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Session 2: Quality Improvement in Clinical Care

This session provides exposure to QI in clinical care settings and especially draws from material from the American Academy of Family Physicians and the American Academy of Pediatrics. A document from the Institute of Medicine that proposed how the health care system can be reinvented is read and examined in relationship to the Patient Protection and Affordable Care Act passed in 2010. Implementing a QI process to promote the ability of primary care providers to provide intensive obesity counseling is explored also. A research article about the development, implementation, and evaluation of a quality improvement project in clinical care allows the learner to identify key components (e.g., specific aim, how to know if a change is an improvement, etc.) of a QI project.

PREPARATION: The readings and review of webpages are to be completed at the learner’s desired pace, but prior to engagement in the active learning section.

Read: Institute of Medicine — Crossing the Quality Chasm: A New Health System for the 21st Century, Report Brief March 2001

Watch: Model for Improvement. American Academy of Family Physicians Video (10 min)
Developed by the American Academy of Family Physicians

Review: EQIPP: Helping You Improve Care for Children Homepage
Developed by the American Academy of Pediatrics

Read: Lee HC, Kurtin PS, Wight NE, et al. A Quality Improvement Project to Increase Breast Milk Use in Very Low Birth Weight Infants Pediatrics. 2012:130(6):e1679-e1687.
This article is available free of charge from the American Academy of Pediatrics.

ACTIVE LEARNING: The preparation section focused on the use of QI in clinical settings. The following active learning section suggests questions and issues to promote application of information learned during the preparation section. Topic areas for active learning are each bulleted and shown in bolded font. Questions to ask are italicized.

  • Comparison of the Institute of Medicine’s (IOM) 10 rules of redesign and the Affordable Care Act (ACA)

The Institute of Medicine (IOM) Report: Crossing the Quality Chasm: A New Health System for the 21st Century discusses how the health care system can be reinvented. In addition to the 6 aims for improvement, 10 rules for redesign are proposed. These include: 1) care is based on continuous healing relationships; 2) case is customized; 3) patient is source of control; 4) information is shared; 5) evidence-based; 6) safety; 7) transparency; 8) needs are anticipated; 9) waste is decreased; and 10) cooperation among clinicians.

What is similar between the IOM’s 10 rules for redesign and the ACA? What is different? Which of the IOM’s 10 rules for redesign are not components of ACA?

  • Quality improvement and Intensive Obesity Counseling

The Centers for Medicare and Medicaid Services released a statement in 2010 that primary care providers can be reimbursed for intensive obesity counseling for Medicare patients. Consider a setting where primary care providers are delivering obesity counseling. Brainstorm a QI process that can increase the abilities of primary care providers to provide obesity treatment successfully.

Who should be on a QI team for this project?

Apply the PDSA cycle to a process about how to increase the knowledge and skills of primary care providers. For the Plan stage of PDSA, what are possible solutions to the problem? From the list of possible solutions, select one.

How will the selected solution be implemented?

How will implementation of the proposed solution (process) be evaluated?

How will the solution be implemented in the larger system of all primary care offices? What if the outcomes are not as planned with the selected solution? What solution developed in the planning stage will be tried next?

  • QI in Research

Use “A quality improvement project to increase breast milk use in very low birth weight infants” or similar research article that reports on implementation of a QI project.

What is the aim or purpose of the QI project? Who is the target population? What is the time frame of the project? How will you know if the change is an improvement? What change can be made that will result in improvement?

  • Wrap-up

What QI processes have you experienced in clinical care?

What is one way that you could use QI processes in clinical care where you work or have worked?

From this session, what is a single take-home message from this session that you have about using QI in clinical care?


This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number T79MC09805, Leadership Education in Maternal and Child Health Nutrition, $176,795, 50% funded by the University of Tennessee, Department of Nutrition. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.