#MEQAPI – Tweetchat Nov 30-2017 3:00ET Obesity: Effects on Practice

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement, and you can visit us at http://www.meqapi.org.

The steep rise in prevalence of obesity has had an effect on how medical practices operate. Everything from the width of doorways to seating configurations in waiting rooms, OR and inpatient bed reinforcements, gurney and stretcher design, hypodermic needle length, and dosage increments have had to accommodate the increasing size of patients.

Many years ago on an ambulance call to a local restaurant, and before the obesity epidemic, I came face to face with the practical problems related to obesity. The patient was a middle-aged male complaining of radiating chest pain, shortness of breath, and that old specter of “impending sense of doom”. Immediate history was a large meal, several units of wine, brandy and cigars, and a fierce argument with his wife over desert. What may have started with indigestion, anger, and a touch of gastric reflux turned into stress-induced angina. Of course, his 5’8″ 250 lb frame and history of hypertension added to the mix.

The most immediate problem was that he had sagged into a low chair, and our three-person EMT team was unable to lift him onto the collapsible ambulance gurney – which was also too narrow and did not have sufficiently strong struts in the collapsible undercarriage to bear his weight.

This Mobi Ambulance stretcher is a good example of equipment that is designed to be light-weight, and for its ability to load and secure easily in a standard ambulance. Ours was similar, but also many years ago, before fancy titanium alloys.

mobi-3g-aluminum-alloy-stretcher

Plan-B was to use the scoop stretcher.

Civiere_a_aubes

Author CDang

We quickly realized that we couldn’t get the halves together without manhandling the patient, pinching him, or tearing chunks out of ourselves. Once on the stretcher, we found he was overflowing the sides which were putting pressure on his tissue to an alarming degree. On lifting him, our alarm shifted to an unexpected degree of bowing in the stretcher frame that threatened to pop open the catches at the ends.

Naturally, the elevator was too short to accommodate us, and the two flights of stairs to the ground level was a physical challenge, as was the process of lifting him into the back of the ambulance.

The patient was safely delivered to a ED without being dropped or harmed, but the experience and our painful backs taught us that our equipment was just not suited to heavy patients, and that we had to rethink what we would dispatch to calls that involved high-BMI patients.

In this chat, we will scan the six arms of the QI framework, and discuss what challenges are encountered in medical practices, clinics, and hospitals, and what adaptations are required to provide care  for patients with high BMI.

 

 

Obesity

Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:

    • Methods
      • Policies: office, organization, or national policies, including, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Quality Improvement Policies
      • Subsidies and funding
      • Facility Policies
      • Specialty Policies
      • Employment policies
      • National and State Laws
      • Training
      • Navigable processes and policies
      • Patient Centeredness
      • Evidence Based Medicine standards
      • Value-based Care
    • Machines (incl equipment, EHR)
      • Personal Safety Equipment
      • Real Time Locator Systems (RTLS)
      • Med Equipment
      • Test and scanning equipment
      • Equip Ergonomics
      • Interoperability
      • EHR/Software
      • TeleHealth
      • Home Equipment
      • Access Control
      • Office Equipment
      • Product tracking
      • Outcomes tracking
    • People
      • Staffing: sufficient and qualified staff
      • Patients – objectives, attitudes, ability to cope, beliefs, power-distance, health literacy
      • Subject Experts
      • Malpractice suits
      • Role Models, celebrity influence
      • Peer support/conflict
      • Training
      • Vendors
      • Friends/Family
      • Patient participation
      • Attitudes/Bullying
    • Materials
      • Patients: as the “raw material” of the medical process. Patients may come with a range of attitudes, health problems, life situations, and ability to comply with treatment that are challenging and stressful.
      • Supplies: medical or office, inferior fax paper,
      • Data: ability to securely share with correct patient, specialist, lab, etc., and Access to Information
      • Patient self-care materials including checklists and how-to instructions, contact information for questions, and self-care consumables
      • OTC and home remedies and drugs
      • Impurities and variances in product strength and effect
      • Internet sources and access
      • Checklists, SoPs
      • Uniforms, footwear, personal protective equipment
      • Costed consumables
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Adverse effects reporting and metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Gini Index
      • Incentives and rewards
      • Adverse Event reporting
      • Effectiveness of measurement
      • Productivity Metrics
      • Patient Goals
    • Environment
      • Noise: distracting noises, sound levels too high, etc. due to computer systems
      • Space: Cramped, uncomfortable work space etc.
      • Time: Too little time per patient or order, too little time in a day, too many demands
      • Location: things where they should be on the screen, click distance, and location of workstation relative to point of care and patient
      • Control: the degree to which the individual can control their workload and how to accomplish it
      • Fairness: the perception that the burdens and rewards, the effort and outcomes are spread amongst stakeholders in an equitable way
      • Contamination and impurities
      • Temperature: too cold, too hot, too variable
      • Interruptions
      • Political climate
      • Social norms and group identity
      • Electrical Power
      • Climate and weather
      • Income inequality
      • Time
      • Direct marketing to patients

