Many health clinics in rural areas of the United States face unique challenges in sharing best practices in quality improvement due to their limited ability to network in-person with other health care professionals.
In the state of Nebraska, the Great Plains Quality Innovation Network—the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Kansas, North Dakota, Nebraska and South Dakota—sought to improve communication among clinicians by implementing a virtual program to convene clinical communities across the state.
Between September 2016 and March 2017, the QIN-QIO hosted three virtual clinical training sessions, enabling providers from across Nebraska to convene and share insights on health care quality improvement.
Among the participants in the training sessions was Grand Island Clinic of Grand Island, Nebraska. Prior to participating in the virtual trainings, the Grand Island Clinic had few employees with backgrounds in formalized interventions, was uncertain of its own goals in this area and had no formalized programs to focus specifically on improving health care outcomes and quality of care.
“No one ever expected how quality encompasses all aspects of the clinic,” said Patricia Enck, the administrator of Grand Island Clinic. “Our providers wanted to enhance patient care by utilizing the unique information that we were seeing in our quality measure reporting through the Meaningful Use Initiative.”
As part of its virtual training sessions with the Great Plains QIN, Grand Island completed clinical “to-do” assignments between learning sessions. Based on one of the assignment’s recommendations, Grand Island decided to implement a team-based approach to quality improvement in which clinical protocols are established for nurses and clinicians to standardize processes for clinical activities.
“No one ever expected how quality encompasses all aspects of the clinic. Our providers wanted to enhance patient care by utilizing the unique information that we were seeing in our quality measure reporting through the Meaningful Use Initiative.”
Since blood pressure management is a big focus for Grand Island Clinic, the quality improvement team decided to create a protocol for that area. The facility implemented simple interventions such as establishing common practices in measuring blood pressure by asking patients to put two feet flat on the floor and placing their arms at heart level. Through these interventions, Grand Island Clinic was able to successfully standardize blood pressure measurement and yield better data on patient needs in their care community. Quality data from EMR reports allowed the clinic to review medical records of all patients with hypertension to identify necessary interventions. If necessary, the clinic contacted patients about rechecking their blood pressure or recommended changing their medication.
Through this process, Grand Island Clinic determined that nurses would benefit from training to appreciate the value of the interventions, while patients would benefit from the ability to self-monitor their blood pressure without the supervision of a licensed care professional. The clinic’s Patient Care Coordinators contacted pharmacies in the area to determine which ones could provide self-monitoring devices to patients at cost. This outreach resulted in a partnership with U Save Pharmacy on-site, which enabled hypertension patients to receive self-monitoring equipment at an affordable rate on the day of their appointment, without having to leave the facility.
In 2017, Grand Island Clinic hired a full-time quality improvement professional to help coordinate and implement Quality Improvement. This on-site coordinator is currently developing written clinical quality improvement policies to improve overall hypertension rates among the clinic’s patients and within its care community.