Quality Improvement Resources

Welcome to CHAMPS online quality improvement (QI) resources.  This set of resources is intended to assist Region VIII Community Health Centers (CHCs) in becoming more familiar with the functions of quality improvement.  Please contact the CHAMPS Clinical Quality Improvement Director if you have any questions about these materials or would like to share other useful resources you have found.

Please follow the links below for:
Brief History of QI in CHCs
Patient-Centered Medical Home and Meaningful Use
Links to Online QI Tools
QI Plan Assistance
QI Terms and Acronyms, Strategizing, and Decision Making
QI Related Webcasts & Videos

BRIEF HISTORY OF QI IN CHCS

Since the formation of CHCs during the 1960s, the goal has been to improve the health of underserved communities across the nation.  In the decades following, questions were raised as to whether CHCs provided good health care.  Literature on QI efforts in CHCs began to surface in the 1990s and CHCs became increasingly interested in learning how to continually improve services and demonstrate improved outcomes.

One of the largest QI undertakings in CHCs to date was the Health Disparities Collaborative™ (HDC).  Initiated in 1998 by the Health Resources and Services Administration (HRSA), Bureau of Primary Health Care (BPHC), in partnership with the Institute for Healthcare Improvement (IHI), the goal of the HDC was to improve health outcomes for all medically underserved people with chronic diseases.  The Chronic Care Model (CCM) was utilized as the overarching model for the HDC.  The CCM describes multiple dimensions that need to be addressed in order for health care services and patient outcomes to be improved; community resources and policies, healthcare organization, self-management support, decision support, delivery system design, and clinical information systems.

The HDC emphasized rapid Plan-Do-Study-Act (PDSA) cycles among other QI methods.  CHCs were taught through learning sessions based on a learning and improvement model adapted from the Institute for Healthcare Improvement’s Breakthrough Series.  The first HDC program focused on improving diabetes care.

Initially only five high-functioning health centers were chosen to pilot the HDC in 1998.  By 2004, 497 CHCs were participating in the HDC.  In addition to diabetes, the HDC focused on cardiovascular disease, asthma, depression, cancer, and the business case/redesign during the decade following 1998.

In more recent years, HRSA has encouraged PCAs to continue to support QI efforts in CHCs utilizing the methods and tools taught by the HDC as well as other QI methods.  HRSA initiated the HIV/AIDS Cross Part Collaborative in 2008, and the Patient Safety and Clinical Pharmacy Services Collaborative in 2011.  HRSA also formalized support for the Patient-Centered Medical Home (PCMH) and Meaningful Use models in 2011 to continue QI efforts in CHCs.

PATIENT-CENTERED MEDICAL HOME (PCMH) AND MEANINGFUL USE

Patient-Centered Medical Home (PCMH) principles and Meaningful Use (the adoption and use of electronic technology, including electronic health records, in a meaningful way) currently make up a large portion of QI activities in CHCs.  Please see the following CHAMPS webpages for more information on PCMH and Meaningful Use including histories and backgrounds, definitions, trainings, tools and resources:

Patient-Centered Medical Home (PCMH) Resources

Meaningful Use Information and Resources 

LINKS TO ONLINE QI TOOLS

Global Voice of Quality
http://asq.org/index.aspx
American Society for Quality
A global community providing information about quality improvement tools, ideas, events, trainings, and best practices

Health Center Quality Improvement
http://bphc.hrsa.gov/qualityimprovement/index.html
Health Resources and Services Administration (HRSA), Bureau of Primary Health Care (BPHC)
Addresses Clinical Quality Improvement, Performance Measures, Support Systems, etc. relating to the Health Center Program

Innovations and Quality Tools
https://innovations.ahrq.gov/
Agency for Healthcare Research and Quality (AHRQ)
Provides over 600 innovations carried out by health care organizations including the problem addressed, description of the activity, and results, and also provides over 1,500 quality improvement tools including guides, toolkits, methods, and best practices to improve care

Integrating Chronic Care and Business Strategies in the Safety Net: A Toolkit for Primary Care Practices and Clinics
www.ahrq.gov/professionals/systems/primary-care/businessstrategies/index.html
Agency for Healthcare Research and Quality (AHRQ)
Informs safety net providers on how to redesign their systems of care along the lines of the Chronic Care Model while attending to financial realities

Knowledge Center
www.ihi.org/knowledge/Pages/default.aspx
Institute for Healthcare Improvement
Provides tools, change ideas, quality measures, white papers, audio, video, improvement stories, and more

National Healthcare Quality and Disparities Reports
https://nhqrnet.ahrq.gov
Agency for Healthcare Research and Quality
A source for data on more than 250 measures of care quality, access and disparities that cover a broad array of health care services and settings of care.

