A quality improvement committee based at a primary care clinic wishes to improve screening and follow-up of patients with obesity. Currently, 30% of patient encounters include documentation of BMI, and 10% of patients with BMI ≥30 kg/m² are scheduled for weight management follow-up appointments. The committee sets a goal to increase BMI documentation to 40% and BMI follow-up to 30% in 3 months. It decides to test the effectiveness of a clinical decision support tool in achieving this goal. The tool is designed for clinical providers and integrated into the electronic medical record; it includes a BMI calculator and a prompt to arrange follow-up when BMI is ≥30 kg/m². An email introducing the tool and its purpose is circulated to all clinical providers.
After the tool is implemented for 3 months, which of the following is the most appropriate next action according to the Plan-Do-Study-Act paradigm?

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Quizplus · Accepted Answer

Explanation: 11ec2b69_c1f0_8b3a_8f63_dbb2b05a9a6d_MD0005_00 The Plan-Do-Study-Act (PDSA) paradigm is a continuous and incremental method of improving a process. It involves iterative implementation, assessment, and refinement of a quality improvement (QI) intervention to achieve a desired change (eg, improvement in obesity screening). The PDSA cycle includes 4 steps: Plan: Identify a specific, realistic goal (including timeframe), factors affecting process quality, and a testable intervention. This QI project defined a goal for obesity documentation (to 40%) and follow-up (to 30%), and an intervention (clinical decision support tool) addressing convenience and efficiency. Do: Implement the plan and continually collect data that will be used to measure change and effectiveness (eg, information from electronic records). Study (or Check): After the defined timeframe, analyze data to determine whether the intervention achieved the defined goals. After this QI project is implemented for 3 months, the next best step is to review charts to assess for changes in BMI documentation and follow-up because this information directly measures the defined outcome. Act: After data analysis, determine modifications needed for the next cycle based on lessons learned in the Study stage. The entire PDSA cycle can be repeated as needed, with each cycle further refining the intervention and process until the desired goal is reached. (Choices A and B) Staff feedback can be collected during the Study stage to inform lessons learned and needed modifications. Similarly, data on cost-effectiveness can help determine feasibility and value (ie, optimizing quality while minimizing costs). However, neither action directly assesses project goals (ie, percentage of providers documenting and following up on BMI). Therefore, chart review should be done first to quantitatively determine overall performance. (Choices C and E) Determining provider barriers to BMI documentation and identifying best practices of providers with highest documentation and follow-up are examples of actions in the Plan stage (because they could have inform the tool's content and design). They are less appropriate at this stage because the tool has already been implemented. Educational objective: The Plan-Do-Study-Act paradigm guides improvement of a process through continuous and incremental implementation, assessment, and refinement of a quality improvement intervention. References: Applying the Plan-Do-Study-Act (PDSA) approach to a large pragmatic study involving safety net clinics. (http://www.ncbi.nlm.nih.gov/pubmed/28629348)

A Quality Improvement Committee Based at a Primary Care Clinic