Module 5: Improvement — Developing a Strategy for Diabetes Quality Improvement

1. Have assembled in this document the information from Modules 1-4 above that presents: a) the case for diabetes quality improvement in the State; b) a preliminary strategy suited to the State; and c) strategic partnerships for diabetes quality improvement efforts.

a. Build the case for diabetes quality improvement in the State. Create a document that assembles the information you have written down in response to these questions:

1. From Module 1, questions 1a, 1b, 1c, 1d, 1e, 1f, 1g, 1h:
   • Has diabetes increased in prevalence from 1994 to 2002 in your State?
   • Why should improving diabetes care be a priority?
   • What populations are vulnerable to gaps in diabetes care?
   • What measures for diabetes care are below average in your State?
2. From Module 2, questions 2a, 2b, 2c, 2e, 3a, 4a, 4b, 4c:
   • How does your State compare with national and best-in-class averages?
   • How close are you to the Healthy People 2010 goals?
   • How does your State compare with other States in your region or locality?
   • Where do you need the most improvement?
   • What is the cost of diabetes in your State?
   • How do you compare with other States in your region or locality?
3. From Module 2, question 2d and Module 3, questions 1a, 1b, 2a, 2b:
   • Which diabetes health care measures are below the national average?
   • What factors affect the quality of diabetes care in your State?

b. Add a preliminary strategy, suited to the State, to the document you started above. Convene a working meeting with your internal staff. Use the information you collected throughout this Workbook (noted in parentheses) to fill out the outline below.

1. Decide on topic areas related to quality improvement.
   • What do you predict as the current obstacles to quality care? (Module 1, question 1e)
   • What factors influence diabetes care? (Module 2, questions 2d, 2e, 3a; Module 3, questions 2a, 2b)
   • What questions do you have about the quality of diabetes care? (Module 2, question 2g; Module 3, questions 2a, 2b)
   • What does current research indicate about diabetes care in your State? (Module 2, questions 2b, 3a, 4b, 4c)
2. Develop predictions about how the State performs, why, and how the State could improve.
   • Why has diabetes prevalence increased? (Module 1, questions 1a, 1b, 1e; Module 2, question 2d; Module 3, questions 2a, 2b)
   • How could your State improve? (Module 2, questions 1b, 2b, 2c, 2e, 3a, 4b; Module 3, questions 1a, 1b, 2a, 2b)
3. Develop goals for quality improvement. (Module 1, question 1g; Module 2, questions 1a, 1b, 2b, 2c, 4b, 4c; Module 3, questions 3a, 3b, 4a; Module 4, questions 2a, 2b)
4. Take an inventory of current diabetes quality improvement programs in the State, including non-governmental, Federal, or local initiatives. Make a preliminary list of additional actions to take. Module 4, questions 1a, 1b, 3a)
5. Identify data needs, including measures, benchmarks, and data sources.
   • Do you have data for diabetes measures (Module 1, question 1f; Module 2, questions 2a, 3a; Module 3, question 2b)
   • What data sources does your State have? (Module 2, questions 2f, 2h, 3a
   • What information on costs does your State have? (Module 2, questions 3a, 4a)
   • What additional data do you need? (Module 2, questions 3b, 4d)

c. Identify strategic partnerships for diabetes quality improvement efforts.

Read Module 5 of the Resource Guide.

Add to the document, ideas for partnerships that would be strategic for achieving diabetes quality improvement. Include the key experts and stakeholders in quality improvement (consumers, health care team members, purchasers, health plans, and topic experts), as well as champions in health care who will carry key messages to the front line of health care. Decide who are strategic partners of quality improvement and recruit them to the project, such as health specialists, statisticians and data experts, researchers, evaluation specialists, and key State leaders and agencies. Begin filling in names, organizations, and their role in the table below. (Also refer to your answers in Module 4, questions 2c and 3a.)

2. Have a preliminary "Plan" as part of the "Plan-Do-Study-Act" (PDSA) model of the cycle of quality improvement.

Now that you have completed the preliminary plan, you can move from the "Plan" to the "Do" stage of the PDSA model.

Read Module 5, Integrating Quality Improvement Activities Across Conditions of the Resource Guide on implementing the PDSA model. You cannot complete the next steps of the PDSA cycle alone. The partnership defined above will be critical.

Do:

• Assemble a collaborative of quality improvement champions and stakeholders.
• Give them a charge to improve health care quality in your State.
• Discuss diabetes versus other conditions ripe for quality improvement and select a condition.
• Work with them to set goals; to develop an intervention, plan, and evaluation strategy; to collect data, and to test the plan.
• Draw on the Resource Guide, especially if diabetes is the topic selected.
• Keep the group on track. Keep assessments timely and do not let the perfect be the enemy of the good.
• Move to the next step.

Study:

• Pilot test the group's ideas.
• Collect data—baseline and post-intervention data—even in the pilot stage.
• Analyze the results and draw conclusions. Differentiate between solid conclusions and inconclusive findings; use this information to improve the tracking system.
• Plan an effective tracking system to know if the intervention matters when it is rolled out statewide.

Act:

• When the group agrees, implement the quality improvement strategy statewide.

The PDSA model will be a resource again and again—to create this plan, to work with your quality improvement team on goals for diabetes, to keep the cycle going, and to attack other health care issues.