One option to complete an Improvement in Medical Practice activity for Maintenance of Certification (MOC) Part IV credit is to design your own Improvement in Medical Practice project using a standard quality improvement methodology, such as the Plan-Do-Check-Act (PDCA) cycle.
If you are connected to the American Academy of Ophthalmology’s IRIS® Registry, you are encouraged to base your project on the monthly performance rates on clinical quality measures and quality improvement measures provided on the registry dashboard. These data may be used to identify for improvement, set specific goals for each, outline the steps to achieve the goals, and evaluate success by looking at the subsequent monthly performance rates provided by the IRIS dashboard.
But particularly if you’re new to the science of quality improvement, creating a project of your own may seem daunting. What should you study? Where should you start?
Before you begin, be sure to browse the American Board of Ophthalmology’s Improvement in Medical Practice project library to view samples of successful improvement projects created by ABO diplomates. In addition to sparking new ways of thinking about improvement in your own practice, selecting a pre-approved project template means your project will not need additional pre-approval from the ABO in order to get started.
Projects in the ABO’s sample library are divided into clinical and non-clinical examples; projects developed using AAO IRIS® Registry data are marked as registry-based. Below are a few highlights from the library:
Assessing the Degree of Pain Associated with Intravitreal Injections In this practice, internal guidelines called for patients to be brought into the treatment room for an intravitreal injection within 5-20 minutes following instillation of 2% Lidocaine gel. However, compliance with this guideline was only at 64%. After implementing steps to streamline processes, 94% of patients were treated within these guidelines. In addition, patients’ average pain index score decreased from 1.12 to 0.5 after the project’s interventions.
Improving Effectiveness of Treatment of Patients with Diabetic Macular Edema Diabetes is an increasingly common, systemic disease often complicated by sight-threatening visual loss resulting from diabetic macular edema. Successful treatment can be slow and difficult, involving numerous visits and very expensive drugs. The aim of this project was to leverage resources to achieve improved eye health in patients with diabetic macular edema. Patients in this study experienced a greater rate of decrease in both blood sugar and systolic blood pressure following project implementation.
Improving Rate of Gonioscopy Performed on Glaucoma Patients About 33% of patients presenting for glaucoma evaluation were receiving goniosopic evaluations. Gonioscopy was falling through the cracks, perhaps because patients were dilated prior to being identified as glaucoma suspects or having POAG. Implementation of a reference chart to ensure that the diagnostic tests were performed resulted in improved quality of care, with 97% of subsequent patients receiving a gonioscopy evaluation.
*Registry-Based* Increasing Tobacco Use Counseling This project focused on increasing the rate at which tobacco use counseling was provided to patients (within a mostly Medicare-age population), particularly those with ARMD. In July 2017, just 2.7% of patients received tobacco use counseling. After the implementation of a systematic checklist prompting staff to ask about patient tobacco use, that percentage increased to 94.09% by the end of 2017.
Improving Doctor-Parent Communication for High-Risk ROP Patients In addition to receiving printed educational materials, just 13% of NICU parents were routinely receiving phone calls to discuss the status of their child’s ROP. To improve parent education, the team developed a plan to better educate parents about the need for close follow-up. By adding a phone call to a newly created checklist for ROP patients, the practice successfully reached 93% of parents to discuss care questions and schedule follow-up visits.
In-Office Procedure Checklist Protocol Implementing a checklist protocol akin to airline pilots helps surgeons avoid unnecessary errors. In this project, a new system checklist was applied to in-office laser procedures. Following the introduction of the checklist, time-out use for these procedures rose to 100%. Utilizing a standardized checklist system increased the practice’s efficiencies, decreased patient wait times, and enhanced the ability to provide high quality patient care.