Engage in testing and refinement of IT infrastructure and reports (as needed)

Six pillars guide a quality improvement initiative: prepare, engage, design, implement, report, sustain/scale. Each pillar is expanded by specific action steps. The steps are fluid: steps may occur simultaneously or in a different order throughout the pillars.

Framework Pillars

The Prepare Pillar comprises steps and key considerations to begin a QI initiative in atrial fibrillation care. These foundational steps include gathering the personnel and data that are essential to engage a healthcare system in the initiative.&nbsp;

Prepare

The Prepare Pillar comprises steps and key considerations to begin a QI initiative in atrial fibrillation care. These foundational steps include gathering the personnel and data that are essential to engage a healthcare system in the initiative. 

While AF is the most common arrhythmia, it continues to be undiagnosed, untreated, and undertreated. The consequence for untreated patients can be high, especially for stroke prevention, as AF is associated with a five-fold increased risk of stroke, and strokes resulting from AF are more severe and disabling.&nbsp;

1.1 Identify AF as Condition Warranting Improvement

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A supportive network of QI champions often emerges during a QI initiative, which could include primary care, cardiology, electrophysiology, pharmacy, IT, administrators, or other representatives.
Some champions may become part of the QI initiative implementation team, others may not. All should remain regularly informed of status and progress as the initiative progresses.&nbsp;
An important first step is to identify one champion to act as the primary lead. This lead champion does not have to be a physician but it is recommended that a physician be included in the champion network to facilitate initiative success.&nbsp;
A strong lead champion should embody specific criteria.
<ul>
<li>is passionate about, and ideally has experience in, leading quality QI initiatives</li>
<li>has available time to devote to the initiative</li>
<li>has the authority to advocate effectively for the QI initiative and gain executive sponsorship from system leaders</li>
<li>understands the overall system and systemic changes that might result from initiative outcomes</li>
<li>has a comprehensive understanding of, and ability to, field questions regarding the gap in AF care that is being addressed in the QI initiative</li>
</ul>

 1.2 Identify AF Quality Champions

System priorities typically are based on a balance between patient outcomes, operational feasibility, and financial considerations. While not required for all health systems, developing a compelling business case for the QI initiative will supplement and support the clinical importance of the initiative and provide metrics upon which success will be measured.&nbsp;
A business case evaluates the benefit, challenges, cost and risk of action/inaction regarding the gap to be addressed and includes a recommendation and rationale for the proposed solution. This financial and clinical comparison enables the healthcare system leadership to determine if the initiative should be approved.

1.3 Develop a High-Level Improvement Plan

The focus of the Engage Pillar is forming, motivating, and activating the project team that will design and implement the QI initiative, as well as the expanded network of key clinical and system champions and stakeholders who will support and advocate for the initiative.

Engage

The focus of the Engage Pillar is forming, motivating, and activating the project team that will design and implement the QI initiative, as well as the expanded network of key clinical and system champions and stakeholders who will support and advocate for the initiative.

2.1 Identify and Engage an Executive Sponsor

The healthcare system leadership must agree that patient and business outcomes warrant the use of resources to implement the QI initiative. These leaders will balance the outcomes of improved care for patients with AF with the associated costs/benefits to the system. The executive sponsor must be prepared with clinical and financial data to present to the system leadership and advocate for the QI initiative.

2.2 Obtain Leadership Agreement to Prioritize Improvement in AF Outcomes

2.3 Identify and Align Specialty and Therapeutic Settings

2.4 Establish Core Project Team

The Design Pillar defines the steps to develop the QI design and scope for the QI initiative implementation and results in a documented plan.

Design

The Design Pillar defines the steps to develop the QI design and scope for the QI initiative implementation and results in a documented plan.

The design stage defines the steps to develop the QI design and scope for the QI initiative implementation and results in a documented plan. Click below for additional references to support the QI planning process. &lt;insert link to resource library for additional resources, such as below&gt; https://asana.com/resources/project-management-plan&nbsp;

3.1 Create Improvement Plan

3.2 Obtain Approval of Project Plan by Project Stakeholders and Participants

3.3 Obtain IRB or QI Committee Approval (as needed)

The QI initiative is launched with the Implementation Pillar. The plan is tested and refined as barriers and issues are encountered. Ongoing reporting to the project team and stakeholders occurs during this pillar.

Implement

The QI initiative is launched with the Implementation Pillar. The plan is tested and refined as barriers and issues are encountered. Ongoing reporting to the project team and stakeholders occurs during this pillar.

The QI initiative is launched during the implementation stage. The plan is tested and refined as barriers and issues are encountered. &nbsp;Ongoing reporting to the project team and stakeholders occurs during this stage.

4.1 Execute Improvement Plan

Report

Reports play an essential role in the quality improvement process. Many options exist depending upon the healthcare system, the audience, and the purpose of the report.

5.1 Status Reports

5.2 Develop Summary Report

5.3 Disseminate Findings

5.4 Institute Communication Plan

Sustain/Scale

A plan to review regularly atrial fibrillation data resulting from the completion of a quality improvement initiative is essential to sustain the results. If the initiative has resulted in improved outcomes, healthcare system leaders may broaden the plan to other sites or to other systems.

A plan to regularly review the data resulting from the completion of the QI initiative assures that the positive outcomes will be sustained.

What is the HRS Quality Improvement Framework?

The community-based framework, which is customizable, measurable, adaptable, sustainable, and scalable, will grow as users provide curated content.

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