Quality Improvement: An ACQIP Exercise on the Management of Otitis Media

As part of Pediatrics in Review's ongoing focus on quality improvement, we present a self-assessment exercise taken from the American Academy of Pediatrics' Ambulatory Care Quality Improvement Program (ACQIP). Tabulated responses of pediatricians who completed this exercise as part of the ACQIP program are presented on pages 253 to 254, allowing readers to see how their own answers compare and providing material for thought and discussion. Readers are encouraged to participate in the ACQIP program. Additional information can be obtained by calling or writing the Division of Quality Care, American Academy of Pediatrics, Box 927, Elk Grove Village, IL 60009-0927. Monitoring Otitis Media EDUCATIONAL OBJECTIVES This exercise and the follow-up materials should help you identify areas of improvement in how your practice monitors and documents information for children with acute or chronic otitis. INSTRUCTIONS Beginning with tomorrow's appointments, answer the questions below for the most recent, but not the current episode of otitis media in the first 10 patients you see who are younger than 4 years of age and experiencing at least their second episode of otitis. You will need to review charts to answer the questions. Put a check in each box in which you find the information in your medical record listed.

Download Full-text

Quality Improvement: An ACQIP Exercise on Vaccine Administration—Part 1

Pediatrics in Review ◽

10.1542/pir.15.10.400 ◽

1994 ◽

Vol 15 (10) ◽

pp. 400-400

Author(s):

Shannon Smith-Ross ◽

Keyword(s):

Quality Improvement ◽

American Academy ◽

Otitis Media ◽

Health Maintenance Organizations ◽

Care Quality ◽

Improvement Program ◽

Health Maintenance ◽

American Academy Of Pediatrics ◽

Practice Parameters ◽

Tract Infections

As part of Pediatrics in Review's ongoing focus on quality improvement, we present for the use of our readers this self-assessment exercise taken from the American Academy of Pediatrics' Ambulatory Care Quality Improvement Program (ACQIP). ACQIP is an educational program for pediatricians that embodies the concept of continuous quality improvement. It has been implemented successfully in physicians' offices, health maintenance organizations, and hospitals. Currently, more than 2000 physicians worldwide are enrolled in ACQIP. The program is designed to help pediatricians evaluate their practices by comparing themselves with other physicians in similar practices and communities. Pediatricians in groups can use ACQIP to analyze practice variations within the group. Three aspects of care are addressed: • Practice management • Delivery of preventive care • Patient satisfaction Each year, a theme is selected. In 1992-1993, the first year, the theme was immunizations. The 1993-1994 program focused on telephone management, developmental assessment, and management of asthma. ACQIP is being used by the American Academy of Pediatrics (AAP) as a vehicle to disseminate and implement its new practice parameters on asthma, neonatal hyperbilirubinemia, otitis media, gastroenteritis, head trauma, febrile seizures, and urinary tract infections. This year's exercises (September 1994 to August 1995) will be on otitis media and hyperbilirubinemia and will be based on the parameters.

Download Full-text

Quality Improvement: An ACQIP Exercise on the Management of Acute Asthma—Part 1

Pediatrics in Review ◽

10.1542/pir.16.7.273 ◽

1995 ◽

Vol 16 (7) ◽

pp. 273-276

Author(s):

Shannon Smith-Ross ◽

Lisa Honigfeld

Keyword(s):

Quality Improvement ◽

American Academy ◽

Ambulatory Care ◽

Acute Asthma ◽

Care Quality ◽

Quality Improvement Program ◽

Self Assessment ◽

Improvement Program ◽

American Academy Of Pediatrics

As part of Pediatrics in Review's ongoing focus on quality improvement, we present a self-assessment exercise taken from the American Academy of Pediatrics' Ambulatory Care Quality Improvement Program (ACQIP). A previous exercise and a description of the program were published last year.1 Tabulated responses of pediatricians who completed this exercise as part of the ACQIP program will be published next month, allowing readers to see how their own answers compare and providing material for thought and discussion.

Download Full-text

Improving Patient Follow-Up through Implementation of an Ambulatory Care Quality Improvement Program

Journal of Nursing Care Quality ◽

10.1097/00001786-199702000-00010 ◽

1997 ◽

Vol 11 (3) ◽

pp. 62-67 ◽

Cited By ~ 1

Author(s):

Stephanie Granneman ◽

Cynthia L. Russell

Keyword(s):

Quality Improvement ◽

Ambulatory Care ◽

Care Quality ◽

Quality Improvement Program ◽

Improvement Program

Download Full-text

Quality Improvement: An ACQIP Exercise on the Management of Acute Asthma—Part 2

Pediatrics in Review ◽

10.1542/pir.16.8.311 ◽

1995 ◽

Vol 16 (8) ◽

pp. 311-315

Author(s):

