MOQC Current State
Douglas Blayney, MD
Physician Lead, MOQC
MOQC RECOGNITION
MOQC QOPI CERTIFIED PRACTICES
MOQC Palliative Care Demonstration Project
Participants
MOQC OVERALL PERFORMANCE
ORAL CHEMOTHERAPY QOPI MEASURES MOQC SPRING 2012 RESULTS
Start Date Documented Symptoms/toxicities Assessed
0.0
20.0
40.0
60.0
80.0
100.0
0.0
20.0
40.0
60.0
80.0
100.0
Oral chemotherapy monitored on visit/contact following start of therapy
Documented Plan / Education prior to Start of Therapy
OPPORTUNITIES FOR IMPROVEMENT
STRONG PERFORMANCE
n = 20 sites
PALLIATIVE CARE DEMONSTRATION PROJECT:
Palliative Care Demonstration Project Overview
8 Teams 8 Months Compelling Reason to Change Clinical Framework: Integrated Palliative Care Measure of Performance: MOQC Dashboard Validated Tool: ESAS Quality Improvement Model: Institute of
Healthcare Improvement
Framework: Integrated Palliative Care
Palliative Care
Disease Modifying Treatments
Hospice
DiagnosisTreatments to Relieve Suffering/Improve QOL
6Mo Death
Bereavement
Measure of Performance
MOQC Palliative Care Dashboard
WHAT IS A DASHBOARD?
A dashboard is a visual display of the most important information needed to achieve one or more objectives; consolidated and arranged on a single screen so the information can be monitored at a glance
Like the one in your car, a business dashboard keeps your eye on key measures so you can prioritize appropriate actions
It is used by both those in leadership/ management and the general workforce as they are easy to understand and are a call to action
WHY USE A DASHBOARD?
• Quick and Easy– Provides a quick, easy to understand
look at how you are doing as a practice
• Focused– Concentrates on measures of top
importance
• Accountability – Uses goals to interpret results
WHAT IS THE MOQC PALLIATIVE CARE DASHBOARD?
It is an oncology practice management tool that presents performance on key palliative care QOPI measures in a summarized manner
Measures were selected from over 80 QOPI measures that were deemed most important for an oncology practice to assess their palliative care processes
MOQC- participating practices will receive an updated dashboard with every round of QOPI data
MOQC PALLIATIVE CARE DASHBOARD
MOQC MEASURE SELECTION
The corresponding QOPI #
for each measure
PALLIATIVE CARE CURRENT STATE ASSESSMENT
EXPLANATION OF CURRENT STATE
• CURRENT– Your practice’s score for from the most
current QOPI data (Or the most recent time period you submitted data)
• TREND ARROWS–Whether you improved, decreased or
stayed the same from the previously reported time period for that measure
• GOAL– Target for each measure set by MOQC
CURRENT STATE: STATUS INTERPRETATION
Green > 85% performance exceeding target
Yellow = 60-84% performance approaching goal
Red < 60 % performance – requiring attention
NOTE: Thresholds for # 7 (Chemo in last 2 weeks of life) are Green- <15% Yellow -16-30 % Red >30%
Fall '10 Spring '11 Fall '11 Spring '1240%
60%
80%
100%Dashboard Trend: MOQC Overall Performance
Pain: 2nd visit
Constipation: opioid
Well-being: 2nd visit
Pain: EOL
Dyspnea: EOL
Hospice/Pallia-tive Care
Goal: 60%
Goal: 85%
n= 41 sites and ~2,800 charts in Spring 2012
Fall '10 Spring '11 Fall '11 Spring '120%
20%
40%
60%
Dashboard Trend: MOQC Overall Performance
7
Goal: 30%
Goal: 15%
Lower Score is Better
n= 41 sites and ~2,800 charts in Spring 2012
Chemo last 2 weeks
PERFORMANCE IMPROVEMENT PLAN
1. Check Current Performance
2.Determine WHY Issue
3. Establish Improvement Plan
VALIDATED TOOLEDMONTON SYMPTOM ASSESSMENT SYSTEM
IMPROVEMENT MODELKevin DeHority
Quality Improvement Specialist University of Michigan
Adopted from: Langley GL, Nolan KM, Nolan TW, Norman CL, and Provost LP. The
Improvement Guide: A Practical Approach to Enhancing
Organizational Performance. Jossey-Bass, 1996.
