Plan−Do−Study−Act!
Using the PDSA Cycle to Improve Your
Performance Improvement Projects
March 18, 2014
Presenter:
Christi Melendez, RN, CPHQ
Associate Director, Performance Improvement Projects
Health Services Advisory Group, Inc.
Slide 1
Performance Improvement Principle
• Your current systems and improvement
strategies have resulted in your current
outcomes.
• What you’re doing is getting you the results
you have.
• To GET different results, you have to DO
something different.
Slide 2
Selecting Changes
While all changes do not lead to improvement,
all improvement requires change.
What changes can you make that will
result in improvement?
Slide 3
PDSA Cycle
Slide 4
Identifying Barriers
• Conduct an initial barrier analysis to identify
possible barriers.
– Brainstorming and the “Five Whys”
– Fishbone Diagram
– Key Driver Diagram
Slide 5
Prioritizing Barriers
• Request data related to identified barriers.
• Evaluate whether data support barriers’
relevance.
• Rank barriers—from highest to lowest priority.
Slide 6
Plan Interventions
Development of Interventions
Avoid “Passive” Interventions
• Mailers
• Reminder letters
• Newsletter articles
• Postcards, flyers, and brochures
• Updating Web site/portals
• Robot calls
Slide 7
Plan Interventions (cont.)
Develop “Active” intervention(s) that directly
address prioritized barriers and will impact
indicator outcomes.
• Face-to-face education efforts (enrollee and
provider)
• Outreach events—“boots on the ground”
• Policy/process changes
• Performance report cards
• Incentive programs (enrollee and provider)
Slide 8
PDSA Cycle
• Develop a strategy to implement the
interventions.
• Develop a plan to test the intervention (Who?
What? When? Where? What data need to be
collected?)
Slide 9
PDSA Cycle (cont.)
• Try the intervention on a small scale.
• Carry out the intervention as designed.
It’s better to do a few interventions well!
Slide 10
PDSA Cycle (cont.)
•
•
•
•
Evaluate the effectiveness of the intervention.
Analyze your results.
What did you learn?
What were the results compared to your
prediction?
Slide 11
PDSA Cycle (cont.)
• Use what you learned from the
evaluation/analysis.
• Refine or revise.
• Determine next steps.
– If successful, how will the intervention be
rolled out on a larger scale?
– If unsuccessful, repeat the cycle.
Slide 12
What It Takes to Get Improvement
Improvement will not happen without these
components:
 Will
 Ideas
 Execution
Slide 13
Setting Goals
What are you trying to accomplish?
The goal should be “S-M-A-R-T”.
Specific
Measurable
Attainable
Relevant
Time-bound
Slide 14
Managed Medical Assistance (MMA)
Statewide PIPs
There are two statewide PIPs:
1. Preventive Dental Services for Children
2. Improving Prenatal Care and Well-Child
Visits in the First Fifteen Months of Life—Six
or More Visits
Slide 15
Preventive Dental Indicator PIP
Title: The percentage of enrollees 1 to 20 years of age who
had at least one preventive dental service during the
measurement year.
Numerator: Total number of unduplicated enrollees 1 to 20
years of age who had at least one preventive dental service
under the supervision of a dentist. Codes: D1000—D1999.
Denominator: Eligible enrollees 1 to 20 years of age who
have been continuously enrolled in Medicaid or Children’s
Health Insurance Program (CHIP) Medicaid Expansion
programs for at least 90 days and are eligible to receive
Early and Periodic Screening, Diagnosis, and Treatment
(EPSDT) services.
Slide 16
Prenatal/WCV PIP
Four Potential Study Indicators
Potential Study Indicator #1
Title: The percentage of women who had a live birth and
received a prenatal care visit as an enrollee of the MMA plan
in the first trimester or within 42 days of enrollment in the
health plan.
Numerator: Total number of women who had a live birth and
received a prenatal visit in the first trimester or within 42 days
of enrollment.
Denominator: Eligible women who delivered a live birth on
or between November 6 of the year prior to the measurement
year and November 5 of the measurement year.
Slide 17
Prenatal/WCV PIP (cont.)
Potential Study Indicator #2
Title: The percentage of women who had a live birth and
received greater than or equal to 81 percent of expected
prenatal visits.
Numerator: Total number of women who had an
unduplicated count of greater than or equal to 81 percent of
the number of expected prenatal visits (adjusted for the
month of pregnancy at time of enrollment and gestational
age).
Denominator: Eligible women who delivered a live birth on
or between November 6 of the year prior to the measurement
year and November 5 of the measurement year.
Slide 18
Prenatal/WCV PIP (cont.)
Potential Study Indicator #3
Title: The percentage of women who received a full
course of antenatal steroids completed prior to delivering
a live, preterm newborn(s).
Numerator: Total number of women who received a full
course of antenatal steroids completed prior to delivering
a live, preterm newborn(s). Course of steroids must be
completed prior to date of delivery.
Denominator: Women enrolled in the MMA plan
delivering a live, preterm newborn(s) with >=24 and <32
weeks gestation completed.
Slide 19
Prenatal/WCV PIP (cont.)
Potential Study Indicator #4
Title: The percentage of children 0−15 months of age
who received six or more well-child visits with a
Primary Care Physician (PCP) during the measurement
year.
Numerator: Total number of children who received six
or more well-child visits with a PCP during their first 15
months of life.
Denominator: Eligible children 0−15 months of age
during the measurement year.
Slide 20
Measurement Periods
Baseline: January 1, 2014, through December 31, 2014
R1: January 1, 2015, through December 31, 2015
R2: January 1, 2016, through December 31, 2016
The eligible population size will be smaller for
baseline than subsequent years due to the transition.
Slide 21
Important Dates
DATE
TASK
April 2, 2014
Comments and/or feedback on statewide PIP
methodologies due to contract managers
April 15, 2014
Remaining two PIP proposals due to the
Agency for Health Care Administration
(AHCA)
May 20, 2014
Quarterly Meeting—Tallahassee
May 21, 2014
On-site, one-on-one technical assistance, as
requested
August 1, 2014
PIPs due to AHCA with first six activities
completed (Study Design)
Slide 22
Questions
Slide 23