Shannon Smith-Ross ◽

Lisa Honigfeld ◽

Keyword(s):

Quality Improvement ◽

Quality Care ◽

Normal Activity ◽

Forced Expiratory Volume ◽

Care Quality ◽

Activity Levels ◽

Improvement Program ◽

Office Management ◽

Acute Exacerbations ◽

Asthma In Children

Last month's issue of Pediatrics in Review contains the questions asked of participants in the Ambulatory Care Quality Improvement Program (ACQIP) exercise on the management of acute exacerbations of asthma in children. The answers of those who completed that exercise, which was part of the 1993-1994 program, are summarized in this article. In addition, pointers for clinicians are presented as well as practical "pearls of wisdom" from subscribers. Readers who wish to evaluate their own practices may use this exercise and should consider enrollment in the ongoing ACQIP program. Further information may be obtained through the Division of Quality Care of the American Academy of Pediatrics. [See table in the PDF file] Quality Pointers for the Office Management of Acute Exacerbations of Asthma in Children TREATMENT Goals of Treatment: General treatment goals include helping patients to maintain "normal" pulmonary function rates, maintain normal activity levels, prevent chronic and troublesome symptoms (eg, nocturnal coughing or dyspnea), prevent recurrent exacerbations of asthma, and avoid adverse effects from asthma medications. The principal goal of management for the acute exacerbation is the recognition of early indicators, such as a worsening peak expiratory flow rate or forced expiratory volume over 1 second or an increase in symptoms, and early treatment to reverse these symptoms.

Download Full-text

Quality Improvement: An ACQIP Exercise on Vaccine Administration: Subscriber Responses and Recommendations

Pediatrics in Review ◽

10.1542/pir.15.11.433 ◽

1994 ◽

Vol 15 (11) ◽

pp. 433-436

Keyword(s):

Quality Improvement ◽

Information Quality ◽

Adverse Reactions ◽

Care Quality ◽

Self Assessment ◽

Improvement Program ◽

Immunization Practice ◽

Vaccine Administration ◽

Care Services ◽

Clinical Encounters

In last month's issue of Pediatrics in Review, we presented a self-assessment exercise on vaccine administration from the Ambulatory Care Quality Improvement Program (ACQIP) of the American Academy of Pediatrics. This ongoing program provides participants with summaries of all responses and with the appropriate answers to the questions in each exercise. The vaccine administration exercise was distributed in the 1992 to 1993 program, and more than 2000 ACQIP subscribers completed the survey. Their responses are summarized below, and the recommended response to each question is provided. Readers are encouraged to review their answers and compare them with this information. Quality pointers on vaccine administration and practical suggestions from subscribers also are presented. Subscriber Responses Question 1: Which of the following apply to your immunization practice? Recommended Response: All of the statements are recommended immunization practices. National Rates: 96% of the respondents indicated that their practices schedule immunizations in conjunction with appointments for other child care services, 71% said that they use all clinical encounters to screen for immunizations, 87% said that all scheduled immunizations are given simultaneously at the time of each visit, 87% said that parents/guardians are asked routinely about contraindications and adverse reactions, and more than 95% said that they tell parents/guardians where to obtain medical care after hours in the event of adverse reactions.

Download Full-text

The EASE Project Revisited: Improving Safe Sleep Practices in Ohio Birthing and Children’s Hospitals

Clinical Pediatrics ◽

10.1177/0009922819850461 ◽

2019 ◽

Vol 58 (9) ◽

pp. 1000-1007 ◽

Cited By ~ 2

Author(s):

Jamie R. Macklin ◽

Michael A. Gittelman ◽

Sarah A. Denny ◽

Hayley Southworth ◽

Melissa Wervey Arnold

Keyword(s):

Quality Improvement ◽

American Academy ◽

Quality Improvement Program ◽

Improvement Program ◽

Children's Hospitals ◽

Safe Sleep ◽

American Academy Of Pediatrics ◽

Children’S Hospitals ◽

Improve Compliance ◽

Sleep Behaviors

Literature has shown hospitalized infants are not often observed in recommended safe sleep environments. Our objective was to implement a quality improvement program to improve compliance with appropriate safe sleep practices in both children’s and birthing hospitals. Hospitalists from both settings were recruited to join an Ohio American Academy of Pediatrics collaborative to increase admitted infant safe sleep behaviors. Participants used a standardized tool to audit infants’ sleep environments. Each site implemented 3 PDSA (Plan-Do-Study-Act) cycles to improve safe sleep behaviors. A total of 37.0% of infants in children’s hospitals were observed to follow the current American Academy of Pediatrics recommendations at baseline; compliance improved to 59.6% at the project’s end ( P < .01). Compliance at birthing centers was 59.3% and increased to 72.5% ( P < .01) at the collaborative’s conclusion. This study demonstrates that a quality improvement program in different hospital settings can improve safe sleep practices. Infants in birthing centers were more commonly observed in appropriate sleep environments than infants in children’s hospitals.

