Transition To Residency · Year 4 · from Transition To Residency
Case 3: Quality Improvement Using PDSA
Clinical Image
Source: Wikipedia - PDCA - CC BY-SA 4.0
Case Presentation
A 27-year-old female family medicine resident notices that diabetic patients in her continuity clinic frequently miss their annual eye exams, with only 35% completion rate compared to the national goal of 60%. She proposes a quality improvement project using the PDSA (Plan-Do-Study-Act) methodology. Plan: She hypothesizes that lack of reminder systems and inconvenient scheduling contribute to low rates. She designs a small test: for 20 diabetic patients, the MA will provide an eye exam reminder card at checkout and offer to schedule the appointment immediately. Do: The intervention is implemented for one month. Data collection includes tracking how many patients receive cards and how many schedule appointments. Study: Analysis shows 15/20 patients received cards (3 rushed checkouts, 2 MA forgot), and 8/15 scheduled appointments (53% uptake). Patient feedback reveals that the cards were helpful but some preferred phone reminders. Act: Based on learning, she modifies the intervention to include MA checklist prompts and adds phone reminder option. She expands to all diabetic patients over the next quarter. After 6 months, eye exam completion rises to 52%. She presents findings at the clinic's QI meeting and the intervention is adopted practice-wide.
Key Learning Points
- Quality improvement differs from research in its focus on local process improvement through iterative cycles rather than generating generalizable knowledge
- The PDSA cycle (Plan-Do-Study-Act) provides a structured methodology for testing changes through small-scale implementation, learning, and refinement
- Quality measures include process measures (percentage receiving reminders), outcome measures (exam completion rates), and balancing measures (clinic flow impact)