| Total Sample size (must be 10 or more) | Number of successes (has had 2 or 3 HPV vaccine doses) | Success % | Review and summarize your practice's performance (50 words or more) | Performance improvement method(s) that I would like to propose for my practice | Performance improvement method(s) that I have chosen to implement in my practice | Date that I have completely implmented my performance improvement method(s) into my practice operations. | PI method implemented in pracice operation for 8 weeks | Follow-up data total Sample size (must be 10 or more) | Follow-up data number of successes (has had 2 or 3 HPV vaccine doses) | Success % | |
| Due Date | Apr 8 | Apr 8 | Apr 8 | Apr 22 | May 13 | May 27 | June 24 | Aug 19 | Sep 16 | Sep 16 | Sep 16 |
| Dr. Henry Bernstein | 10 | 4 | 40% | I thought I was doing better than what I found. I can now see how this process will work. I'm looking forward to the next step. As pediatricians, we all think that our immunization rates are really high and to find that they aren't is very disappointing which is why it needs to improve. Adolescents are clearly more difficult to immunize. | My practice uses an EMR. The EMR has a best practice alert that is associated with a particular chief complaint or main diagnosis. I'm going to find out if the EMR can insert a vaccine update alert as a reminder for all teens who don't usually come in for well child checks. Instead, they come in for abdominal pain, sore throats, and sports injuries. The vaccine alert will help us to remember to update their HPV vaccine status. | I did find out that our EMR can give us a routine pop-up screen that will provide small note reminding us to ask about adolescent vaccines for all visits in children/teen's 12 years old and above. I will be adopting this as my PI method. Our IT department has implemented this measure yesterday so it is already in place and operational. | Started in May sometime. | Done | 10 | 6 | 60% |
| Dr. Ann Burke | 17 | 7 | 41% | I'm disappointed that my immunization rate isn't better. Many of my successes only had two and not three vaccine doses. I'm really glad that I joined this project. I think it's really important to find out how much more we can do. This has really peaked my interest and I am now highly motivated to improve on this. | We have an EMR so my plan is to run a single computer search for all my patients who are 12 and above and then I will have the staff check their HPV vaccine status. Those who have 0-1 HPV vaccine doses will be a priority for us. We will call them in for a vaccine only visit if that is what it takes to get them in. | I will do the search and update method that I described. | In full operation as of June 20 | Done | 10 | 6 | 60% |
| Dr. Donna D'Alessandro | 18 | 8 | 44% | Looks like my practice is about in the middle. I wonder if practices that see a lot of adolescents may do better than those that see less and if we could learn something from those practices. It will be interesting to see what we decide to do as an intervention. | I'm having some difficulty in thinking of a method to improve. I like some of the ideas that have been proposed, but they don't fit my pratice very well. My practice does not use an EMR. Perhaps I will just try to be more aware that my adolescent HPV vaccine rate needs to improve. That personal knowledge is probably enough for me to be more active in vaccinating adolescents. | I can't do any of the things other people suggest so i am going to try to just be more personally vigilant in looking at each patient's immunizations. | I started doing it in the previous block | Done | 10 | 7 | 70% |
| Dr. Terry Kind | 15 | 10 | 67% | In our practice there was a big initiative last year to improve vaccination completeness for the <24 month pts, and I think there may have been some positive spillover to our teen vaccination rates, resulting in a percent as high as 67%. On the other hand, we might have been concentrating too heavily on the younger patients (because that’s where our practice focus was at the time) and perhaps our teen HPV vaccination rate would have been even higher! In our practice, we make extensive use of the online regional immunization registry. The front desk staff prints this for each pt that comes for a well check, and the registry is quite a smart system, letting us know what the patients are due to receive. However, I think we could improve if we printed this out for every visit, not just the well check visits. | 1) We went to electronic records in July 2009 and I don’t know if there is an analogous “electronic chart color” that