Download Full-text

An evaluation of the implementation of quality improvement (QI) in primary care dentistry: a multi-method approach

BMJ Open Quality ◽

10.1136/bmjoq-2019-000839 ◽

2021 ◽

Vol 10 (2) ◽

pp. e000839

Author(s):

Heather Cassie ◽

Vinay Mistry ◽

Laura Beaton ◽

Irene Black ◽

Janet E Clarkson ◽

...

Keyword(s):

Primary Care ◽

Quality Improvement ◽

Case Studies ◽

Quality Care ◽

Theoretical Domains Framework ◽

Team Members ◽

Knowledge And Skills ◽

Scottish Government ◽

The Impact

ObjectivesEnsuring that healthcare is patient-centred, safe and harm free is the cornerstone of the NHS. The Scottish Patient Safety Programme (SPSP) is a national initiative to support the provision of safe, high-quality care. SPSP promotes a coordinated approach to quality improvement (QI) in primary care by providing evidence-based methods, such as the Institute for Healthcare Improvement’s Breakthrough Series Collaborative methodology. These methods are relatively untested within dentistry. The aim of this study was to evaluate the impact to inform the development and implementation of improvement collaboratives as a means for QI in primary care dentistry.DesignA multimethod study underpinned by the Theoretical Domains Framework and the Kirkpatrick model. Quantitative data were collected using baseline and follow-up questionnaires, designed to explore beliefs and behaviours towards improving quality in practice. Qualitative data were gathered using interviews with dental team members and practice-based case studies.ResultsOne hundred and eleven dental team members completed the baseline questionnaire. Follow-up questionnaires were returned by 79 team members. Twelve practices, including two case studies, participated in evaluation interviews. Findings identified positive beliefs and increased knowledge and skills towards QI, as well as increased confidence about using QI methodologies in practice. Barriers included time, poor patient and team engagement, communication and leadership. Facilitators included team working, clear roles, strong leadership, training, peer support and visible benefits. Participants’ knowledge and skills were identified as an area for improvement.ConclusionsFindings demonstrate increased knowledge, skills and confidence in relation to QI methodology and highlight areas for improvement. This is an example of partnership working between the Scottish Government and NHSScotland towards a shared ambition to provide safe care to every patient. More work is required to evaluate the sustainability and transferability of improvement collaboratives as a means for QI in dentistry and wider primary care.

Download Full-text

Evidence-Based Practice Implementation: Case Report of the Evolution of a Quality Improvement Program in a Multicenter Physical Therapy Organization

Physical Therapy ◽

10.2522/ptj.20130541 ◽

2015 ◽

Vol 95 (4) ◽

pp. 588-599 ◽

Cited By ~ 8

Author(s):

Joel M. Stevans ◽

Christopher G. Bise ◽

John C. McGee ◽

Debora L. Miller ◽

Paul Rockar ◽

...

Keyword(s):

Quality Improvement ◽

Case Report ◽

Physical Therapy ◽

Care Quality ◽

Routine Practice ◽

Evidence Based ◽

Implementation Barriers ◽

Improvement Program ◽

Improvement Project ◽

Systems Perspective

Background and Purpose Our nation's suboptimal health care quality and unsustainable costs can be linked to the failure to implement evidence-based interventions. Implementation is the bridge between the decision to adopt a strategy and its sustained use in practice. The purpose of this case report is threefold: (1) to outline the historical implementation of an evidence-based quality improvement project, (2) to describe the program's future direction using a systems perspective to identify implementation barriers, and (3) to provide implications for the profession as it works toward closing the evidence-to-practice gap. Case Description The University of Pittsburgh Medical Center (UPMC) Centers for Rehab Services is a large, multicenter physical therapy organization. In 2005, they implemented a Low Back Initiative utilizing evidence-based protocols to guide clinical decision making. Outcomes The initial implementation strategy used a multifaceted approach. Formative evaluations were used repeatedly to identify barriers to implementation. Barriers may exist outside the organization, they can be created internally, they may result from personnel, or they may be a direct function of the research evidence. Since the program launch, 3 distinct improvement cycles have been utilized to address identified implementation barriers. Discussion Implementation is an iterative process requiring evaluation, measurement, and refinement. During this period, behavior change is actualized as clinicians become increasingly proficient and committed to their use of new evidence. Successfully incorporating evidence into routine practice requires a systems perspective to account for the complexity of the clinical setting. The value the profession provides can be enhanced by improving the implementation of evidence-based strategies. Achieving this outcome will require a concerted effort in all areas of the profession. New skills will be needed by leaders, researchers, managers, and clinicians.

Download Full-text