Building Quality Improvement Partnerships in the VA: The Colorectal Cancer Care Collaborative .


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C4: Colorectal Cancer Care Collaborative. Started in 2005To survey and enhance the nature of colorectal disease care from screening and finding through treatment. Course of events. Today\'s Workshop. How could we have been able to we begin on the collaboration?Overview of Colorectal Cancer Care CollaborativeMeasurement challengesBuilding an estimation systemSpreading lessons to the VALessens for QUERI agents.
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Building Quality Improvement Partnerships in the VA: The Colorectal Cancer Care Collaborative QUERI National Meeting Phoenix, AZ December 2008 George L. Jackson, Ph.D., MHA; Leah L. Zullig, MPH Adam A. Powell, Ph.D., MBA; Diana L. Ordin, MD, MPH Dawn T. Provenzale, MD, MS

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Phase I: Diagnosis * screening * introduction with side effects through conclusion Phase II: Treatment * period from determination of CRC through treatment & follow-up C4: Colorectal Cancer Care Collaborative Began in 2005 To evaluate and enhance the nature of colorectal disease mind from screening and finding through treatment

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Sept. 2005-Sept. 2006 Oct. 2006-Present March 2007-March 2008 Summer 2005 Collaborative arranging Spread of lessons from Phase 1 (analysis treatment) Collaborative Phase 1 (screening result determination) Collaborative Phase 2 Time Line

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Today\'s Workshop How did we begin on the coordinated effort? Review of Colorectal Cancer Care Collaborative Measurement challenges Building an estimation framework Spreading lessons to the VA Lessens for QUERI agents

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Why C4? Started in 2005: Earlier CMO consider recommended convenience issues QUERI inquire about outcomes showed crevices in colorectal growth finding and treatment OIG report Congressionally-ordered survey of disease care (GPRA – Government Performance and Results Act) Colorectal, bosom, lung, prostate, hematologic

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Colorectal Cancer Second driving reason for tumor passing Third most regular sort of malignancy among men and ladies in the United States 11% of all new growth cases 90% five-year survival when analyzed at stage I 5% five-year survival when determinations at stage IV Source: VA Colorectal Cancer QUERI Fact Sheet, January 2006 Source: VA Colorectal Cancer QUERI Fact Sheet, Jan. 2006

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Signs & Symptoms Initial Screen + - Repeat CDE* Cancer Adenomas Surveillance Treatment Surgery Chemotherapy Radiation * CDE=complete demonstrative assessment CRC Continuum

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250 % Patients with 63% + Fecal Occult Blood Test 200 Scheduled for Diagnostic 48% 150 Evaluation 95% 100 45% 23% 64% % Scheduled Completing 50 Diagnostic Evaluation w/in 1 Year 0 Facility B Facility C Facility A mean sched defer mean appt time mean fruition delay Follow-Up Positive FOBT

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Modifiable Risk Factors for Advanced CRC 549 patients 43% gave late stage (organize III or IV) colorectal tumor The main variable related with giving late stage was not having a standard wellspring of medicinal services Median patient postponement – 9 weeks Median doctor delay – a month and a half Stage at introduction was not related with either patient or doctor postpone Fisher DA, Martin C, Galanko J, Sandler RS, Noble MD, Provenzale D. Hazard elements for cutting edge ailment in colorectal disease. Am J Gastroenterol 2004;99:2019-2024.

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Modifiable Risk Factors for Advanced CRC Median patient postponement – 9 weeks Median doctor delay – a month and a half Stage at introduction was not related with either patient or doctor defer Fisher DA, Martin C, Galanko J, Sandler RS, Noble MD, Provenzale D. Hazard components for cutting edge ailment in colorectal malignancy. Am J Gastroenterol 2004;99:2019-2024.

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OIG Report: CRC Detection and Management in VHA Facilities Feb. 2006 Metrics to assess and enhance CRC dx auspiciousness Prioritization prepare for dx c-scopes Directive tending to time spans Pt notice of screening results inside 7 working days Consistent notice and documentation necessity for dx testing

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OQP Vision Measures and estimation apparatus improvement (QUERI/HSR&D) Pilot community venture to distinguish and create change techniques/devices (OQP/SR) National spread of venture (SR/OQP) Monitors or Performance Measures to make "pull" for development Ongoing backing to encourage sharing, recognizable proof of extra viable procedures/devices

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OQP Vision Partnership among OQP, specialists, PCS, Advanced Clinical Access/Systems Redesign Strong, continuous assessment segment

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Anticipated Challenges Measurement challenges Improvement challenges Dissemination challenges Two stages: determination and treatment Project framework New organization show "In the nick of time" arranging Pace and outline of venture Sense of direness Cultural "conflicts" Research versus operations Anecdote versus confirm

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Anticipated Outcomes and Products Measurement Standardized office level methodologies for QI measures Real-time estimation devices Documentation of boundaries to national estimation Improvement apparatuses/techniques Dissemination instrument Improvement before outer audit distributed Lessons on the most proficient method to do this better next time Project association and accomplice parts C4-sort cooperative