Some of the authors of the works cited above may be responding to the following topics, and participants are invited to describe their experiences of medication errors, and offer their insights and observations.

Topics

  1. What METHODS are involved in risks, issues, or practice adaptations to obesity
  2. What MACHINE factors are involved in risks, issues, or practice adaptations to obesity
  3. What PEOPLE factors are involved in risks, issues, or practice adaptations to obesity
  4. What MATERIALS are involved in risks, issues, or practice adaptations to obesity
  5. What MEASUREMENT factors are involved in risks, issues, or practice adaptations to obesity
  6. What ENVIRONMENTAL factors are involved in risks, issues, or practice adaptations to obesity

Background

MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.

To quote the IHI on what the Triple Aim encompasses:

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered. We expand this to include Affordability, STEEEPA.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

http://www.meqapi.org

The Author and Moderator: Matthew is a principal analyst for healthcare improvement at the Washington D.C. based firm of Whitney, Bradley, and Brown (WBB), and is a strategic adviser to the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and writes on topics related to healthcare quality improvement and knowledge management.

 

 

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Upcoming #MEQAPI Chats

Here is the schedule for forthcoming #MEQAPI chats

  • Nov 16 – No Chat
  • Nov 23 – Obesity and practice. Adapting to the increase in patient obesity rates
  • Nov 30 – No Chat (PEX VA conference)
  • Dec 7 – No Chat (Visiting ZA)
  • Dec 21 – Perfecting Practice – What would a perfect practice look like from QI perspective

Unscheduled but planned:

  • TBI & PTSD
  • Healthcare laws
  • Perfecting Patients
  • Perfecting Physician Education

Note: suggestions welcome! – Please DM @meqapi or use the #MEQAPI hashtag to pass on your ideas/

#MEQAPI – Tweetchat Nov 2-2017 3:00ET Complementary Modalities

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement, and you can visit us at http://www.meqapi.org.

Firstly, some definition around what we mean by “complementary care” modalities.

We are distinguishing between care modalities that are “alternative” and those that are “complementary”. By alternative, we mean any care modality that is not Evidence Based Medicine (EBM) and which replaces EBM. Offering aromatherapy, yoga, or homeopathy instead of EBM, would be seen in this context as “alternative”.

In contrast, some of the same modalities may be seen as complementary where they are used in conjunction with EBM. Here there is a lot to say for modalities which enhance access or efficacy of EBM and which thereby lead to improved patient outcomes.

In looking at complementary modalities, we should perhaps examine them in the light of the MEQAPI standard – will they lead to care that is STEEEPA. Will the resulting care be Safe, Timely, Effective, Efficient, Equitable, Patient-Centered, and Affordable?

Consider this: while we might dismiss the use of aromatherapy as a replacement for drugs to treat cancer, what if the aromatherapy could help the patient to stick with their chemotherapy? What if art therapy didn’t replace clinical talk therapy and anti-psychotics, but enabled the patient to attend sessions and stay on their medication?

If a complementary care modality results in a patient achieving their health goals in a way that is STEEEPA, is there any reason to object? If their drumming sessions, acupuncture, or meditation puts them in a mental place from which they are more able to access, use, and stay with their EBM care plan, should it be encouraged?