• Institute for Healthcare Improvement (IHI) web site, “How to Improve,”
Foundations of Quality Improvement
Rapid Cycle QI requires teams to set aims, try out changes, and measure the effects…
• What are we trying to accomplish? (Aim)• How will we know that the change is an
improvement? (Measures)• What can we do to improve things? (Change)
How will I know if an idea will work?PDCA (Plan Do Check Act)
Step 1: Plan
• Decide with your team how you will implement this change on a small scale (plan it step by step)
• Identify who will do what and when they will accomplish the task
• Make some predictions about what you expect to happen after the change is implemented
• Set deadlines for key steps• Identify data you will need to see what effect this change has
made during the test period
How will I know if an idea will work?PDCA (Plan Do Check Act)
Step 2: Do
• Try it• Document problems and unexpected observations• Collect and monitor the data
How will I know if an idea will work?PDCA (Plan Do Check Act)
Step 3: Check
• Analyze what happened, look at what the data says about the change
• Summarize what you learned from the test. Did your data and observations match what you had predicted for this change?
– If yes, what else happened?– If not, then why not? Even failed tests teach teams a great deal about
their care system.
How will I know if an idea will work?PDCA (Plan Do Check Act)
Step 4: Act
By now, you know whether the change you tested is working
• If it is working...– You can plan to standardize and implement on a larger scale
• If it is not working…– Evaluate what happened so as to get ideas on how to modify the
change– Determine whether to try something else
Either way the cycle moves back to step 1 (Plan)
Displaying the Data
Two primary ways to display your data…
• Time Series Graphs— Collecting and plotting data over time
• Storyboards— Helps you display your project to others— Helps the team to understand its own progress— Show your results in a simple and structured way to
patients, families, senior leaders, other staff, and other organizations
Root Cause / Problem Solving
Waste / Problems are symptoms• We need to identify the root causes of waste /
problems• We must get to actionable, measurable, processes in
the future state that:
– Eliminate root causes of waste / problems– Prevent similar problems from reoccurring– Make future reoccurrences visual
PDCA (Plan Do Check Act)
PUTTING IT ALL TOGETHER:GETTING RESULTS
Pain Addressed: 2nd Visit
Well-being Assessed: 2nd Visit
Pain Addressed: EOL
Dyspnea Addressed: EOL
Hospice / Palliative Care
Constipation: Opioid Prescription
Chemotherapy: Last 2 Weeks
0% 20% 40% 60% 80% 100%
Spring 2012 QOPI Palliative Care MeasuresPalliative Care Demonstration Participants vs Other MOQC
Other MOQC Sites PC Demo Participants
Pain Addressed: 2nd Visit
Well-being Assessed: 2nd Visit
Pain Addressed: EOL
Dyspnea Addressed: EOL
Hospice / Palliative Care
Constipation: Opioid Prescription
Chemotherapy: Last 2 Weeks
0% 20% 40% 60% 80% 100%
QOPI Palliative Care MeasuresPalliative Care Demonstration Participants: Fall 2011 vs. Spring 2012
Spring 2012 Fall 2011
Average ESAS Scores for 8 Demonstration Participants
n= 730 ESAS forms / 8 practices
LESSONS LEARNED FROM KARMANOS
Michael Stellini, MD Palliative Care Specialist
Larmender Davis, MSW, LMSW Director Social Work & Support Services
Karmanos Cancer Institute
+
+
MichiganOncologyQualityConsortium
Transforming Oncology Care Together
Improving Symptom Management Exercise
FUTURE STATE: OPPORTUNITIES TO GET ENGAGED
Transforming Oncology Care Together
MOQC PALLIATIVE CARE NEEDS ASSESSMENT
1. Foundational (Advanced Directives)
8. Inter-disciplinary team approach
availability
2. Access
6. Communication w/Patients/Families
7. Documentation (Goals of Care &
Social Needs)
5. Communication w/in Care System
3. Symptom Management
4. Patient & Caregiver Education
Adapted from National Quality Forum
Complete The
Survey
Helpful ResourcesGroup Email• Email distribution where you can reach all MOQC
members interested in sharing best practices [email protected] drives in your folder• Includes tools, slides and other info to help your
quality improvement and Palliative Care effortsWebsitewww.MOQC.org
MOQC Working Groups
Annual Infusion Staff Competency Review checklist developmentExtravasation Management process and checklist development
• Commitment? ~4 hours of webinar participation and conference calls, from July to September
• Who? Infusion nurses, pharmacists, educators, or anyone interested in improving the infusion process
Mock Survey
We offer help in achieving QOPI Certification!• Assess your performance against the current
safety standards, prior to QOPI Certification site visit
• You will receive site-specific feedback, including a report with recommended improvements and resources
• Commitment? ~4 hours during the site visit