Individual PQI Projects

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Individual PQI Projects
 

Participating as an Individual: Part 4 Standards for Individual PQI

In some practice settings, diplomates may not have access to colleagues with the similar Part 4 interests necessary to perform PQI as a group, or diplomates may have subspecialty PQI requirements that are not shared by practice associates. In these and other situations, individual PQI participation is appropriate.

Getting to Work: Performing an Individual PQI Project

Individual PQI projects may be selected from a variety of existing projects sponsored by national organizations and societies or self-designed by the diplomate.

Sponsored PQI Projects, including registries, are preferred for use in MOC by either individuals or groups. The ABR has approved these projects for use by its diplomates, and they are listed on the ABR website. They have standardized formats for use by the diplomate and offer project-specific templates to be followed throughout their completion. Such projects often address significant, common radiological care issues, and participation may aid in improving not only the diplomate’s own practice, but also in understanding the impact of quality improvement efforts on a national level.

Self-Designed Projects are best suited for individual PQI participants. These are conceived and formatted by the diplomate to fulfill a perceived or documented quality issue in his or her practice. Such projects do not require approval for use; however, certain constructs in the design and execution of the project must be observed (as specified below), and documentation with record-keeping is required.

Designing My Own PQI Project. A number of elements should be considered when selecting a suitable topic and performing a self-designed PQI project. The following presents a step-by-step process for project selection, development, and completion – the “Plan-Do-Study-Act” cycle – which is followed until the project is concluded.

BASELINE PDSA CYCLE (Cycle #1)

    I. PLAN.

1. This first step involves selecting a project area of interest (topic) that is relevant to your practice, that you would like to improve, and that is amenable to repeated measurement. In doing so, it is often helpful to evaluate your practice in the light of the six Institute of Medicine Quality Aims: What about your practice could be made safer, timelier, more efficient, more effective, more patient centered, or more equitable? You should choose a topic that has the potential to make an improvement. Because the purpose of PQI is to address and improve real issues in your practice, performance topics that do not present challenges or perceived gaps in practice are not appropriate for PQI projects.
    
2. Your next task is to devise an appropriate measure to gauge the issue you have selected. Initially, this may often be articulated as a quality question from which a metric can be derived. Once you adopt a measurement, set a target level of performance desired in your practice. It is also helpful to predict what you believe your measure will show when applied to your practice. If you predict that your goal will be met on initial measurement, then this is likely not a suitable topic, and another should be chosen.

For example,

Area of Interest (Topic): “Time Out” at Interventional Radiology Procedures

Quality Question: In what percentage of interventional radiology procedures in my practice was a “time out” performed?

Measurement to be Taken: Number of procedures in which a “time out” occurred/total number of interventional radiology procedures x 100%.

Desired Target Level (Goal) of Performance: “Time out” before beginning a procedure occurs in 100% of cases.

Baseline Measurement Prediction: I believe that, upon initial measurement, “time out” before beginning of procedure will have occurred in 70% of cases.

C. Devise a plan or process for collecting the data.

II. DO. Put your plan into action, making baseline measurements in an unbiased manner and for an appropriate number of cases/data points. Collect your data.

III. STUDY. Analyze your baseline data and compare the data with both the predicted result and the desired performance target. Summarize your conclusions and what you have learned. One of two results will be pertinent:

A. If the results did not meet your performance target, determine the factors to which you attribute the result and examine all potential root causes (then proceed to Step IV, ACT).

 B. If, unexpectedly, the results did meet the performance      target, institute a plan to sustain the gain and re-measure at   appropriate intervals. Then, you must attest to project 
  completion on your ABR myABR and select a new project.

IV. ACT. Devise a plan for performance improvement that addresses the perceived root causes for not achieving the performance target. Implement your improvement plan before re-measurement.

POST-IMPROVEMENT PLAN PDSA CYCLE (CYCLE #2)

After implementing the improvement plan, repeat the PDSA cycle by making a new set of measurements in an appropriate number of cases/data points; analyzing the re-measurement data; and determining whether the project goal has been met or whether additional action is needed. The PDSA cycle can be repeated until the goal is met or until an endpoint is otherwise determined.

Once you have reached your goal, make the improved process a standard practice. Measuring the improved process intermittently through a PDSA cycle can help ensure that the gain will be sustained.

IV. SELF-REFLECTION. When you complete you project, you must prepare a short paragraph of self-reflection, stating the way(s) in which the project positively impacted your practice and/or your patients.

ABR INDIVIDUAL PARTICIPANT PQI PROJECT TEMPLATE

To assist individual participants in following and documenting the required process, the ABR has developed an optional  template (Individual PQI Participant PDSA Checklist and Summary Record), which may be used in completing PQI projects. Society-sponsored PQI Projects generally provide templates to be used in completing the projects. If not, the ABR template may be used as appropriate.

Fulfilling the MOC Cycle PQI requirements

You must follow the above “Plan-Do-Study-Act” steps or engage in a society-sponsored project to complete at least one PQI project every three years. Don’t forget to attest on your ABR Personal Database (myABR) when you have completed a PQI project.

Please click to access your myABR.