Journal of Continuing Education in the Health Professions



HOME \| SITE MAP \| CONTACT US
Your Location: Home > Volume 30, Issue 2

CURRENT ISSUE BACK ISSUES SUBSCRIBE ADVERTISE ABOUT JCEHP FOR AUTHORS JCEHP AWARD SEARCH (Members only) FULL-TEXT		Volume 30 (2) Volume 30, Issue 2, Spring 2010 J Contin Educ Health Prof 2010; 30(2) ORIGINAL RESEARCH Infrastructure for Large-Scale Quality-Improvement Projects: Early Lessons From North Carolina Improving Performance in Practice Warren P. Newton, Ann Lefebvre, Katrina E. Donahue, Thomas Bacon, Allen Dobson A b s t r a c t Introduction: Little is known regarding how to accomplish large-scale health care improvement. Our goal is to improve the quality of chronic disease care in all primary care practices throughout North Carolina. Methods: Methods for improvement include (1) common quality measures and shared data system; (2) rapid cycle improvement principles; (3) quality-improvement consultants (QICs), or practice facilitators; (4) learning networks; and (5) alignment of incentives. We emphasized a community-based strategy and developing a statewide infrastructure. Results are reported from the first 2 years of the North Carolina Improving Performance in Practice (IPIP) project. Results: A coalition was formed to include professional societies, North Carolina AHEC, Community Care of North Carolina, insurers, and other organizations. Wave One started with 18 practices in 2 of 9 regions of the state. Quality-improvement consultants recruited practices. Over 80 percent of practices attended all quarterly regional meetings. In 9 months, almost all diabetes measures improved, and a bundled asthma measure improved from 33 to 58 percent. Overall, the magnitude of improvement was clinically and statistically significant (P = .001). Quality improvements were maintained on review 1 year later. Wave Two has spread to 103 practices in all 9 regions of the state, with 42 additional practices beginning the enrollment process. Discussion: Large-scale health care quality improvement is feasible, when broadly supported by statewide leadership and community infrastructure. Practice-collected data and lack of a control group are limitations of the study design. Future priorities include maintaining improved sustainability for practices and communities. Our long-term goal is to transform all 2000 primary-care practices in our state. Lessons for Practice Curriculum can evolve from working with practices to achieve necessary system drivers into telling practices to complete a series of activities to improve quality. Quality-improvement consultants experienced in hospital quality-improvement campaigns may be readily available. Regional meetings should be held within driving distance and after hours so that practices need not close in order to attend. For this project, the greatest single obstacle to sustainable quality improvement may be the challenges and costs of acquiring data from EHR systems. Incentives may prove to be critical, but in this early phase, we have been able to get significant, positive movement with modest use of incentives. Many practices did not avail themselves of PI CME credit, and many were not aware of MOC Part IV.
HOME \| SITE MAP \| CONTACT US Copyright © 1996-2012 JCEHP.com & The Journal of Continuing Education in the Health Professions All rights reserved Disclaimer · About This Site · Web Editor · Make JCEHP Your Homepage Information on this site was last updated: 31 January 2012