Chart Review data cllectin instrument attached) Surveys cmpleted by teams will als be used t determine the usefulness f the tls (at mid- and end-pint) and t assess current systems fr prviding care (at mnths 1, 3, and 5). Surveys nt yet develped. 7. What is yur planned mechanism t spread results f yur Prject? (eg, publicatin f results in jurnal, tlkit develped, revisins made t plicy statement, etc) Publish a tlkit fr sale by the AAP; publish results in peer-reviewed jurnal; present results at cnferences 8. What are the funding surces fr the Prject? AAP Sectin n Perinatal Care funds, AHRQ CERTS grant, McNeil grant Prir t submitting yur RFP fr funding, please cmplete this applicatin and submit t: Keri Thiessen, MEd Senir Health Plicy Analyst QuIIN kthiessen@aap.rg 847-434-4260 Thank yu! AAP Practice Imprvement Netwrk 8
PIN Page 9 Sample Data Cllectin Tl AAP Practice Imprvement Netwrk 9