February 2007

Question:
Are there strategies and models typically used in primary care settings that I can use to evaluate and improve mental and overall health care in my community?

Answer:
Quality assurance and quality improvement has evolved from reviewing individual performance to developing models for improvement that emphasize structural improvement of organizations. One of these models, the Plan, Do, Study, Act (PDSA) cycle, has been used to improve the infrastructure in which people work and thereby improve processes and outcomes in health care organizations. Many of the primary care practices participating in the National Medical Home Learning Collaboratives, sponsored by the Maternal and Child Health Bureau of the Health Resources and Services Administration (HRSA) of HHS, have used the PDSA model to improve quality of care in their practices.

The PDSA model is both generic and flexible and thus may apply to a variety of different settings including primary care, behavioral health care and family organizations. The health care organizational structures that might find this process useful can include but are not limited to managed care, Community Health Centers, Community Mental Health Centers and independent private practices. The model has two parts that include:

• Three questions that can be addressed in any order, and
• The Plan-Do-Study-Act (PDSA) cycle to test and implement changes in real world settings. The PDSA cycle guides the test of a change to determine if there is an improvement.  

Fundamental Questions
The first step is to form the team that will be implementing the change. Team members should be chosen to suit the goals of the process. Once the team is formed the questions that should be answered are:

• Setting aims that are time-specific and are measurable and pertinent to the population served,
• Establish quantitative measures to determine if a specific change leads to an improvement and
• Selecting changes that are most likely to result in an improvement.

The PDSA cycle
The PDSA cycle is an acronym for testing a change in a real-world setting by planning it, implementing it, observing the results, and acting on what is learned. This is the scientific approach to action-oriented learning. After testing a change on a small scale, learning from each test, and refining the change through several PDSA cycles, the team can implement the tested and improved plan on a broader scale (e.g., expanding an integrated health care project from a focused population within the Medical Home and System of Care communities to an entire city or county). After successfully, implementing a change or a series of changes, the team can spread the changes to other organizations and States.

For an example of how the PDSA cycle might be used in practice, stay tuned for April’s Primary Care FAQ or contact Mary Tierney at mtierney@air.org.