Quality Improvement Initiative (QII)

“What’s measured improves.” — Peter Drucker.  

Long used in technology, engineering, and manufacturing, measurement is the foundation of improvements in many consumer and industrial products—from cars to computers.

NPF’s Quality Improvement Initiatives (QII) brings this approach to Parkinson’s.  In partnership with our Centers of Excellence, NPF has launched the first data-driven quality improvement initiative to introduce to Parkinson’s disease a focus on continuous improvement. This project systematically measures and tracks care over time for every patient diagnosed with Parkinson’s disease. The goal is to explore the variation in current clinical practice in order to determine the “recipes” for best outcomes in Parkinson’s.  Our ultimate aim is to create and share models of excellent care, so that every Parkinson’s patient receives the most effective treatment options available, whether they are seen by a specialist at a NPF Center of Excellence, a general neurologist or their primary care physician.

NPF’s QII aims to:

• Drive identification of best practices in PD care
• Disseminate these practices to benefit every patient
• Establish proven baselines for care to increase the sensitivity of future research
• The data collected in QII relies not only on physicians to assess but also the experiences of patients.

But NPF doesn’t just track medical management.  For the first time, this project seeks to understand the role that comprehensive care plays in managing the disease.  As a result, we are tracking referrals to allied health professionals.  Recent research has established the importance of exercise, and the importance of quality physical therapy.  Speech therapy prevents pneumonia.  Occupational therapy helps people live independently and prevents falls. All of these are tracked in this first-of-its kind database.

Importance to Research

One of the challenges in medical research is that every patient is different.  Most Parkinson’s disease research relies on a neurologist’s observation of patients, and the differences among patients affects this.  Even the results of blood tests and imaging studies are dependent on differences among patients and also the way their disease is treated. 

Andrew Siderowff, MD Center Leadership Conference
12/3/2010, Houston Texas:

"The Quality Improvement Initiative has had a real impact on my practice and my research.  When we put the data together, I can see how other centers handle similar patients.  By being exposed to practices at other centers, I realized, for example, that each center addressed mood in Parkinson's disease in different ways, and this led me to re-examine my approach.  I think that my patients receive better care because of this project.  In addition, I have used some of the infrastructure from this project to support my research, work that recently led to the identification of several progression biomarkers in Parkinson's disease."

Currently active in 17 research centers worldwide, with more centers joining.  Despite being a new project just past its pilot phase, it is already resulting in important research.  Publications from this project include:

In 2011, NPF will continue to roll out the QII program to Centers of Excellence across the United States, Canada, and internationally.  Data collection will be standardized through a robust, web-interface system to facilitate data collection in place.  Our ultimate goal is to create and widely disseminate models of excellent care, so every Parkinson’s patient receives the most effective treatment options available, whether they are seen by a specialist at a NPF Center of Excellence, a general neurologist or their primary care physician.

Preliminary Findings:

• Early indications of the positive effects of exercise programs
• A high degree of comorbidities
• Distinct variations in physician treatment patterns and preferences
• A high incidence of psychiatric and cognitive issues

Lead organizers and Co-Chairs of this initiative are:

• Jay Nutt, MD, Professor and Medical Director of the NPF Center of Excellence at Oregon Health Sciences University; and
• Andrew Siderowf, MD, MSCE, Assistant Professor and Medical Director of the NPF Center of Excellence at the University of Pennsylvania. 

Special advisor to NPF:

Gerald O’Connor, PhD, ScD, Professor of Medicine and of Community and Family Medicine and Associate Dean for Health Policy and Clinical Practice at Dartmouth Medical School.  Dr. O’Connor is a leader of Dartmouth’s world-renown health policy group and a noted expert in studying disparities in health care delivery and patient outcomes.  He served as an advisor to the Cystic Fibrosis Foundation’s Quality Improvement Initiative

Statement on the importance of NPF's Quality Improvement Initiative by Dr. Tanya Simuni, Northwestern University:

"What do clinical trials tell us about how to care for patients? They provide very limited information. Clinical trials tell us whether one therapy is better, worse, or the same as another in a set of carefully selected Parkinson's disease patients meeting requirements of that particular study, who ideally are otherwise healthy without co morbidities. I am a Principal Investigator on many trials and I choose these people myself because I want to make sure that they can successfully get through the trial, but they represent a small fraction of the patients I see in my clinic. I have been practicing at Northwestern for 10 years and I have many patients who I have been seeing that long. These patients are nothing like the ones who participate in clinical trials. I want to track how what I choose to do affects these people, and I want to know the choices that other neurologists are making with similar patients and the outcomes they are achieving."

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