Appendix 6_Success Story Template DRAFT 10.4.2023.docx

Appendix 6: Success Story Template

1. Stated Problem:

Define and address an explicitly stated problem using qualitative or quantitative evidence (or both). How does this problem relate to a 13th SOW aim, sub-aim, or foundational aim ?

Identify the specific suspected root causes that the QIO hoped to address or identify the ways in which the QIO helped a provider to identify and try to address those root causes

2. Structure:

Identify the specific provider or providers who were supported by the QIO to address this problem. Provide some details about the(se) facility, e.g., # of beds, average daily census (hospital), number of residents (NH), Star Rating, survey citations

Describe one or more activities carried out by your QIO that is distinct from the activities of the health care provider, a state health department, or other community, state, or federal agency. If the QIO did not engage in its own distinct activity, this is not a “QIO Success”.

How did the QIO motivate the provider(s) to accept its quality improvement services specific to this problem?

What business case did the QIO make to participate?

If a provider needed more funding/resources to address this problem, what business case did the QIO use to convince the organization to set aside more resources? Did the QIO assist the provider in identifying external resources to address this problem?

How else did the QIO motivate providers to engage with this particular issue?

Were there other partners critical to the success of the intervention such as provider associations, state health departments, or area agencies on aging? Please identify these partners.

Other than identifying funding/resources and external partners, did the QIO address any other systems level problem to facilitate the provider(s)’ quality improvement progress? If yes, please describe the problem and the approach.

Process:

Identify the specific intervention or set of interventions that the provider or QIO used to try and address these root causes; if a provider used the intervention, what was the QIO’s role? (If there is no distinct QIO role, it is not a QIO success.)

Provide the rationale for selecting this specific intervention and why it was appropriate for this problem and this context.

Define the timeline for this intervention. Identify the exact date at which each intervention was implemented by each specific provider/facility/practitioner, and each of the dates and modifications were made to the intervention if the initial approach did not work. Identify the last date during which a modification occurred.

Outcomes:

How was success of the intervention measured? Identify outcomes being tracked specific to this problem or its root cause. These must be measurable and well-defined.

State how long one would expect a change in the outcomes being monitored (days, weeks, months, years) after engaging in the quality improvement activities described above. Note the first and last date for which outcome data are available.

If the outcome(s) being tracked are more short-term than the contract metric being addressed, explain the relationship between the outcome being tracked and the contract metric.

Sustainability:

Describe sustainability of the quality improvement changes made. Are the quality improvement activities ongoing? Have activities evolved over time? If so, discuss how these activities have changed over time and why.

To Attribute Success:

Demonstrate how the QIO or a provider used an evidence-based intervention with fidelity in population and method.

Describe the evidence used.

Use the literature supporting this intervention to quantify the expected impact on the outcome. For example, a 20% improvement in patients with controlled hemoglobin A1c over a 6 month intervention period.

Translate the expected effect size to the number of beneficiaries that would likely be helped or the number of outcomes improved. For example, 400 patients with controlled hemoglobin A1c over the same 6 month intervention period.

OR

If adapting an evidence-based intervention to a different population or adapting the method, do one of the following:

Using the IHI’s “Health Care Data Guide” demonstrate nonrandom signals of change, and that these changes are consistent with the timing of the specific interventions described above as the direct consequence of a QIO action. A QIO may advise a provider to stop working on an intervention that does not appear to be working, but must show data over adequate time and both before and after the intervention began to establish “non-random signal of change” if the QIO believes the intervention does work. OR

Use experimental or quasi-experimental methods to demonstrate attributable change in outcomes in a specific community or provider or groups of providers.

OR

If developing a completely new evidence-base:

use experimental or quasi-experimental methods to demonstrate effectiveness.

Evaluation Criteria:

Importance and magnitude of the outcome/process changed –for example a 20% reduction in CLABSI is more important than a 20% reduction in ‘minimal harm inspection deficiencies’ (since CLABSI is not minimal harm), and a change in 5 facilities serving 20,000 beneficiaries is better than a comparable change in 1 facility serving 4,000 beneficiaries

Clarity of presentation, especially demonstrating the QIOs unique contribution to the improvement

Adherence to all aspects of the Success Story guidelines such as obtaining sufficient data before and after intervention to indicate ‘an improvement signal’ as indicated in the “Health Care Data Guide”

Level of leadership engagement as indicated by resource/staff commitments Appropriate level of resource usage—with innovation where appropriate; fidelity to the evidence where appropriate

Lessons Learned

Document lessons learned, positive and negative, through this intervention. Identify best practices for future interventions.