Design and Measurement of Quality Improvement Indicators in Ambulatory Pulmonary Care: Creating a “Culture of Quality” in an Academic Pulmonary Division

摘要

Background: Quality improvement (QI) measures often are cited as goals for individual practicesnand medical centers and may someday form a component of reimbursement guidelines.nRelatively few QI metrics relevant to ambulatory pulmonary medicine have been published. Wendescribe the development and implementation of a QI program in an academic pulmonaryndivision, including progress to date and lessons learned.nMethods: Metrics for the pulmonary QI Dashboard were developed based on an extensivenliterature review. Patients were identified through International Classification of Diseases-basednbilling databases, and results data were obtained from a manual and automated review of thenelectronic medical record. The performance of the division was monitored and presented innregular faculty meetings. Quarterly, confidential, individual scorecards gave each cliniciannfeedback about his or her performance and compared the feedback to that of the faculty of thenentire division.nResults: Significant improvements were found in many QI measures during a 2-year period. Thennumber of patients with asthma who received appropriately prescribed inhaled corticosteroidsnincreased from a baseline of 76 to 92%to 98%. Flu shot and pneumococcal vaccine administrationndocumentation for patients with COPD increased from baseline values of 11 to 32% and 11 ton34%, respectively, to 90% and 93%, respectively. The COPD Global Initiative for ObstructivenLung Disease pharmacotherapy guidelines adherence increased substantially for patients with allndisease stages. Chest CT scan results notification documentation improved from a baseline of 67nto 76% to 98%. Comparison between baseline and QI periods yielded statistically significantnincreases for these indicators.nConclusions: QI measures for an ambulatory pulmonary practice can be designed, implemented,nand monitored. Key components include a well-structured electronic medical record, measurablenoutcomes, strong QI leadership, and specific interventions, such as providing feedback throughnQI review meetings and individual “report cards.”