NIPN builds the quality focus



As the era of quality-focused health care descends upon the health care landscape, the National Improvement Partnership Network is laying a foundation to help pediatricians and family physicians improve the quality of care they deliver.

NIPN began as a state-based initiative in Vermont and has evolved into an umbrella organization that is helping pediatricians and family physicians across 22 states, with more working to come on board.

Back in 1999, a state-based program called the Vermont Child Health Improvement Program (VCHIP) was launched by a group of individuals as well as representatives from the state department of health and the state Medicaid agency, explained NIPN associate director Dr. Wendy Davis.

The three groups were “thinking together about what were the things that needed to be improved in terms of children’s health care delivery and population health outcomes,” Dr. Davis said in an interview. “What was our data telling us in the state about where we were doing well and where there were areas for improvement?”

Over the years, VCHIP morphed into a program that had participation from pediatricians and family physicians as well as those in the obstetric community, and looked beyond physical care to encompass mental and behavioral health as well.

But, as a starting point, to prove the value of the partnership, the group took a simple topic – preventive health care – and adopted scientific methods of quality improvement, particularly those used in the manufacturing sector, to help find ways to improve health care.

“If you want physicians to change their behavior and how they deliver care, you need to have them take a very practical approach,” said Dr. Davis, who also is a professor of pediatrics at the University of Vermont, Burlington. You need to “examine what they are doing in their offices and test out some of the best practice strategies in a very systematic way, and always examine what the data on their patients is showing them in terms of figuring out whether they’ve made improvements or not.”

The framework employed by VCHIP, and ultimately NIPN, is a basic strategy of using the Plan-Do-Study-Act (PDSA) model. This pathway starts with setting an objective, testing a new way of doing something, studying the results, and finally implementing changes.

To illustrate it, Dr. Davis used the example of immunization rates. Pediatricians would be asked to determine if they were following national guidelines to get their pediatric patients immunized. They could look at their records in a systematic way to determine what percentage of patients were receiving their shots at the right times. Then they examine the processes used to get patients in the office, and finally, test ways to improve processes and get more children into the office for immunization.

“What organizations like ours do then is teach the clinicians and the practice staff how to look at and analyze and break down their process, and what they can do that is going to make that process better,” Dr. Davis said. “So we run them through a series of PDSA cycles to see if they can get better and better at not missing any of the kids [who] are coming through, and at the end of the project, we have them look at their data again, and hopefully, if we’ve done a good job, they’ve done a good job.”

Dr. Davis stressed that this is not a one-size-fits-all approach to quality improvement. She noted that when it comes time to offer ideas for best practices to test out, many factors can determine what might work best for a given office, so the group likes to offer a number of best practice options that physicians can use to improve their work.

And as word started spreading about the work of VCHIP at various medical conferences, other states started approaching Vermont to build their own version. From there, NIPN was born.

“In 2009, we realized that we had a good critical mass of states, and it would be helpful to have an organization as an umbrella supporting all of these different state-based organizations so that we could begin to share and learn from each other,” Dr. Davis said.

NIPN allows for the easy transfer of knowledge between states and the sharing of ideas on how to improve quality of care, helping doctors learn from each other, all the while maintaining that local focus. The organization also helps pediatricians in other ways, such as by helping them meet maintenance of certification requirements.

“One of the things that we’d like to say is all improvement is local,” Dr. Davis said. “That is why we’ve approached this with the state-based concept because we can share the general concepts and the tools and materials. But when it comes to helping physicians and other health care professionals improve their practice, there are often individual twists and unique features of a particular state that mean that you really have to have people on the ground in that state helping to foster this work so that it can be responsive to the climate of that particular state.”

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