Overview
Assignment 4: Methodology
To understand methods in quality improvement, a contrast between research and quality improvement is necessary.
TABLE 1 Elements, Research and Quality Improvement
| Elements | Research | Quality Improvement |
| Origin of question | Can come from clinical, prior research, papers, conversation | Can come from clinical, prior research, papers, conversation |
| Process | Required IRB approval, protection of human subjects | IRB may be required for the organization, but human subjects not part of QI |
| Methods | Qualitative, Quantitative, Randomize Clinical Trials-experimental design | PDSA, Pre-Post Test, system assessment, for example |
| Analysis | Statistics, modeling, seeking causality, relationships | Descriptive statistics, comparison of words or text, for example |
| Goal | Answer research question, generalizability of results | Answer PICOT question, applicable to site |
Implementation-Here there must be a specific plan. Include detail from points A to B and onward. Describe each step like a recipe so anyone should be able to read this section and repeat the project in their institution. As readers (faculty) are looking for specifics.
1. If you are using PDSA from the IHI model-take a paragraph or so and describe what that is and what it means. Then describe the Plan and Do for the first cycle. You won't know the rest until after these are completed. Keep track of each phase of the cycle and take good notes of conversations and observations-for cycle 2, what will be adjusted towards success? In the final write up of the project, include tables for each cycle showing what was done and outcomes to reaching the goals.
2. Pre-post test-Include the tests in the appendix. These should be either well established tools or one you wrote. The intervention (education) should also be well described and included in the appendix. For the surveys be very specific as to how these will be administered-hard copy, electronic?
3. System assessment-Perhaps your project is assessing the organization to understand current processes. This should be done in detail-follow the process from start to finish. Explore the systems within the system. Draw the system if possible and include in the results along with other data-feedback loops, conversations, observations.
Evaluation-Here is your interpretation of what you found, outcomes, and/or cycle data. Including the over arching evaluation and strengths and limitations of the project-if you had it to it again, how would you adjust the project? We all can learn from projects-the best plans...
Sustain the project-How will the project be sustained? Is there buy in for this to continue after you step back or leave? Is there a champion? Do changes need to be made to the electronic health record to sustain the project?
Dissemination-Where and how will you share the project and outcomes? The site should be first on the list. Publications? Presentations? Professional organizations? Remember, you are about to be a leader in this area of work for your scholarship.
Policy-How will you move this project towards policy? What is your professional organization? This is a good place to start. Perhaps forming a work group and write up the policy and begin to gain motivation towards changing practice at the national level.
INSTRUCTIONS
Using the DNP Proposal template, begin to write the Methodology section for your proposed project. The methodology is like a recipe that you are providing so others could follow your project in their site. Include the following:
- Describe the proposed Design for your DNP Project. (1-2 sentences)-Quasi-Experimental Single-Group Pre-test/Post-test: The most common design. Providers or patients are assessed before an intervention (e.g., baseline screening rates, provider confidence) and re-evaluated after the intervention without a randomized control group.
- Describe the Participants or Data Source for your Project. Modify this section as appropriate for your project (e.g., health policy project). If you are proposing a project that involves directly interacting with patients (e.g., educational intervention, practice change), include the following: description of the patients, how they will be selected, timeframe to obtain participants. -Patient ages 3-18, who is non-compliant in taking their medications. Select the appropriate heading above, based on your project. (1-2 paragraphs).
- Describe the Setting (Outpatient clinic setting) for your project. Discuss how the project is appropriate for the setting and aligns with the vision and mission for the organization. See the attached vision and mission of the company. Clearly define the stakeholders (Stakeholders are listed below). Identify the agency consultant. (1-2 paragraphs)
- Describe the Intervention/Program and the Data Collection Procedures. Describe what will be done, how it will be done, who will be responsible for implementing the program or process change, and the duration and timing of the program. Modify this section as appropriate for your project (e.g., health policy project). Refer to class materials for more information. Modify the heading based on your project (2-3 paragraphs). As the provider will be responsible for implementing/educating. The office staff will be responsible for sending electronic reminders. I will look at appointment history and medication refill patterns during the visits.
- Describe the Measures/Tools/Instruments. Discuss the project outcomes (variables) to be measured. Describe the measurement tool(s) that you will use to measure your variables. Discuss how the tools will be used (e.g., when & how administered). Be sure to include reliability and validity information, information about whether the tools have been used in similar populations or setting, and any other information that supports your use of this tool for this project. For projects that are using existing data, provide information about the variables that you will use to answer your question and how they were measured in the original dataset. Describe the Project Approvals needed before you can conduct your project. . Discuss plan to obtain signed Cooperative Agreement with your clinical agency/site/organization. (I currently work for the organization, and the VP of operations, who is also an LMHC, will oversee my project. If IRB approval is needed, include this sentence: “The University of Florida Internal Review Board (IRB) approval will be obtained prior to initiating the DNP Project.” If your clinical agency requires agency-specific IRB approval or Quality Improvement project registration (QIPR), please state this and state that these will be completed prior to initiating the project. QIPR is required for projects at UF Health.
- Develop the Implementation Timeline. Develop a Gant chart that includes the various activities to successfully implement the project. Project the amount of time for each activity and chart the sequence of events. Include the projected start and end of entire project. (about ½ page, depending on the number of activities).
- Describe the Evaluation Plan. Describe how you plan to evaluate the results of the project and/or analyze the data.(I will have IT to pull the data) The evaluation plan should include the criteria that will be used to evaluate what worked and what may not have worked in the project. Refer to class materials from NGR6836 on how to evaluate QI projects. (1-3 paragraphs). I don’t have access to this class material
- Describe the Dissemination and Sustainability Plans. Describe your plan for disseminating your project results prior to graduation from the DNP Program. Plan should include discussion of how you will communicate your project results to the agency/site/organization and stakeholders. Also include a statement regarding your plans for sustainability of the changes and briefly discuss issues that may affect its sustainability. (1 paragraph)
Stakeholders for Legacy Behavioral Health Center, Inc. in Port St. Lucie, FL, include regional health networks, educational institutions, and healthcare providers. These groups collaborate to fund, certify, and support mental health services across the Treasure Coast. [1, 2, 3]
Core Stakeholders & Partners
- Southeast Florida Behavioral Health Network (SEFBHN): A managing entity that oversees funding and certifies clinical facilitators and coaches for mental health programs in the region. [1]
- Local School Boards: Legacy collaborates directly with the school boards of St. Lucie and surrounding counties to provide mental health and behavioral support for at-risk youth. [1]
- State & Regional Coalitions: Community organizations like Helping People Succeed and the Hibiscus Children's Center partner with Legacy to deliver targeted family and child behavioral services. [1, 2]
- Hospital Systems: Entities such as Cleveland Clinic Tradition Hospital include Legacy and other behavioral providers in their regional Community Health Needs Assessments to address local mental health gaps.
- Internal Leadership & Management: Legacy’s internal stakeholders include their executive team, risk management, the finance department, and the Froehlich & De La Rua CPA firm that handles strategic and fiscal