There are obviously considerations and potential complications – will the complementary modality add any risks, affect dosages or create additional side effects, or lead to confusion in results of medical tests?

The potential downsides to complementary care are numerous: they are often unregulated and have wide variation is dosage and effect. Herbal and other potions, lotions, and products may containvery serious contaminants, including arsenic, lead, and mercury. Physical manipulations such as chiropractic have been linked to internal injuries, including broken bones, and may create a significant stroke risk.

Some “natural” remedies have very serious interactions with EBM drugs, and many cases have been listed of injury and death because the remedy either reduced the efficacy of a critical drug, or added to the effect in ways that resulted in harmful overdose.

We will take a QI approach, and discuss the topic using each of the typical arms of the basic Quality Improvement Ishikawa diagram to guide and support discussion. An Ishikawa diagram will be provided ahead of time and during the chat.

Complimentary Care

Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:

    • Methods
      • Policies: office, organization, or national policies, including, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Quality Improvement Policies
      • Subsidies and funding
      • Facility Policies
      • Specialty Policies
      • Employment policies
      • National and State Laws
      • Training
      • Navigable processes and policies
      • Patient Centeredness
      • Evidence Based Medicine standards
      • Value-based Care
    • Machines (incl equipment, EHR)
      • Personal Safety Equipment
      • Real Time Locator Systems (RTLS)
      • Med Equipment
      • Test and scanning equipment
      • Equip Ergonomics
      • Interoperability
      • EHR/Software
      • TeleHealth
      • Home Equipment
      • Access Control
      • Office Equipment
      • Product tracking
      • Outcomes tracking
    • People
      • Staffing: sufficient and qualified staff
      • Patients – objectives, attitudes, ability to cope, beliefs, power-distance, health literacy
      • Subject Experts
      • Malpractice suits
      • Role Models, celebrity influence
      • Peer support/conflict
      • Training
      • Vendors
      • Friends/Family
      • Patient participation
      • Attitudes/Bullying
    • Materials
      • Patients: as the “raw material” of the medical process. Patients may come with a range of attitudes, health problems, life situations, and ability to comply with treatment that are challenging and stressful.
      • Supplies: medical or office, inferior fax paper,
      • Data: ability to securely share with correct patient, specialist, lab, etc., and Access to Information
      • Patient self-care materials including checklists and how-to instructions, contact information for questions, and self-care consumables
      • OTC and home remedies and drugs
      • Impurities and variances in product strength and effect
      • Internet sources and access
      • Checklists, SoPs
      • Uniforms, footwear, personal protective equipment
      • Costed consumables
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Adverse effects reporting and metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Gini Index
      • Incentives and rewards
      • Adverse Event reporting
      • Effectiveness of measurement
      • Productivity Metrics
      • Patient Goals
    • Environment
      • Noise: distracting noises, sound levels too high, etc. due to computer systems
      • Space: Cramped, uncomfortable work space etc.
      • Time: Too little time per patient or order, too little time in a day, too many demands
      • Location: things where they should be on the screen, click distance, and location of workstation relative to point of care and patient
      • Control: the degree to which the individual can control their workload and how to accomplish it
      • Fairness: the perception that the burdens and rewards, the effort and outcomes are spread amongst stakeholders in an equitable way
      • Contamination and impurities
      • Temperature: too cold, too hot, too variable
      • Interruptions
      • Political climate
      • Social norms and group identity
      • Electrical Power
      • Climate and weather
      • Income inequality
      • Time
      • Direct marketing to patients

Some of the authors of the works cited above may be responding to the following topics, and participants are invited to describe their experiences of medication errors, and offer their insights and observations.

Topics

  1. What METHODS increase or reduce risks related to use of Complementary Care Modalities
  2. What MACHINE factors increase or reduce risks related to use of Complementary Care Modalities
  3. What PEOPLE issues increase or reduce risks related to use of Complementary Care Modalities
  4. What MATERIALS increase or reduce risks related to use of Complementary Care Modalities
  5. What MEASUREMENT factors increase or reduce risks related to use of Complementary Care Modalities
  6. What ENVIRONMENTAL factors increase or reduce risks related to use of Complementary Care Modalities

Background

MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.

