Improving Performance In Practice (IPIP) Overview

The healthcare system has become increasingly complex, with multiple competing demands and several impending changes. Although many primary care practices understand the need for change, most do not have the resources or infrastructure to implement major modifications. Improving Performance in Practice (IPIP) is aimed at transforming the way we deliver healthcare by giving doctors the tools, systems and support they need to provide consistently high quality care to all patients, all the time. IPIP will provide in-office assistance to practices, improving quality of care, efficiency and satisfaction for both patients and the healthcare team. Practices will initially use diabetes, smoking cessation, and asthma as the content around which to develop efficient patient-centered systems that can be applied to other conditions moving forward.

Initiative Goals

IPIP aims to dramatically improve patient outcomes by:

IPIP Implementation Strategies

Internal and Family Medicine practices selected to participate in IPIP may be assigned to one of the following groups:

1. Improving Performance In Practice (IPIP) Coached Practice Redesign

Quality Improvement (QI) Coach
Disease registry (required)
Practice Redesign Team
Consultation on work flow analysis, Chronic Care Model, Open Access Scheduling, Practice Culture Change, EMR conversion
Focus on system redesign
1 or 2 Learning Sessions per year
Led by CCGC

2. Enhancing Practice, Improving Care (EPIC) Facilitated Diabetes Improvement

Practice Improvement Facilitator
Disease registry (recommended)
Improvement Team
Chronic Care Model
Diabetes and change tools
Focus on practice relationships and communication
2 Learning Sessions per year
Led by UCHSC

3. Self-Directed Practice Redesign

Access to all tools available to other groups
Initial period of self-directed change
Opportunity to have QI coach at a later date
Led by UCHSC

All three groups will offer participating practices a range of office systems and tools to improve chronic care and other aspects of practice operation. The IPIP Coached Practice Redesign Group and EPIC Facilitated Diabetes Improvement Group will receive in-office assistance from a coach/facilitator to help make changes in office systems and clinical care. Both of these programs will use evidence-based approaches to improve chronic care, although the specific details of the approaches differ slightly. Practices will receive feedback on the results of a practice assessment and develop an individualized plan for proceeding. Both programs will also provide scheduled Learning Sessions in which the participating practices can share the practical experiences they’ve gained from the programs.

The Self-Directed Group will give practices the opportunity to see what they can accomplish utilizing a comprehensive website containing practice change resources on their own initially and then have an opportunity to work with a QI Coach to see if that will further extend their improvement efforts.

What Can IPIP Do For Me?

IPIP has many personal, professional, and practice benefits including - but not limited to - the items below.

Personal Benefits:

Satisfaction of providing consistently high quality care
Ability to demonstrate high quality care to others
Opportunity to regain the joy of practicing medicine

Professional Benefits:

CME credit
COPIC ERS Points
Credit toward maintenance of board certification
Preparation for Pay for Performance

Practice Benefits:

Consultation with experts to improve infrastructure and systems
Free registry for disease management

Program Expectations

Practices will participate in learning activities and work in collaborative networks to share data and experiences with other participating practices.

IPIP Coached Practice Redesign Program Participants Will Be Expected To:

Identify a Practice Redesign Team to develop a plan and implement improvement activities.
Implement a registry to track patients and their care, starting with diabetes and asthma (this will be provided at no cost if practices do not have an existing registry in place).
Collect and report on progress toward IPIP diabetes and/or asthma measures.
Test and implement improvement strategies in the practice and report those monthly.
Participate in monthly collaborative activities, most of which will be via teleconference, with the exception of some face-to-face workshops and one or two learning sessions per year.
Participate in the program evaluation described below.

EPIC Facilitated Diabetes Improvement Program Participants Will Be Expected To:

Form (or modify an existing) Improvement Team or proceed with an equivalent change strategy.
Improvement Team will meet with the Facilitator at least 9 times over six months to consider, test, and implement chronic care office systems and procedures to improve diabetes and/or depression care.
Participate in 2 (two) half-day Learning Sessions with other practices in the Facilitated Practice Improvement program.
Participate in the program evaluation described below.

Self-Directed Practice Redesign Program Participants Will Be Expected To:

Participate in the program evaluation described below.

Program Evaluation

Pediatric practices will not participate in the evaluation described below.

Family and Internal Medicine practices in ALL three groups will participate in an evaluation that will be conducted at baseline, 9 and 18 months. Measurements include a survey to be completed by all practice staff, on-site interviews, observation of practice operation, and medical record reviews. Practices will also be asked to develop a list of patients with diabetes and modify/approve a letter to patients asking for their participation in a brief mailed survey at baseline, 9 and 18 months. The cost and logistics of managing letters to and responses from patients will be covered by IPIP/EPIC.

Practices in the EPIC and self-directed groups will be asked to provide a list of patients with depression and to allow two sets of chart audits on these patients over 18 months. Practices will be reimbursed for this activity.

Key Collaborators

Colorado Clinical Guidelines Collaborative - Lead Agency
University of Colorado Health Sciences Center
Colorado Foundation for Medical Care
Colorado Academy of Family Physicians
Colorado Chapter of the American College of Physicians
Colorado Chapter of the American Academy of Pediatrics
Colorado Department of Public Health and Environment
Colorado Medical Society
Colorado Business Group on Health
Colorado Health Information Exchange
Colorado Regional Health Information Organization
Area Health Education Centers
COPIC Insurance Company

Additional Information

For questions and additional information, please contact Allyson Gottsman at (720) 297-1681.