we could use for patients 12 and up. Perhaps we could make use of “alerts” built in to the electronic medical record that to date we have made no meaningful use. 2) Perhaps we too could update our room signage with new HPV vaccine glossy posters reminding patients/parents to ask their providers about this vaccine (or all teen vaccines) and reminding the provider to offer it at proper intervals. [we did this] 3) We could have a staff meeting (nurse/provider) where we share our HPV vaccine completeness data (67%) with all providers and nurses and ask everyone to brainstorm and come up with ideas for improving our rates for the practice, like a mini-MyQIP but in my own practice 4) Shall we arrange to have a pharmaceutical company sponsored lunch where all the providers and nurses receive education about the vaccine and see if that alone boosts vaccination rates? | Will build an alert into the EMR for teen females needing HPV, and we will discuss this as well as our current vaccination rate (as motivation) at the next staff meeting. | Done on May 30 | Done | 15 | 10 | 67% |
| Dr. John Parboosingh | 13 | 6 | 46% | I not only looked at the data, but I also reviewed some of the comments that were submitted prior to my comments now. This review and reflection aspect is really important and this is what we discuss at our Royal College of Review and Reflection meetings. I can see that it has raised enthusiasm for improving this particular aspect of practice. Bravo. I am hoping to improve my practice as well. | I like the idea of color coding charts by age. I will ask my office manager if this can be done easily. | My office manager agrees that we can do this plan so I will stick with this. | Done on June 22 | Done | Due Sep 16 | Due Sep 16 | - |
| Dr. Robert Poth | 15 | 8 | 53% | I was actually surprised to that our practice was immunizing at least 50% given we have not been active in HPV immunization. In my group o f6 physicians, I know we each recommend it but I was not sure how well we were doing, hence my participation in this project. I am intrigued by Dr. Teitelbaum's use of a color coded system and the idea of signage encouraging teens to ask about their immunization status. I plan to present the data to my team and discuss some of the options we can use to increase our rates, including those used by Dr. Teitelbaum's group. | In our practice there was a big initiative last year to improve vaccination completeness for the <24 month pts, and I think there may have been some positive spillover to our teen vaccination rates, resulting in a percent as high as 67%. On the other hand, we might have been concentrating too heavily on the younger patients (because that’s where our practice focus was at the time) and perhaps our teen HPV vaccination rate would have been even higher! In our practice, we make extensive use of the online regional immunization registry. The front desk staff prints this for each pt that comes for a well check, and the registry is quite a smart system, letting us know what the patients are due to receive. However, I think we could improve if we printed this out for every visit, not just the well check visits. | We plan on using the following strategies: 1) Each chart will have a copy of the immunization record from the state registry placed on the front for physician review. 2) Charts of adolescents (12 years and older) will be flagged with a red sticker alerting the physician to specifically address HPV status. 3) Signs have been placed in each exam room and waiting areas to encourage discussion about HPV vaccination. | Done on June 1 | Done | 15 | 14 | 93% |
| Dr. Jonathan Teitelbaum | 20 | 14 | 70% | My practice has worked hard to ensure that patients are fully immunized. We have placed a sheet on the front of each patients chart outlining the immunization schedule and have placed the years in which older children are targeted to receive the immunization. Each year is color coded so that 2010 is blue. If a nurse or doctor sees a blue year on the sheet they should be alerted to the fact that an immunization is due. In truth I am disheartened to see that my rate was not 100% and I now plan to have a meeting with all the docs and nurses in the practice to review our charting system for immunizations to ensure better performance. I will also put a sign in each exam room asking “Ask me if you are you up to date with your shots?” | As stated I plan on having a meeting with staff to review our immunization policy (indeed I did a IPOC to review what ages we should start HPV immunization and to see what the data says about immunization of my male patients (seems like not yet FDA approved, but maybe soon). We have printed up signs which I have attached a copy of if anyone wants to use in their office. I like Loren’s idea about coloring adolescent charts, and will consider that in the future as well. | I plan on having a meeting with staff to review our immunization policy. I have printed up signs to hang in the waiting and exam rooms. | Done on June 11 | Done | 18 | 18 | 100% |