To quote the IHI on what the Triple Aim encompasses:

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered. We expand this to include Affordability, STEEEPA.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

http://www.meqapi.org

The Author and Moderator: Matthew is a principal analyst for healthcare improvement at the Washington D.C. based firm of Whitney, Bradley, and Brown (WBB), and is a strategic adviser to the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and writes on topics related to healthcare quality improvement and knowledge management.

 

 

#MEQAPI – Tweetchat Nov 2-2017 3:00ET Complementary Modalities

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement, and you can visit us at http://www.meqapi.org.

Firstly, some definition around what we mean by “complementary care” modalities.

We are distinguishing between care modalities that are “alternative” and those that are “complementary”. By alternative, we mean any care modality that is not Evidence Based Medicine (EBM) and which replaces EBM. Offering aromatherapy, yoga, or homeopathy instead of EBM, would be seen in this context as “alternative”.

In contrast, some of the same modalities may be seen as complementary where they are used in conjunction with EBM. Here there is a lot to say for modalities which enhance access or efficacy of EBM and which thereby lead to improved patient outcomes.

In looking at complementary modalities, we should perhaps examine them in the light of the MEQAPI standard – will they lead to care that is STEEEPA. Will the resulting care be Safe, Timely, Effective, Efficient, Equitable, Patient-Centered, and Affordable?

Consider this: while we might dismiss the use of aromatherapy as a replacement for drugs to treat cancer, what if the aromatherapy could help the patient to stick with their chemotherapy? What if art therapy didn’t replace clinical talk therapy and anti-psychotics, but enabled the patient to attend sessions and stay on their medication?

If a complementary care modality results in a patient achieving their health goals in a way that is STEEEPA, is there any reason to object? If their drumming sessions, acupuncture, or meditation puts them in a mental place from which they are more able to access, use, and stay with their EBM care plan, should it be encouraged?

There are obviously considerations and potential complications – will the complementary modality add any risks, affect dosages or create additional side effects, or lead to confusion in results of medical tests?

The potential downsides to complementary care are numerous: they are often unregulated and have wide variation is dosage and effect. Herbal and other potions, lotions, and products may containvery serious contaminants, including arsenic, lead, and mercury. Physical manipulations such as chiropractic have been linked to internal injuries, including broken bones, and may create a significant stroke risk.

Some “natural” remedies have very serious interactions with EBM drugs, and many cases have been listed of injury and death because the remedy either reduced the efficacy of a critical drug, or added to the effect in ways that resulted in harmful overdose.

We will take a QI approach, and discuss the topic using each of the typical arms of the basic Quality Improvement Ishikawa diagram to guide and support discussion. An Ishikawa diagram will be provided ahead of time and during the chat.

Complimentary Care

Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:

