full pdf of issue - Middle East Journal of Family Medicine

MEDICINE AND SOCIET YNew Rules for the 21st CenturyHealth Care System could besummarized as the following 37 :••••••••••Care is based on continuoushealing relationships.Care is customized according topatient needs and values.The patient is the source ofcontrol.Knowledge is shared andinformation flows freely.Decision making is evidencebased.Safety is a system property.Transparency is necessary.Needs are anticipated.Waste is continuously decreased.Cooperation among clinicians is apriority.Family physicians and their healthprofessional colleagues must assumeresponsibility for the constantassessment and improvement oftheir care. Working together onbehalf of patients requires teamworkthat occurs within a complex set ofrelationships and services. It requiresskillful management with appropriateauthority and collaboration as well asa mindset of vigilance and continuousprocess improvement 39 .Emphasis on quality and safetySystems is considered as one ofthe important characteristics of thenew model of family medicine, andis fully described as: “Systems arein place for the ongoing assessmentof performance and outcomes andfor implementation of appropriatechanges to enhance quality andsafety 38 .Quality Improvement (QI) is apractical approach to systems orprocess change. A growing body ofliterature shows how QI principlescan help create much-neededimprovements in a variety of healthcare situations.The goal of “rapid cycle qualityimprovement” is to allow teams to1.2.3.identify what they want toaccomplishdevelop a measure for evaluatingchange, anddetermine a change or an actionthat a QI team believes will resultin an improvemen t40 .Quality Improvement in FamilyPracticeA new recipe is presented, splittingquality improvement into 4 levels. TheQ1 level corresponds to the everydayprocesses that guide our daily workflow. Q2 corresponds to commonlythought of outcome measures. Q3relates to the executive functionsthat permit seasoned clinicians todraw generalizations about care forindividual patients by synthesizinglarge amounts of data. Finally Q4reflects more population-basedquality improvement activities.Each of these levels requires adifferent approach for improvementactivities. Each must be seen inthe context of an expanded “qualitycompass” and in the paradigm of theQI cycle. Finally, a practical applicationof how this could be instituted at aFamily Practice residency is given 41 .So, Practices will document qualityand safety through ongoing analysesof practice patient care data. 36Patient feedbacks will be solicited toensure that the practice is meetingpatients’ expectations, satisfying theirneeds for access to the practice, andresponding to the needs of increasinglydiverse populations. Each practice willdevelop and use a structured, recurringadministrative mechanism to examinethe measurements of the practice andthe patients under its care. Practicestaff, along with representativepatients, will be included in thesequality improvement processes. A highpriority will be on taking steps to ensurepatients’ safety within the practice,including the use of electronic data anddecision support systems 42 .GP and FM practices that useelectronic medical records and receiveregular performance reports canimprove their adherence to clinicalpractice guidelines. But, on the otherside, no intervention to improve dataquality has been put to rigorous enoughtests. We still lack empirical knowledgeas to how improvement can be broughtabout 43 .A roadmap for quality improvementin physician offices (PracticeManagement)Population-based medicine targetsinterventions at discrete subpopulationsof patients within the medical practiceand anticipates needed servicesaccording to evidence-based guidelinesusing quality measures to track resultsand make adjustments.Physicians integrate caremanagement into their routine clinicalcare by using these guidelines andquality measures to assess patients’needs, create care plans and coordinateand monitor services for their patients.In order to meet the need for betterchronic care management successfully,a medical practice will need to progressthrough nine discrete steps 44 .1.2.3.4.5.6.Define the subpopulation of patientsin need of care management.Choose a physician performancemeasurement set of qualitymeasures.Use a clinical information systemto track quality measures.Establish patient goals for qualityimprovement.Analyze the current workflowprocesses to identify areas forimprovement.Implement a change in the workflowprocess.7. Measure and analyze results 38 .8.Repetitively implement workflowchanges and measure results untilgoals are reached.9. Sustain the improvements.Promotion of QualityAs the number of physicians whoenter residency training in familypractice gradually increases, so doesthe need to evaluate the effect of theirtraining and postgraduate educationon the quality of care in their practices.Quality of care provided by familyphysicians can be measured usingadministrative data.A group from the European WorkingParty on Quality in Family Practice(EQuiP), working with over 20European colleges of primary care,has assessed what, in their view,is needed to improve the quality ofcare at the interface between generalpractice and specialists. Experiencesand ideas from a wide range of peoplewere gathered through focused groupdiscussions. From these it was clearthat, for real improvement at theinterface of care, changes are neededMIDDLE EAST JOURNAL OF FAMILY MEDICINE • VOLUME 6, ISSUE 6 17