National Quality Strategy Tools
http://www.ahrq.gov/workingforquality/toolkit.htm
Agency for Healthcare Research and Quality
An introduction to the National Quality Strategy and links to stakeholder toolkits

NCQA
http://www.ncqa.org/
National Committee for Quality Assurance
In addition to accreditation and certification resources and products, NCQA is a resource for health care measures data reports and provides access to PCMH benchmarking tools

Patient Safety, Quality and Risk Management Products/Services
www.ecri.org/components/HRC/Pages/RiskQual4.aspx
ECRI Institute
Institute provides clinical risk managment program resources on behalf of HRSA, for free to HRSA funded organizations, including evidence-based reviews, courses for continuing education credit, sample policies, standards and guidelines, and newsletters

Quality Improvement
www.hrsa.gov/quality/
Health Resources and Services Administration (HRSA)
Online resources including news, QI tools, leaders in quality, and a video forum

Resource Center
www.healthcarecommunities.org/ResourceCenter.aspx
Healthcare Communities
Web-based system that provides multiple means for the healthcare quality improvement community to share knowledge and contribute to each others’ QI work (formerly the Health Disparities Collaborative webpage)

Resource Library
www.improvingchroniccare.org/index.php?p=Resource_Library&s=159
Improving Chronic Illness Care
Offers a range of resources and tools designed for leading and managing improvement efforts within a variety of settings

Standardized Healthcare Performance Measures
http://www.qualityforum.org/who_we_are.aspx
National Quality Forum (NQF)
Reviews, endorses, and recommends use of standardized healthcare performance measure, also called quality measures

Team STEPPS for Office Based-Care
http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/officebasedcare/index.html
Agency for Healthcare Research and Quality (AHRQ)

This program adapts the traditional TeamSTEPPS concepts for use with office-based teams. TeamSTEPPS offers techniques, tools and strategies to assist health care professionals optimize team knowledge and performance.

QI PLAN ASSISTANCE

All CHCs should have a QI plan in place.  Following is an excellent tool designed to assist health centers with assessment of the current QI plan, equip staff to revise the plan, provide a QI plan design with a description of each plan element, and assure all the necessary elements are contained in the plan:
Quality Plan Assessment Tool
Georgia Association for Primary Health Care

HRSA provides a series of archived presentations aired live in 2010 and 2011 on designing and implementing a successful QI program that meets CHC core program and FTCA requirements.  The following series includes two sessions on designing and maximizing the effectiveness of a QI plan:
Quality Improvement and Risk Management Training
Health Resources and Services Administration (HRSA)

The National Association of Community Health Centers (NACHC) provides resources to assist community health centers with quality managment, including a link to a quality primer, a monograph, and training options.
Quality Management
National Association of Community Health Centers (NACHC)

Bi-State Primary Care Assocition, serving Vermont and New Hampshire, provides resources for developoing a QI Plan including a master work plan schedule, policy and procedure templates, PDSA worksheet, and other documents:
QI Plan
Bi-State Primary Care Association

QI TERMS AND ACRONYMS, STRATEGIZING, AND DECISION MAKING

Please follow the links below for more QI resources:
Quality Improvement Glossary of Terms and Acronyms
Quality Improvement Strategizing
Clinical Quality Improvement Decision Making and Flows 

QI RELATED WEBCASTS & VIDEOS

CLICK HERE to find the following archived webcasts in the CHAMPS Distance Learning Library:

Managing Change Series: Empowering CHCs to Succeed
Session 1 – Change as a Process, 8/25/10
Session 2 – Roles within the Change Process, 10/6/10
Session 3 – Resistance to Change, 12/1/10

Customer Service in CHCs Series
Session 1 – The Culture of Customer Service, 6/10/09
Session 2 – Customer Service: The Art of Caring, 7/22/09

Change for the Better Series
Session 1 – Creating Positive Work Relationships: Tools for Increasing Trust and Building Commitment to Shared Goals, 10/4/07
Session 2 – Introduction to Ethical Influencing: Asking for What You Want and Making Behavior Requests, 12/5/07
Session 3 – Confrontation without Conflict: How to Address Difficult Issues Directly and Respectfully, 2/7/08

CLICK HERE to find the following archived presentations from the 2015 CHAMPS Primary Care Conference:

Achieving the Quadruple Aim

Improving Clinic Workflow Efficiency with Learn Six Sigma Methodology

From Competition to Collaboration: Insights from the ACO Journey

Quality Transformation/PCMH