Implementation of the Standard of Care to Address Childhood Overweight and Obesity in Primary Care

QUALITY IMPROVEMENT PLAN:

By: Kimberly A. Deppe, MSN, ARNP-C, DNP studentNorthern Kentucky University

Learning Objectives:AT THE END OF THIS PRESENTATION:

•The student will develop an understanding of the need to identify overweight and obese children

•The student will analyze the quality improvement project value in supporting the adoption of the evidence-based guideline for the provision of care to overweight and obese children in primary care

•The student will be able to articulate areas of the plan causing questions and suggest changes to facilitate continual quality improvement in care.

Introduction

•Student

•Quality plan

•Relevant informtion from DNP project

•How is the quality plan needed

•How does the quality plan fit into the strategic plan of the facility/institution

The Multidisciplinary Team•W

ho is a shareholder• Healthcare organization

• Healthcare provider

• Patient

• Insurer

• General community

• Student

Multidisciplinary Team (cont.):• What are the shareholder responsibilities

• Healthcare organization

• Healthcare provider

• Patient

• Insurer

• General community

• Student

The Quality Model: •T

he PDCA Cycle for Improvement

•

Plan-

• D

o-

• C

heck-

• A

ct-

The PDCA Cycle for Learning and Improvement

Act

• What changes are to be made?

• Next cycle?

Plan• Objective• Questions and predictions (why)• Plan to carry out the cycle (who, what, where, when)• Plan for data collection Check

• Complete the analysis of the data

•Compare data to

predictions•Summarize what was

learned

Do• Carry out the plan• Document problems and unexpected observations• Begin analysis of the data

From: Associates in Process Improvement

Repeated Use of the PDCA Cycle

Hunches Theories

Ideas

Changes That Result

in Improvemen

t

A P

C D

APC

D

A P

C D

D CP A

Small Scale Testing

Follow-up Tests

Test new conditions

Implementation of Change

What are we trying toaccomplish?

How will we know that achange is an improvement?

What change can we make thatwill result in improvement?

Model for Improvement

Learning and Im

prove

mentEvid

ence &

Data

From: Associates in Process Improvement

Multiple PDCA Cycle Ramps

Test

ing a

nd

adap

tatio

n

A P

C D

A PC D

A P

C D

D CP A

A P

C D

A PC D

A P

C D

D CP A

A P

C D

A PC D

A P

C D

D CP A

A P

C D

A PC D

A P

C D

D CP A

Adopt guideline

Group visits

Non-MD roles in visit

flow

Registry

Change ConceptsFrom Associates in Process Improvement

Quality Planning•O

bjectives:• Apply evidence based guidelines as evidenced by the :

• Documentation of BMI

• Use of correct ICD 9

• Use of a specific care plan

Childhood Overweight and Obesity: Measuring Quality of Care

Process Outcome

Recognition of elevated BMI Counseling on diet and exercise Periodic follow-up Assessing symptom progress

BMI <85th percentile NORMAL BMI

Children with Overweight and Obesity: Challenges to Measuring Quality of Care

Process Outcome Correct diagnosis Periodic follow-up Assessing symptom progress Initiation of care plan

Improved BMI and symptom resolution

Quality Planning

•Data collection•Chart reviews

•BMI measurement• ICD-9 or 10 code for diagnosis•CPT code for treatment•Provider demographics

Quality Planning (cont.):

•Retrospective Review

•External Validity

•Selection Biases in Quasi-experimental design

Evaluation Methods

•Benchmarks

•Sustainability

•Ongoing evaluation

Communication Plan

•Methods

•Timing

Conclusion:

•Promotes quality care

•Protects

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