| Dr. Teri Turner | 12 | 5 | 42% | I always thought I was doing a lot better on immunizing the children in my practice. The other practitioners in the group and I are nearing time for board recertification and we were examining EQIPP modules. We opted NOT to do the one on immunizations because we felt we were doing a good job on immunizing our children. But this is not the case. I really like Jonathan’s idea about the color coded sticker. I think this is something we could easily do in our practice. I also want to try the idea about putting a sign up in the room. Another thing I will do is have all my adolescent patients sign a release of information at each well child check and at any initial new visit allowing me to obtain their immunization records from the school and I am going to measure other immunization rates in my practice to re-examine the need for the EQIPP module. | 1. Purchase the EQIPP module and measure all our immunization rates as well as participate in QI for immunizations in general 2. A nurse will review all immunization records for the scheduled appts the following day and place a red sticker on charts of children (not just adolescents) whose immunizations are not up-to-date. She will list on the sticker what vaccines are needed. 3. If a parent calls to schedule a same day appt. The appt coordinator will print out the immunization record and place a black dot on it signaling it has not been reviewed for status. Physicians will be responsible for this review. 4. Release of information forms will be signed ahead of time and given to patients who do not have immunization records. 5. My receptionist’s son is using his laser printer to work on cool signage for the back of our exam room doors and in the weigh and measure room. | I will do the plan that I proposed in the previous round. | Done on June 9 | Done | 10 | 6 | 60% |
| Dr. Susan Wiley | 15 | 9 | 60% | We spend a lot of time on improving our immunization rates. Our last overall audit was 97% so this 60% rate was not expected. I now realize that adolescents are much more difficult to immunize. We don't have the routine well child visits to remind us to immunize them. We need to have more active measures to get them in for these immunizations. | I hope it is OK to copy Dr. Teitelbaum's strategy. I think it will work well for my practice. | My staff has agreed to use the strategy described by Dr. Teitelbaum. | Done on June 19 | Done | Due Sep 16 | Due Sep 16 | - |
| Dr. Beverly Wood | 12 | 4 | 33% | It appears my practice is not doing its job up to the standard. Not closing the gap between performance and ideal. Jonathan should prepare some comments on his success and how it is achieved. If we are going to measure change, we need to institute some effective changes, that makes it a QI project with measurables to identify improvement. | I think we could easily implement the strategy Jonathan is using in his practice, and we willl place a color coded page in the front of each patient’s chart to alert as to their immunization status and the fact they are due an immunization. That way, the information is automatically available and there is no need to rely on looking up the status in the record. If we could achieve a rate even close to his 70%, we would be pleased. Our target right now, using the color coded “immunization due” sheets is to reach 60% success in eligible kids. | After discussion with my office staff, we have decide to go with the strategy that I described in the previous round. Thanks for the great suggestion Jonathan. | Done on June 2 | Done | 12 | 6 | 50% |
| Dr. Loren Yamamoto | 12 | 3 | 25% | It looks like my practice is the worst performing practice in our community. I am looking forward to thinking about an improvement plan that will improve the performance of my practice. Perhaps some of the other practices are already doing something in their practices that might be working well. Dr. Kind and Dr. Teitelbaum have the best performing practices in our community so perhaps they can point out why their pratices are performing well so that the rest of us can benefit form these strategies. | I would like to see what others will be proposing, but for now, I think I will be changing the color of my chart folders for patients when patients are 12 years old. My young patients have their charts accessed frequently and their folder is wearing out anyway. My practice will get used to changing the folder color from white to blue/red. This will prompt us to update our adolescent information including their HPV status. | I will pick the plan that I described in the May 13 round.? | Done on June 10 | Done | 10 | 7 | 70% |
