دورية أكاديمية
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Lean Six Sigma quality improvement approach to implement clinical practice guidelines for prescribing opiates for chronic pain in a primary care setting.

التفاصيل البيبلوغرافية
العنوان: Lean Six Sigma quality improvement approach to implement clinical practice guidelines for prescribing opiates for chronic pain in a primary care setting.
المؤلفون: Bakhai S; Internal Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA sybakhai@buffalo.edu., Mustafa J; Internal Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA., Cloutier M; Internal Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA., Islam F; Internal Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA., Gudleski GD; University at Buffalo, The State University of New York, Buffalo, New York, USA., Reynolds JL; Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA.
المصدر: BMJ open quality [BMJ Open Qual] 2024 Sep 16; Vol. 13 (3). Date of Electronic Publication: 2024 Sep 16.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: BMJ Publishing Group Country of Publication: England NLM ID: 101710381 Publication Model: Electronic Cited Medium: Internet ISSN: 2399-6641 (Electronic) Linking ISSN: 23996641 NLM ISO Abbreviation: BMJ Open Qual Subsets: MEDLINE
أسماء مطبوعة: Original Publication: London : BMJ Publishing Group
مواضيع طبية MeSH: Quality Improvement* , Chronic Pain*/drug therapy , Analgesics, Opioid*/therapeutic use , Primary Health Care*/statistics & numerical data , Primary Health Care*/standards , Total Quality Management*, Humans ; Practice Guidelines as Topic ; Pain Management/methods ; Pain Management/standards ; Pain Management/statistics & numerical data ; Female ; Male
مستخلص: Background: Implementing guidelines for chronic opioid management during a clinic merger posed significant challenges. Our aim was to increase the percentage of chronic pain evaluations and urine toxicology tests in patients on chronic opioid therapy from the baseline rate of less than 20% to 50% within 1 year at an academic, primary care clinic.
Methods: We applied the Define, Measure, Analyze, Improve, Control (DMAIC) approach of Lean Six Sigma for this quality improvement (QI) project. The QI tools included the creation of stakeholder mapping, root cause analysis, process flow mapping and a driver diagram. Lack of patient and provider education emerged as a significant barrier. The outcome measures were percentage of chronic pain evaluations and urine drug toxicology with an increase in controlled substance agreement completion rates as our process measures. Major interventions included patient and provider education, leveraging health information technology, care coordination and implementing new clinic protocols. Data analysis was performed by monthly run charts. Descriptive statistics were used to summarise clinical variables, while χ 2 analyses were employed to determine statistically significant differences between preintervention and postintervention measures.
Results: We observed an increase in completion rates of clinic visits for chronic pain, rising from 19.0% to 51.9% (p<0.001). During study period, we observed a steady increase in chronic pain evaluations with a median of 4.5. Urine toxicology completion rates increased from 19.9% to 65.8% (p<0.001) during the preintervention and postintervention periods. We observed variable changes in urine toxicology rates with a median of 5.19. Furthermore, we observed an increase in controlled substance agreement completion rates, increasing to 50% from the baseline rate of <10%.
Conclusions: Education to patients and providers, shared decision-making using a patient-centred approach, enhancement of health information technology and system-based interventions in clinic protocols and workflows contributed to the success of this QI project. The DMAIC approach may facilitate the implementation of practice guidelines for chronic opioid therapy and enhance providers' opioid prescribing practices.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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فهرسة مساهمة: Keywords: Clinical practice guidelines; Control charts/Run charts; Evidence-based medicine; Quality improvement
المشرفين على المادة: 0 (Analgesics, Opioid)
تواريخ الأحداث: Date Created: 20240916 Date Completed: 20240916 Latest Revision: 20240920
رمز التحديث: 20240920
مُعرف محوري في PubMed: PMC11409372
DOI: 10.1136/bmjoq-2024-002912
PMID: 39284680
قاعدة البيانات: MEDLINE
الوصف
تدمد:2399-6641
DOI:10.1136/bmjoq-2024-002912