Applying Quality Improvement into Systems-based Learning to Improve XXXX Outcomes in Primary Care.

@entity1 @entity3916 @entity164 @entity6
In the U.S., where the prevalence of @entity164 2 @entity6 has reached epidemic proportions, many @entity1 with this disease are treated by primary care physicians in community-based systems, including accountable care organisations (ACOs). To address gaps in the quality of @entity6 care, national quality measures have been established, including @entity1 -centered measures adopted by the Centers for Medicare and Medicaid Services for its Shared Savings Program for ACOs. From a @entity1 -centered perspective, high-quality @entity6 care depends on effective communication between clinicians and @entity1 , along with @entity1 education and counseling about medications and lifestyle. We designed and implemented a quality improvement (QI) program for 30 primary care physicians treating @entity1 with @entity164 2 @entity6 in three structurally similar but geographically diverse ACOs. Retrospective chart audits were conducted before (n = 300) and after (n = 300) each physician participated in accredited continuing medical education (CME) courses that focused on QI strategies. Randomly selected charts were audited to measurably assess essential interventions for improved outcomes in @entity164 2 @entity6 including the physicians' documentation of @entity1 counseling and assessment of side effects, and @entity1 ' medication adherence status and changes in hemoglobin @entity3916 ( @entity3916 ) and body mass index (BMI). Paced educational interventions included a private performance improvement Internet live course conducted for each physician, small-group Internet live courses involving peer discussion, and a set of enduring materials, which were also multi-accredited for all clinicians in the physician's practice. Continual improvement cycles were guided by analysis of the baseline chart audits, quantitative survey data, and qualitative feedback offered by @entity1 . To extend the benefit of the education, the enduring materials were offered to the interprofessional team of clinicians throughout the U.S. who did not participate in the QI program. For brevity, this article presents outcomes of the 30 primary care physicians. Baseline to post-education improvements were observed for percentages of charts with documented assessment of medication side effects (+11%) and counseling about medication risks/benefits (+28%), medication adherence (+13%), and lifestyle modifications (+8%). Improvements were also observed for documented adherence to @entity6 medications (+24%) and first-to-last visit changes in @entity3916 (-0.16%) and BMI (-2.1). The findings indicate a positive influence of QI education on primary care physicians' performance of @entity1 -centered quality measures and @entity1 outcomes.