| Total | 159 | 78 | 49% | 110 | 80 | 73% |
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September 9 -- 19:23
I'll see Susan at work so I'll remind her. I'll call John to remind him. I would like to complete this early if possible too. Thanks, Donna ----- September 9 -- 15:07 Dear Group: Looks like most of us have had practice performance improvements. Great job. Congratulations to Jonathan who has a 100% HPV vaccine rate in his sample. If anyone communicates with Susan or John, please remind them to turn in their data soon. We are nearly at the end of this MYQIP project and it would be nice to wrap it up early. Thanks, Loren August 13 -- 16:27 Dear Jonathan and anyone else who wants to start early: As long as roughly 8 weeks have elapsed with your PI method in place, it is OK to start your data collection early. But you will get the usual series of MYQIP e-mail reminders on the usual schedule. Thanks, Loren ----- August 12 -- 10:03 Dear Loren: Since Hank is OK'd to start early then I'll be starting early on this also. Thanks, Jonathan ----- August 10 -- 13:15 Dear Hank: Go ahead and start early. Thanks, Loren ----- August 10 -- 12:03 Dear Loren: We are near the completion of the 8 week period. I started my PI plan early so more than 8 weeks have elapsed. Can I go ahead and start my follow-up data collection? Thanks, Hank. ----- June 28 -- 10:15 Dear Bev: Yes, just continue on. I think it is OK to continue wiht the MYQIP project. Thanks, Loren ----- June 27 -- 09:32 Dear Loren: My office manager has been ill and I was relying on him to keep our PI plan in operation. I have asked some of our staff to share in this task, but there has been a lapse in this. I hope it is OK to continue. I suspect that we will not be able to show great improvement because of the lapse, but we will probably still show some improvement. That's the main point right? Thanks, Bev ----- June 18 -- 12:45 Dear Terry: Yes it is OK to slightly modify your PI method. I think that MYQIP basically wants you to do something to improve practice performance. So if you want to add something else or modify the plan, that is probably OK. Thanks, Loren ----- June 18 -- 08:45 Dear Loren: After further discussion with my office staff, we want to change our PI plan slightly. Is that OK or I do I need some kind of special permission? Thanks, Terry ----- May 14 -- 18:12 Dear Loren: I didn't know that I was allowed to have my staff help me with this. I thought that I had to do everything myself. This makes things a lot easier. I will form a team in my office so that we all have to meet the deadline or preferably beat it. This is great news. Thanks, Susan ----- May 14 -- 09:16 Dear Susan: Thanks for meeting the deadline. It will get very messy if one of our members misses a deadline. MYQIP is designed so that there is more than sufficient time to complete the requirements even for busy practitioners. Meeting the deadlines is a requirement. You could lose MOC4 credit if the deadlines are not met. You might want to get your office staff involved in helping you to complete these tasks. It will make things easier You could give them the deadline so that your office staff are also responsible for meeting the requirements. They need their doctor to maintain certification as well so they have an important stake in this. Thanks, Loren ----- May 13 -- 23:12 Dear Loren: I'm really sorry to be holding up the group. I just entered my PI plan under the wire. I am having difficulty in keeping up with this. I run a busy practice and I'm impressed that the rest of the group is generally ahead of schedule. I'll try to keep up. Thanks, Susan ----- May 8 -- 06:45 Dear Loren and Donna: I agree. I found myself thinking the same thing. This project is perfect for my practice. It is real opportunity to improve. Our group members are awesome. They have some great ideas that have stimulated me to think of other performance improvement methods. I'm really glad that MOC4 has pushed me into this kind of program. I other people will see the light. Thanks, Rob ----- May 7 -- 11:06 Dear Donna: Thanks