    • Methods
      • Policies: office, organization, or national policies, including, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Quality Improvement Policies
      • Subsidies and funding
      • Facility Policies
      • Specialty Policies
      • Employment policies
      • National and State Laws
      • Training
      • Navigable processes and policies
      • Patient Centeredness
      • Evidence Based Medicine standards
      • Value-based Care
    • Machines (incl equipment, EHR)
      • Personal Safety Equipment
      • Real Time Locator Systems (RTLS)
      • Med Equipment
      • Test and scanning equipment
      • Equip Ergonomics
      • Interoperability
      • EHR/Software
      • TeleHealth
      • Home Equipment
      • Access Control
      • Office Equipment
      • Product tracking
      • Outcomes tracking
    • People
      • Staffing: sufficient and qualified staff
      • Patients – objectives, attitudes, ability to cope, beliefs, power-distance, health literacy
      • Subject Experts
      • Malpractice suits
      • Role Models, celebrity influence
      • Peer support/conflict
      • Training
      • Vendors
      • Friends/Family
      • Patient participation
      • Attitudes/Bullying
    • Materials
      • Patients: as the “raw material” of the medical process. Patients may come with a range of attitudes, health problems, life situations, and ability to comply with treatment that are challenging and stressful.
      • Supplies: medical or office, inferior fax paper,
      • Data: ability to securely share with correct patient, specialist, lab, etc., and Access to Information
      • Patient self-care materials including checklists and how-to instructions, contact information for questions, and self-care consumables
      • OTC and home remedies and drugs
      • Impurities and variances in product strength and effect
      • Internet sources and access
      • Checklists, SoPs
      • Uniforms, footwear, personal protective equipment
      • Costed consumables
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Adverse effects reporting and metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Gini Index
      • Incentives and rewards
      • Adverse Event reporting
      • Effectiveness of measurement
      • Productivity Metrics
      • Patient Goals
    • Environment
      • Noise: distracting noises, sound levels too high, etc. due to computer systems
      • Space: Cramped, uncomfortable work space etc.
      • Time: Too little time per patient or order, too little time in a day, too many demands
      • Location: things where they should be on the screen, click distance, and location of workstation relative to point of care and patient
      • Control: the degree to which the individual can control their workload and how to accomplish it
      • Fairness: the perception that the burdens and rewards, the effort and outcomes are spread amongst stakeholders in an equitable way
      • Contamination and impurities
      • Temperature: too cold, too hot, too variable
      • Interruptions
      • Political climate
      • Social norms and group identity
      • Electrical Power
      • Climate and weather
      • Income inequality
      • Time
      • Direct marketing to patients

Some of the authors of the works cited above may be responding to the following topics, and participants are invited to describe their experiences of medication errors, and offer their insights and observations.

Topics

  1. What METHODS increase or reduce risks related to use of Complementary Care Modalities
  2. What MACHINE factors increase or reduce risks related to use of Complementary Care Modalities
  3. What PEOPLE issues increase or reduce risks related to use of Complementary Care Modalities
  4. What MATERIALS increase or reduce risks related to use of Complementary Care Modalities
  5. What MEASUREMENT factors increase or reduce risks related to use of Complementary Care Modalities
  6. What ENVIRONMENTAL factors increase or reduce risks related to use of Complementary Care Modalities

Background

MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.

To quote the IHI on what the Triple Aim encompasses:

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered. We expand this to include Affordability, STEEEPA.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

http://www.meqapi.org

The Author and Moderator: Matthew is a principal analyst for healthcare improvement at the Washington D.C. based firm of Whitney, Bradley, and Brown (WBB), and is a strategic adviser to the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and writes on topics related to healthcare quality improvement and knowledge management.

 

 

#MEQAPI – Tweetchat Oct 19-2017 3:00ET #ChoosingWisely

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement, and you can visit us at http://www.meqapi.org.

I want you to look at the following chart. It categorizes the current level of waste in the U.S. Healthcare system in billions of dollars, per year.

MEQAPI- Waste

The “good” news is that we aren’t missing too many opportunities to prevent illness – only $55 Billion dollars a year are lost because we didn’t effectively address a preventable illness.

The rest of the news is pretty appalling. We waste more on fraud and abuse than missed opportunities, and even knowing that medical prices in the U.S. are exorbitant, excessive prices are easily outstripped by how inefficiently we deliver care. And then there is oversupply. $210 Billion in oversupply is a stunning number, made even more ironic because even with that, we still had the $55 Billion worth of missed opportunities.

One component of a solution to bringing down these embarrassing numbers is to partner with patients in a value-based and patient-centered approach to using evidence-based medicine in a way that addresses the patients health goals.

Let’s unpack that jargon-stew.

  • Patient partnership: plainly put, if the patient isn’t part of the team, then chances are they won’t comply at a very high rate, and the care plan will address something other than what the patient sees as priorities. Priorities must be a joint effort, and not dictated by the physicians if we want the patients to comply with the plan and have a sense of ownership, and not left to the patient if we want the plan to be medically sound.
  • Value-based: The alternative option is Fee-for-Service, which prioritizes profit over patient well-being, and nothing will shut down patient trust and partnership faster than the thought that the selection of the care plan is about profits rather than health.
  • Patient-Centered:  IOM (Institute of Medicine) describes patientcentered care as: “Providing care that is respectful of, and responsive to,  individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.”
  • Evidence-based medicine: This is about using things that work, and updating practice to stay in line with what we can prove is working. Masic et al, describe EBM is follows “… the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. EBM integrates clinical experience and patient values with the best available research information.