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The Partnership Quality Enhancement Research Initiative (QUERI) CRC mastery in estimation and change Office of Quality and Performance (OQP) Performance estimation skill Quality change aptitude Systems Redesign Expertise in defer diminishment National foundation, experience, and devices Patient Care Services Clinical ability Link to VA clinical electorates

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C4 Planning Committee Organizes the shared Includes agents from all accomplice associations and other VA community oriented specialists Subcommittees Measurement Issues Collaborative Operations Dissemination

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Optimizing the Partnership Dialog is basic! Starting QUERI-if measures were evaluated by the field C4 works with the field to grow better measures Some may illuminate national information frameworks and some may stay nearby change apparatuses OQP, DUSHOM and VISN CMOs give proceeded with support

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Changing Systems

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C4 Learning Collaboratives 21 volunteer offices (one for each VISN) in finding community oriented 28 volunteer offices (no less than one for each VISN) in treatment communitarian Collaborative: organized, imparting to fast cycle change Planning and assistance by accomplice associations with the contribution of numerous VA partners

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VISN 6 Beckley, WV VISN 7 Columbia, SC VISN 8 San Juan VISN 9 Lexington, KY VISN 10Columbus VISN 11Northern Indiana VISN 20 Portland VISN 21 San Francisco VISN 22 Loma Linda VISN 23 Black Hills, SD Diagnosis Collaborative 21 Improvement Teams VISN 1 Providence VISN 2 Buffalo VISN 3 New Jersey VISN 4 Pittsburgh VISN 5 Washington VISN 12 Chicago (Hines) VISN 15 St. Louis VISN 16 Houston VISN 17 Temple VISN 18 West Texas VISN 19 Salt Lake City

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VISN 6 Beckley, WV Salisbury, NC VISN 7 Columbia, SC VISN 8 Gainesville VISN 9 Lexington, KY VISN 10Dayton VISN 11Northern Indiana VISN 20 Portland Puget Sound VISN 21 San Francisco VISN 22 Loma Linda San Diego VISN 23 Black Hills, SD Nebraska/W. Iowa Treatment Collaborative 28 Improvement Teams VISN 1 Providence VA Connecticut VISN 2 Buffalo VISN 3 New Jersey VISN 4 Pittsburgh Lebanon, PA VISN 5 Washington VISN 12 Chicago (Hines) VISN 15 St. Louis VISN 16 Houston VISN 17 Temple VISN 18 West Texas Albuquerque VISN 19 Salt Lake City

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C4 Learning Collaborative Process Flow-mapping and beginning information accumulation QUERI estimation utilizing CPRS information Local estimation Setting points Plan-Do-Study-Act (PDSA) cycles Coaches help in the change procedure Collaborative sharing by means of face to face gatherings, month to month national calls, month to month reports to mentors and senior pioneers, overhauls to VA authority, site, and listserv

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Collaborative Process Team choice and responsibility In-Person Meeting - Flow mapping - Baseline measures - Aim setting Plan-Do-Study-Act (changes and estimation) Reports to C4 and administration Structured sharing (e.g national calls) PDSA Dissemination

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C4 Team Composition Facility Management Facilities volunteered for the community oriented Applications marked by the medicinal focus chief, head of staff, and nursing official Sites gave measure, multifaceted nature, geographic differing qualities Team Formation Teams incorporate doctors, attendants, and different agents from the included clinical administrations Designated extend administrator Information innovation delegate

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C4 Team Activities Flow-mapping and starting information accumulation Setting points Plan-Do-Study-Act (PDSA) cycles Coaches help in the change procedure Collaborative sharing through face to face gatherings, month to month national calls, month to month reports to mentors and senior pioneers, redesigns to VA initiative, site, and listserv

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Act Plan Study Do Model for Improvement PDSA – Rapid Cycle Improvement What are we attempting to fulfill? By what means will we realize that a change is a change? What changes would we be able to make that will bring about a change? PDSA slides civility of Jim Schlosser, MD, MBA

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Act Plan Objective Questions and forecasts (why) Plan to complete the cycle (who, what, where, when) What changes are to be made? Next cycle? Study Do Complete the investigation of the information Compare information to expectations Summarize what was found out Carry out the arrangement Document issues and surprising perceptions Begin examination of the information The PDSA Cycle for Learning and Improvement

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D S P An A P S D S P An A P S D Examples of PDSA Cycles Improved get to Data Cycle 5: Implement models and screen their utilization Cycle 4: Standardize arrangement sorts and test their utilization Cycle 3: Test the sorts with 1-3 suppliers\' patients Reduction of arrangement sorts will expand arrangement accessibility Cycle 2: Compare asks for the sorts for one week Cycle 1: Define a little number of arrangement sorts and test with staff

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An A P S D S

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