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 MOQCshare@umich.eduThumb 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