for your comments. I agree completely. I hope that others are noticing what is happening. Thanks, Loren ----- May 6 -- 19:12 Dear Loren: I entered my improvement plan proposal. I find this process really interesting. I can see how others who are very creative seem to enter their plans first. Others can view these and think of variations on these improvement plans to best fit their practice. Doing this as a group is MUCH better than doing this alone. I really like the interchange of information. It spreads knowledge and innovation. I think I'm going to be a PCL for my next MYQIP project. -- Donna ----- April 28 -- 10:32 Dear Group: I enjoyed reading the reviews and reflections of the group. Thank you for completing these reviews and reflections on time. Since this is a group project, it is essential for us to stay on or ahead of the timeline. I think that in reviewing the comments, most of us were disappointed that our HPV immunization rates were not higher. I think that without special active surveillence or queries into our practice patient lists, it is difficult to get this rate up high since the adolescents don't come into the office very much. I'm glad to see that once the problem is better defined, this has generated some enthusiasm to improve this aspect of care. As doctors, we tend not to like numbers like 40%, 50%, 60%. In school, those percentages used to get us bad grades. We much prefer 90%, 95%, 100% and just like in school, these numbers usually earned us A's. We are all grade A types so it's not surprising that we all want to improve. Let's do it. Thanks, Loren ----- Apr 17 -- 13:33 Dear Hank: Your comments are perfect. The more important thing in the QI process is not what you write, but that you understand the improvement cycle process. Can you see that we first measured how good we are. Then we review and reflect on that. Upcoming steps will be to plan a method to improve and then intiate an improvement measure. We will then measure our performance again. Hopefully we are better. This cycle can be repeated again, but for this MYQIP project we will just be doing a single follow-up. Stick with us and you will see how powerful this is and you might even like it. Thanks, Loren ----- April 16 -- 18:42 Dear Loren: I submitted my review and reflection stuff. Does it look OK to you? I really want to make sure that I get my MOC4 credit. Thanks, Hank ----- Apr 9 -- 11:43 Dear John: That was a great article you sent us. Thanks, Terry. ----- April 14 -- 23:12 Dear Loren and MYQIP Colleagues: I just want to apologize for not getting my review and reflection in yet. I will be completing it soon. I have been attending a meeting at the Royal College of Reviewers and Reflectors where we discussed some cutting edge and state of the art Review and Reflection articles. Here's a reference for everyone to read: Parboosingh J, Wood B. Review and Reflection is the Dominant Lifelong Learning Facet of QI Projects. J Rev Reflect 2011;32(1):134-126. Thanks, John P. ----- Apr 9 -- 11:43 Dear Hank: Go the MYQIP web site and take a look at what my review and reflection looks like. Basically, look at your data and comment on how you compare with others and think about why you did really well or why you did less well than you would have desired. Thanks, Loren ----- April 9 -- 08:12 Dear Loren: I have a question about this review and reflection stuff. What exactly does that mean? I'm not used this jargon. Thanks, Hank ----- Apr 8 -- 16:25 Dear Group Participants: Thank for submitting your baseline data. Since this is a group project, it is essential that we all meet all our deadlines (or perhaps a little earlier to make Jonathan happy). You should have received an e-mail from MYQIP reminding you to do the next step which is to go to the MYQIP web site to review all the baseline data results; not just yours, but everyone's data. You should review and reflect on this by considering whether your results were better than you expected or not as good as you expected and how you compare with others. Enter your review and reflection commentary in the big green box on the MYQIP web site. This step is required and we have two weeks to complete this. If we can complete it sooner than the two weeks, we will move onto the next step. Thanks, Loren ----- April 2 -- 08:52 Dear Hank: Thanks for submitting your data. Sorry to be putting so much pressure on you. I'll try to not to rush the process too much. Thanks, Jonathan ----- Apr 3 -- 07:45 Dear Hank: Thanks for responding to Jonathan's concern. I agree that we shouldn't place too much pressure on participants to