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Primary Care Examples

Document Your Own PDSA Cycle

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The following examples are written from the perspective of a primary care provider:
 

Aim Statement

"By March 31, 90% of our Medicare Part B-eligible patients will have tobacco use status recorded in the EHR problem list during a visit to our office. This study will begin with Dr. Smith's care team on November 1."

 

PDSA Cycle

Plan: For one week, a single care team will test the use of a daily "tobacco use status report" generated by the EHR. The report will identify patients with appointments scheduled that day who have never been asked about their history of tobacco use. The report will be given to the medical assistant (MA) in the morning before patients start arriving.

Do: For an entire week, a tobacco use status report was generated at the beginning of each clinic day. When the patients arrived for their appointment, identified patients were asked about tobacco use by the MA during vitals collection. The patient's response was entered into the EHR problem list and the provider was verbally informed, prior to entering the exam room, whether the patient was a tobacco user.

Study: At the end of the week, the team studied the PDSA. One or two names appeared each day on the tobacco status report. Chart review revealed that some names generated by the report still did not have the status of tobacco use recorded. The MA believes this is because she remembered to ask those patients who arrived in the morning but by the afternoon she was less diligent about focusing on the tobacco use report. By the end of the PDSA week, 8 of the identified 14 patients had tobacco use status entries in the EHR problem list.

Act: The PDSA was partially successful. After team discussion, it was decided that this PDSA could be improved with a second reminder. A temporary reminder note could be placed in the patient’s electronic chart so the MA would be prompted to inquire about tobacco use while gathering vitals.

Plan: Test for one week the use of a daily tobacoo use status report—in combination with an electronic reminder—to see if this improves the collection of tobacco use status for patients who have never been assessed before.

 

Ideas for Multiple PDSAs

Your practice may want to design multiple PDSAs all working toward the same larger goal. For example, a team trying to reduce LDL to less than 100 in patients with ischemic vascular disease might decide to build PDSAs around several of the following topics:

  • Staff training on medication reconciliation to assure proper statin dosage
  • Dietician visits to learn about diet management of cholesterol
  • Exercise contracts with nurse encouragement and follow-up
  • Community partnerships with pharmacists to track medication refills
  • Patient-centered interviews provided by support staff
  • Community partnerships with local pools and gyms

Each of these topics would have separate goals and measurements with separate successes and failures. Over time—as many of these PDSAs are employed—the greater aim (a reduction in LDL) would be measurable.