 |
Quality Improvement Models
Many health care organizations, including those providing care to people living with HIV, have successfully used specific models to shape their quality program infrastructure and guide quality improvement activities to improve care for their patients.
Model for Improvement
The Model for Improvement [1] focuses on three questions to set the aim, establish measures and select changes, and incorporates Plan-Do-Study-Act (PDSA) cycles [2] to test changes on a small scale.
Improvement efforts should be led by a multidisciplinary core team. Forming the Team
Chronic Care Model
There are six fundamental areas identified by the Chronic Care Model, [3] creating a system that encourages high-quality chronic disease management. Organizations must focus on these six areas, as well as develop productive interactions between patients who take an active part in their care and providers who have the necessary resources and expertise.
- Self-Management: Effective self-management is different from telling a person living with HIV/AIDS disease what to do. Patients have a central role in determining their care, one that fosters a sense of responsibility for their own health.
- Decision Support: Treatment decisions need to be based on explicit, proven guidelines supported by at least one defining study.
- Clinical Information System: A registry — an information system that can track individual patients as well as populations of patients — is a necessity when managing chronic illness or preventive care.
- Delivery System Design: The delivery of care requires not only determining what care is needed, but also clarifying roles and tasks to ensure the patient gets the care; making sure that all the clinicians who take care of a patient have centralized, up-to-date information about the patient’s status; and making follow-up a part of standard procedure.
- Organization of Health Care: The effort to improve care should be woven into the fabric of the organization and aligned with a quality improvement system.
- Community: Community programs and organizations that can support or expand a health system's care for people living with HIV/AIDS disease, and community-wide prevention strategies that are integrated into the care system.
HIVQUAL Model
The HIVQUAL Model [4] was developed to assist health care facilities that are developing a quality infrastructure which supports ongoing processes to improve the quality of HIV care. The model emphasizes that in order to achieve sustainable improvements in quality, activities must focus on both the structural programmatic level and on the project level.
-
Program Cycle: To build and sustain an HIV-specific quality infrastructure, health care facilities need to develop and plan an internal quality improvement program, facilitate the implementation of the program, and routinely evaluate the quality program.
-
Project Cycle: Often multidisciplinary teams are formed to conduct specific quality improvement projects and thereby become vehicles by which a facility makes incremental improvements to its systems of care.
Sources:
1. Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance.
2. The Plan-Do-Study-Act (PDSA) cycle was originally developed by Walter A. Shewhart as the Plan-Do-Check-Act (PDCA) cycle. W. Edwards Deming modified Shewhart's cycle to PDSA, replacing "Check" with "Study."
3. The Chronic Care Model was developed by Ed Wagner, MD, MPH, Director of the MacColl Institute for Healthcare Innovation, Group Health Cooperative of Puget Sound, and colleagues of the Improving Chronic Illness Care program with support from The Robert Wood Johnson Foundation.
4. HIVQUAL Project was developed by the New York State Department of Health AIDS Institute in collaboration with the HIVQUAL consultants.
|