accelerate this process since this could inappropriately encourage them to send us phoney data. We want this done the right way and this takes time. Hopefully the group will see this. Perhaps we shouldn't have agreed to an accelerated time line. But as long as everyone submits their data with integrity and honesty and we follow the QI process, we might be able to finish a bit early. Thanks, Loren ----- April 2 -- 08:52 Dear Jonathan: Sorry that I'm the last one to enter my baseline data. I can't believe that I am part of group with such high performers. I feel like I'm in last place so I'll try to do better in the future. I entered my baseline data today. I hope that no one is making up their data just to get this over with. We wouldn't want that. Thanks, Hank ----- Apr 3 -- 07:45 Dear Jonathan: I sent an e-mail to Hank. MYQIP also sends automated reminders to him. We agreed to the original timeline and we agreed that if we went faster that we could accelerate this. However, he technically has until the deadline date to complete his baseline entry so we will just have to be patient. Feel free to e-mail him directly. Thanks, Loren ----- April 2 -- 08:52 Dear Loren: I wish we could go faster but Hank has still not entered his data. Can we get him to submit his baseline data earlier so we can go to the next step. Thanks, Jonathan ----- Mar 8 -- 10:10 Sorry, but I didn't check my messages earlier. I agree. Thanks, Teri T ----- Mar 6 -- 13:04 I agree. Thanks, Terry K ----- Mar 6 -- 12:47 I agree. Thanks, Donna ----- Mar 6 -- 09:01 I definitely would like to shorten the length of the project if possible so I agree. Thanks, Rob ----- Mar 5 -- 20:17 I have the same concerns as Susan, but I agree that we should try to do this. Thanks, Ann ----- Mar 5 -- 1514 I'm not sure if I can go faster than the original time line, but I will try. It seems like most people in the group want to do this. So I will try to get things done ahead of schedule so we can finish faster. Thanks, Susan ----- Mar 5 -- 07:55 What a great idea. I agree. Thanks, John P. ----- Mar 4 -- 21:39 I agree too. I'll be entering my baseline data soon. Thanks, Hank ----- Mar 3 -- 10:06 I agree. -- Bev ----- Mar 3 -- 08:20 Dear Group Participants: I just sent an e-mail to the entire group. Jonathan is suggesting that if everyone finishes their requirements early, we can go on to the next step early. This would permit us to complete this MYQIP project faster. Please let us know if you agree or disagree. Enter your responses on the MYQIP project web site. Thanks, Loren ----- Mar 8 -- 07:04 Dear Jonathan: This sounds reasonable to me. This is the first time that I'm a PCL. I did hear that some groups do what you're suggesting while other groups will stick to a fixed schedule. These MYQIP projects do take a long time to complete. If you ask me, we should do what you're suggesting. But we should ask everyone in the group. I'll send an e-mail to the group and will post this question on this blog. Thanks, Loren ----- Mar 6 -- 10:32 Dear Loren: I noticed that most of us have completed our baseline data collection ahead of schedule. There are a few people who have not completed their baseline data collection yet. What if everyone completes their baseline data collection ahead of schedule? Would we be able to proceed to the next step earlier. Thanks, Jonathan ----- Mar 3 -- 08:20 Dear Donna: This is a great question. I actually thought it should be three HPV doses also. But then someone pointed out to me that if we are going to show improvement, it would take a long time to take a patient from no vaccine doses to all 3 vaccine doses. If we instead consider two doses to be a success, taking a patient from 1 dose to 2 doses would be a success. You're right that the patient is still not fully immunized, but it is still an improvement. Improvement often results from smaller improvements. Linking these together results in larger improvements. Thanks, Loren ----- Mar 2 -- 13:52 Dear Loren: Can you tell me why we considered to two HPV doses to be a success, when three doses are actually required? Thanks, Donna D'Alessandro ----- Feb 16 -- 08:20 Dear Teri: Yes you can do this. I hope you decide to join us and enroll in this MYQIP project. Thanks, Loren ----- Feb 15 -- 17:55 Dear Loren: I like this topic, but I don't see any patients on my own. I am largely a pediatric educator. I teach residents, but I don't have my own practice. Could I use the patients in the resident teaching clinic? When I supervise the residents, these could be my patient encounters. Would this be OK. Sincerely, Teri Turner. ----- |