Quality Improvement: Primary care clinic

The purpose of this assignment is to provide students with a better understanding of quality improvement methods for use in practice-based improvement efforts in the primary care setting. Students will use The Dartmouth Institute’s Outpatient Primary Care Workbook to analyze their assigned clinical microsystem (clinical site). If you have more than 1 clinical site, please just pick one. 

Assignment 

Part 1 - Primary Care Practice Profile: 

Students will complete the Primary Care Practice Profile based on information from their field work site. This worksheet provides a broad overview of the “5 Ps” of a clinical microsystem: (1) Purpose, (2) Patients, (3) Professionals, (4) Processes, and (5) Patterns. This will help you become familiar with your site and identify potential areas of improvement. 

You will turn in a copy of your Primary Care Practice Profile along with a process map of a typical patient flow through the clinic (see QI lecture for more details on drawing a process map). 

Part 2 - Workbook: 

After completing the Primary Care Practice Profile, students will use the Outpatient Primary Care Workbook as needed to help them further explore areas for potential improvements. 

*An idea of how to improve a patient gap related to SDoH and a clinic-based improvement must be identified. 

-No submission required for this section, but it will help you with the next part. 

Part 3 - Written Narrative: 

After a microsystem analysis has been done and the student (along with the help of their preceptor) has identified an area for potential improvement in the clinic, students will provide a written narrative discussing findings from the analysis and recommendations for improvement supported by evidence from the literature. The written narrative should adhere to APA guidelines and will be no more than a total of 2 pages using the following outline: 

1. Give a general overview of your clinic/ what you learned by completing a microsystem analysis. (1 paragraph) 

2. Describe the patients and any social determinates of health impacting your patient population. Give one recommendation for improvement supported by at least one reference. 3. Choose and describe at least one other area for improvement that you identified (either professionals, processes, or patterns) in your clinical site. Give one recommendation for improvement supported by at least one reference. 

4. Note: please make these reasonable and doable recommendations for a clinic setting. Remember these do not have to be huge changes to make positive impacts. 

Example QI Paper 

See rubric attached to assignment.

https://uab.instructure.com/courses/1595038/assignments/6836764?return_to=https%3A%2F%2Fuab.instructure.com%2Fcalendar%23view_name%3… 1/1 

Sample

Quality Improvement Recommendations

The Primary Care Clinic of focus in this exercise serves the Northeast area of Philadelphia, which hosts a population of 282,745 people. The facility has two medial doctors, two registered nurse practitioners, two massage therapists, two medical assistants (Mas), and two secretaries. The PCC does not have a lead nurse or a nurse manager, but the Practice director serves as the manager and lives around the facility. Some of the diagnoses in the facility are acute disease conditions and check-ups for children 18 months and above. The facility also encounters acute and chronic cardiovascular, metabolic, respiratory, psychiatric, and orthopedic disorders. The patient traffic in the facility is around 90 daily, with eighty new patients every month seeking urgent care services such as EKG, Sutures, Staples, wound care, house call services, sick visits, and a medical weight loss program.

Social Determinants of Health

Poverty is a major social determinant of health in Northeast Philadelphia, Pennsylvania. Research has shown that poverty harms health outcomes, and Northeast Philadelphia is no exception. The high poverty rate in this area has been linked to a range of negative health outcomes, including higher rates of chronic diseases, mental health issues, and substance abuse. According to Weida, Phojanakong, Patel & Chilton (2020), poverty is associated with lower access to health care, higher rates of unemployment, and limited educational opportunities, all of which further contribute to poor health outcomes.

Recommendation

In order to improve the health of the Northeast Philadelphia population, it is important to address the underlying social determinants of poverty, such as inadequate housing, limited access to health care, and educational disparities. Addressing these factors, the community can work together to create a healthier, more equitable environment for all residents. Affordable housing is essential for reducing poverty and improving health outcomes. The city should work to expand the availability of affordable housing and provide support for existing housing initiatives. Access to health care is critical for maintaining good health. The city should work to increase access to health care services in Northeast Philadelphia and should provide support for existing health care initiatives. DeBonis, Meyer & Brodersen (2020) notes that education is one of the most important tools for breaking the cycle of poverty. The city should work to increase access to quality education in Northeast Philadelphia and should provide support for existing educational initiatives.

Need for Improvement

According to the microsystems analysis, one area for improvement in the PCC is the staffing area. Few certified registered nurses are in the facility, exposing patients to possible safety and quality issues. Poor nurse staffing can lead to burnout, decreased morale, and increased risks of medical errors, all of which can lead to adverse patient outcomes (Andel, Tedone, Shen & Arvan, 2022). Additionally, inadequate staffing can increase wait times and decrease patient satisfaction, resulting in a negative patient experience.

Recommendation

One of the recommendations to counter this is to increase the number of nurses in the PCC is essential for improving patient safety and quality of care. The facility should work to recruit and retain qualified nurses in order to increase the number of nurses available. To complement this quality improvement option, the PCC may also develop a flexible staffing model to help ensure that the right number of nurses are available for each patient at any time as recommended by Witczak et al. (2021). The facility should develop a staffing model considering patient acuity, availability, and other factors.

References

Andel, S. A., Tedone, A. M., Shen, W., & Arvan, M. L. (2022). Safety implications of different forms of understaffing among nurses during the COVID-19 pandemic. Journal of advanced nursing, 78(1), 121–130. https://doi.org/10.1111/jan.14952 

DeBonis, R. S., Meyer, J. R., & Brodersen, L. D. (2020). An Educational Initiative to Affect Poverty and Social Determinants of Health-Related Knowledge and Attitudes in Primary Care Settings. Journal of health care for the poor and underserved, 31(2), 756–766. https://doi.org/10.1353/hpu.2020.0059

Weida, E. B., Phojanakong, P., Patel, F., & Chilton, M. (2020). Financial health as a measurable social determinant of health. PloS one, 15(5), e0233359. https://doi.org/10.1371/journal.pone.0233359 

Witczak, I., Rypicz, Ł., Karniej, P., Młynarska, A., Kubielas, G., & Uchmanowicz, I. (2021). Rationing of Nursing Care and Patient Safety. Frontiers in psychology, 12, 676970. https://doi.org/10.3389/fpsyg.2021.676970 

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