QI Framework

6.1 Develop Sustainability Plan to Continue and Expand AF QI Program

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.

6.1.a Upkeep/Maintenance

A challenge often observed in QI initiatives is that upon conclusion the team disbands. It is important to identify who on the team or in the healthcare system will be responsible for continued review and maintenance of AF outcomes and communicating these with stakeholders and system leadership.

6.1.b Transitions of care

Transition points often give rise to discontinuity in patient care. The sustainability plan should include a regular review of transition points to identify issues that may contribute to a continuing or new gap in the care of patients with atrial fibrillation.

6.1.c Update benchmarks

Identified benchmarks may need to be updated to reflect continuing improvement. A review of benchmarks can be included in the sustainability plan.

6.1.d Ongoing Quality Achievement Feedback Reports to Providers, Clinics, Stakeholders

Continuing to provide reports to individual clinicians who are caring for patients with AF and comparing their performance with peer group performance drives change and such reports are often used to judge performance. Ongoing AF data reports to system leaders increases the likelihood that the improvement will be sustained.

6.1.e Reinforcement/Education

Reinforcing the importance of quality patient care assists in sustaining the positive outcomes from a QI initiative. Education is a continuing intervention as guidelines and standards change and refreshes the knowledge base of healthcare providers.

6.1.f Concordance with Culture

Cultures can vary from system to system: some insist on standardization, while others support flexibility. To sustain QI results, the sustainability plan must be in concordance with the system culture.

6.1.g Fit into Workflow

Maintaining quality improvement results is most easily accomplished if interventions are included in the clinical workflow and require no extra work by healthcare providers.

6.1.h HCP Performance/Incentive Goals

Providing incentives for quality performance is a key factor in sustaining outcomes.

6.2 Develop a Scalability Plan to Transfer and Apply Knowledge

Scalability depends upon the availability of an eRecord to identify patients and calculate the CHA2DS2-VASc score. Scalability depends upon accurate data that is trusted by healthcare providers. A plan will be necessary to scale the initiative to other locations and launch further QI initiatives.