Quality Improvement Processes: Efforts in Care to Augment Access to Quality, Equitable Diabetes Care 公开
Shulman, Gillian (Spring 2022)
Published
Abstract
Objective: This literature review aims to assess the use of quality improvement processes (QIPs) as a methodology for improving access to quality, diabetes care in response to the growing prevalence of diabetes mellitus within the United States.
Methods: A literature search was conducted utilizing QIP’s terminology to first develop a comprehensive understanding of the methodology. An additional query was then conducted across three search engines employing terminology associated with diabetes, cross-referenced with QIP terminology to identify recent studies that could be assessed to corroborate QIPs applicability to expanding access to quality, equitable diabetes care. Five exemplars were identified and included to represent QIP methodologies such as Root Cause Analysis, Lean methodology, and Six Sigma methodology applied to the three primary branches of diabetes care: prevention, management, and treatment.
Discussion: Though the availability of exemplars examining the intersection of QIPs and diabetes care was found to be limited, the studies reviewed were found to demonstrate improved clinical outcomes for patients with diabetes. Based on improved clinical outcomes, interpreted as augmented quality, the study authors and implementation teams generally support the use of QIPs to expand access to quality care for patients with diabetes. Studies reported that the implemented QIPs did not yield changes in the equity of care, and thus cannot currently support the use of QIP methodology to promote improved access to equitable diabetes care.
Results: The literature review was utilized in this thesis to develop the Solutions Manual for Quality Improvement Process Implementation within healthcare settings aiming to improve the quality of diabetes care provided. The Manual provides recommendations by QIP methodology and suggests the best practices for each by implementation setting, by desired outcome type, and by consideration of available resources.
Implications: The novelty of QIP methodology implores the need for additional studies assessing its applications and impact within the sphere of healthcare. Though QIPs demonstrate the potential for successful application to expand access to quality, diabetes care; further research is necessary to develop the use of QIPs as a standard operating procedure or common practice in healthcare facilities.
Table of Contents
Introduction .................................................................................................................................................................1
Literature Review ........................................................................................................................................................6
Overview ...................................................................................................................................................................6
Quality Improvement Methods..................................................................................................................................6
Quality Improvement Processes Background ......................................................................................................6
Summary of Formative Models for Quality Improvement....................................................................................9
‘PDSA’ Implementation .....................................................................................................................................11
‘PDSA’ Methodology .........................................................................................................................................12
QIP Methods for Use Consideration in the ‘PDSA’ Cycle .....................................................................................16
Root Cause Analysis...........................................................................................................................................16
A3 Problem Solving ...........................................................................................................................................20
Lean Methodology..............................................................................................................................................24
Six Sigma Methodology......................................................................................................................................29
QIP Methodology Summary....................................................................................................................................36
Literature Review Methodology...............................................................................................................................37
Applications of QIP Measures in Diabetic Care .....................................................................................................39
Applications to Diabetes Preventive Care ..............................................................................................................39
Applications to Diabetes Management Care ..........................................................................................................47
Application to Diabetes Treatment .........................................................................................................................52
Discussion ...................................................................................................................................................................61
Solutions Manual for Quality Improvement Process Implementation .................................................................65
Introduction ............................................................................................................................................................65
Best Practices .........................................................................................................................................................66 QIP Motivations.................................................................................................................................................66
Establishing the ‘PDSA’ Cycle ..........................................................................................................................66
Enacting Upon the ‘PDSA’ Cycle ......................................................................................................................68
Studying the Implemented ..................................................................................................................................68
Accepting the Iterative Nature of the ‘PDSA’ Cycle ..........................................................................................73
Summary .................................................................................................................................................................74
Implications................................................................................................................................................................75
References ..................................................................................................................................................................77
About this Master's Thesis
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