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| The Vermont Health Care Quality Report 2008 |
Ch2: Measuring Quality of Care Ch3: Chronic Illness in Vermont
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The VPQ Learning Community: Improving Care
for People with Chronic Disease
(click for printable PDF)
What is the VPQ Learning Community? In the fall of 2001, five staff members from the Vermont Program for Quality in Health Care (VPQ) attended the Institute for Healthcare Improvement’s Breakthrough Series College and returned to Vermont to launch the Vermont Community Diabetes Collaborative. Nine primary care practices participated in this original collaborative. Participants in this Collaborative worked exclusively to improve the care they were providing for people with diabetes, however many of these early adopters expressed an interest in applying what they were learning to the management of other chronic diseases. Two additional collaboratives were held expanding the state’s ability to improve and track care for patients with chronic conditions. By 2006, the staff at VPQ had identified a need to change how we were reaching out to the provider practices in Vermont. In many cases, small practices were unable to close their practice for a day or two to attend the Learning Sessions but were interested in incorporating and spreading the quality improvement methodology being taught during the Collaboratives into their daily work. This coincided with the initiation of the Governor’s Blueprint for Health and the creation of funding for provider training in six Blueprint communities. The new model was named the VPQ Learning Community and consisted of three components: centralized, statewide Learning Forums; multiple, community based mini-learning sessions (the Collaborative on Wheels); and a virtual Learning Community dimension.
VPQ staff, the Tupelo Group and the Area Health Education Center (AHEC) work with community leaders to provide a variety of training opportunities to the practice teams and develop a statewide quality improvement infrastructure. Currently over 52 provider teams or practices from around the state are part of the Vermont Learning Community. These provider teams consist of primary care providers, specialists, nurses, front office and administrative staff, as well as community members focusing on mental and social health issues. During the 2007-2008 Collaborative year the learning Forums offered opportunities for participants from inpatient and outpatient settings to learn about improving their Clinical Microsystem. On November 6, 2007 Frank A Federico, RPh spoke to a group of fifty-three people on the “Fundamentals of Reliability”. Frank is a Director at the Institute for Healthcare Improvement. Reliability theory is a scientific method of evaluating, calculating, and improving the overall reliability of complex systems and provides a way to examine a multi-component process and increase the probability that the system will perform its intended function in the required time under commonly occurring conditions. On May 8, 2008 participants were introduced to the concept of Crew Resource Management as it applies to Healthcare. “From the Cockpit to the Nursing Unit” was led by Gary L. Sculli, ATP, RN, MSN, a pilot and registered nurse. His keynote centered on his perception of the “culture shock” experienced upon moving from the airline cockpit back to the medical profession. It highlighted the salient concepts of aviation’s Crew Resource Management (CRM), and demonstrated how CRM transformed a culture replete with human communication and teamwork failures. The presentation specifically focused on the elements of CRM that could be exported to the Healthcare Team in order to transform the environment at the front line and enhance patient safety. Along with team working time, the May Learning Forum offered participants the chance to think about how humor can play a part in the effectiveness of our healthcare systems. Sister Patricia E. McKittrick, spoke on “Humor in Health Care”. The day ended with leaders from Fletcher Allen Health Care’s Labor and Delivery unit sharing their experiences with implementation of CRM training. Does the Collaborative Model work? Though there has been debate nationally regarding the effectiveness of the Collaborative model on improving healthcare, it is a model that the staff at VPQ, along with national experts in the field of Quality Improvement believes holds the most promise for improving the healthcare system. It is a bottom up approach that encourages and celebrates teams sharing not only their successes but their “failures” so that all the Collaborative participants can learn from the experience. Anecdotally, past teams have demonstrated improved process measures such as the number of people with diabetes on aspirin and the number of people with diabetes who are getting their HbA1C checked twice a year. Other teams have applied the methodology to process measures such as prescription refills and phone triage. One team decreased prescription refill related calls by 36 percent, decreased staff time spent on these calls by 20 hours weekly, an estimated savings of 37,411 dollars. What’s Next? Looking ahead, VPQ staff have begun to reevaluate our Collaborative experiences and to think about how to make the best use of our limited staff resources. In 2008-2009 VPQ will return to a more, traditional, centralized collaborative model. The Vermont Quality Improvement Collaborative will be based on the Care Model (originally the Chronic Care Model) and will use the Model for Improvement and Clinical Microsystems Methodology to guide teams toward systems change. The focus of the Collaborative will be on helping to create an empowered, engaged, educated patient. This model will allow for networking across the state along with giving engaged outpatient provider teams who are not part of Blueprint Communities an opportunity to participate. Participants will include provider teams from the Blueprint Communities, along with provider teams who are working with Vermont Information Technology Leaders) VITL to implement Electronic Medical Records; teams that are members of the Vermont Rural Health Alliance (VRHA); and provider teams that are outside of all of these venues but who are enthusiastic about improving their patient outcomes (we are calling this group, VPQ friends). The Collaborative will begin with an informational ‘kick-off’ session on October 24, 2008, continue with three Learning Sessions and end with an Outcomes Congress planned for May 8th, 2009. For more information please contact Dail Riley at 802-229-2152, or click on the link below. |
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