The American Board of Internal Medicine (ABIM) has launched the “Choosing Wisely” campaign as an attempt to move us down this path.

Choosing Wisely aims to promote conversations between clinicians and patients by helping patients choose care that is:

  • Supported by evidence
  • Not duplicative of other tests or procedures already received
  • Free from harm
  • Truly necessary

 

The following pertinent articles have been provided by Physician’s Weekly:

We will take a QI approach, and discuss the topic using each of the typical arms of the basic Quality Improvement Ishikawa diagram to guide and support discussion. An Ishikawa diagram will be provided ahead of time and during the chat.

ChoosingWisely

Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:

    • Methods
      • Policies: office, organization, or national policies, including, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Quality Improvement Policies
      • Subsidies and funding
      • Facility Policies
      • Specialty Policies
      • Employment policies
      • National and State Laws
      • Training
      • Navigable processes and policies
      • Patient Centeredness
      • Evidence Based Medicine
      • Value-based Care
    • Machines (incl equipment, EHR)
      • Personal Safety Equipment
      • Real Time Locator Systems (RTLS)
      • Med Equipment
      • Equip Ergonomics
      • Interoperability
      • EHR/Software
      • TeleHealth
      • Home Equipment
      • Access Control
      • Office Equipment
      • Product tracking
      • Outcomes tracking
    • People
      • Staffing: sufficient and qualified staff
      • Patients – objectives, attitudes, ability to cope, beliefs, power-distance, health literacy
      • Subject Experts
      • Malpractice suits
      • Role Models, celebrity influence
      • Peer support/conflict
      • Training
      • Vendors
      • Friends/Family
      • Patient participation
      • Attitudes/Bullying
    • Materials
      • Patients: as the “raw material” of the medical process. Patients may come with a range of attitudes, health problems, life situations, and ability to comply with treatment that are challenging and stressful.
      • Supplies: medical or office, inferior fax paper,
      • Data: ability to securely share with correct patient, specialist, lab, etc., and Access to Information
      • Patient self-care materials including checklists and how-to instructions, contact information for questions, and self-care consumables
      • Internet sources and access
      • Checklists, SoPs
      • Uniforms, footwear, personal protective equipment
      • Costed consumables
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Gini Index
      • Incentives and rewards
      • Adverse Eventss reporting
      • Effectiveness of measurement
      • Productivity Metrics
      • Patient Goals
    • Environment
      • Noise: distracting noises, sound levels too high, etc. due to computer systems
      • Space: Cramped, uncomfortable work space etc.
      • Time: Too little time per patient or order, too little time in a day, too many demands
      • Location: things where they should be on the screen, click distance, and location of workstation relative to point of care and patient
      • Control: the degree to which the individual can control their workload and how to accomplish it
      • Fairness: the perception that the burdens and rewards, the effort and outcomes are spread amongst stakeholders in an equitable way
      • Temperature: too cold, too hot, too variable
      • Interruptions
      • Political climate
      • Social norms and group identity
      • Electrical Power
      • Climate and weather
      • Income inequality
      • Time
      • Direct marketing to patients

Some of the authors of the works cited above may be responding to the following topics, and participants are invited to describe their experiences of medication errors, and offer their insights and observations.

Topics

  1. What METHODS increase or reduce risks related to achieving the aims of #ChoosingWisely
  2. What MACHINE factors increase or reduce risks related to achieving the aims of #ChoosingWisely
  3. What PEOPLE issues increase or reduce risks related to achieving the aims of #ChoosingWisely
  4. What MATERIALS increase or reduce risks related to achieving the aims of #ChoosingWisely
  5. What MEASUREMENT factors increase or reduce risks related to achieving the aims of #ChoosingWisely
  6. What ENVIRONMENTAL factors increase or reduce risks related to achieving the aims of #ChoosingWisely

Background

MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.

To quote the IHI on what the Triple Aim encompasses:

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

http://www.meqapi.org