A Key to Measuring Healthcare Quality Improvement: Use AIM Statements
Don Berwick, physician, former CEO for the Institute of Health Care Improvement (IHI), and healthcare quality leader, is my hero. His now-famous quote about making quality improvement measureable says, “Some is not a number; soon is not a time.” As I work with clients looking to improve a clinical or organizational process, I wonder how I can help them operationalize the wisdom of Dr. Berwick’s quote. The answer comes in focusing on something called an AIM statement.
What is an AIM statement?
An AIM statement provides the template for an improvement initiative. It is a written, measurable, and time-sensitive description of the goal(s) a quality improvement team expects to make from its improvement efforts. It represents an important quality topic that can stimulate enthusiastic team support. An AIM Statement includes the following components:
- Outcomes-focused (directly implies measurement)
- Contains specific achievable goals and stretch goals
- Timeline included
- Target population clearly stated
- Provides value (humanistic and/or financial)
Where do clinicians get ideas for the areas of improvement they wish to make?
They use clinical experts who understand what is both essential and appropriate to achieve results, along with a collection of good ideas ready for use, based in research and best practice. Federal regulatory agencies, professional societies, quality improvement, review organizations, and organizations such as IHI also help drive health care improvements.
A hospital system I am working with identified that one of its largest opportunities for improvement resided within the cardiovascular realm, specifically with heart failure patients. This opportunity was identified through a Key Process Analysis (KPA) application from Health Catalyst. The system decided to focus on decreasing its 30-day readmission rates for heart failure (HF) patients. Using the 2013 ACCF/AHA Guideline for the Management of Heart Failure, (Yancy & Jessup, et al.), the ACCF/AHA/AMA-PCPI 2011 Performance Measures for Adults with Heart Failure, (Bonow & Ganiats, et al), and the National Quality Measure Clearinghouse Measure #9: post-discharge appointment for heart failure patients-inpatient setting (2013), they identified several AIM statements that would lead them to this goal.
AIM Statements included:
- Establish a baseline of all-cause 30-day readmission rates for HF patients, identify and validate a cohort of HF patients found in the Enterprise Data Warehouse, and create and validate 30-day and 90-day readmission rates for all HF patients.
- Identify high-risk heart failure patients and extend the identification of these patients to a Risk Stratification Model to predict the likelihood of all cause 30-day readmission rates.
- Schedule a follow-up appointment for all HF patients within 24 hours of discharge. with a focus on high-risk patients being seen within 48 to 72 hours after discharge.
This hospital system has been very successful in identifying and validating its HF readmission cohort, establishing a risk stratification tool to help categorize which patients are high-risk and in need of additional interventions, and is in the process of implementing an intervention that will bring heart failure patients back within 48 to 72 hours for follow-up. Future AIM statements being discussed include directing high-risk patients to nurse practitioner-run heart failure clinics for immediate follow-up, involving pharmacists in medication counseling prior to patient discharge, and early introduction of palliative care considerations.
It is so exciting to see clinicians accessing and analyzing data to help them identify and implement quality improvements. It makes me want to come to work every day. Improving patient outcomes is what it is all about! A KPA evaluation and the development of AIM statements are the beginning steps of quality improvement.
How does your organization develop goals for quality improvement projects? Comment below, and let us know. Connect with Health Catalyst on twitter and facebook too!
Bonow, R.O., 2012. ACCF/AHA/AMA-PCPI, 2011 performance measures for adults with heart failure. Journal of the American College of Cardiology, 59 (20), 1812-1832 Dharmarajan, K., Hsieh, A.F., Lin, Z., Bueno, H., Ross, J., Horwitz, L.I., &Barreto-Filho, J.A. 2013. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA (309)4, 355-362. National Quality Measures Clearinghouse. 2013. https://www.qualitymeasures.ahrq.gov/, accessed 5/29/2013. Yancy, C.W., Jessup, M., Bozkurt, B.B., Masoudi, F.A., Butler, J., McBride, P.E., Casey, D.E., et al. (2013). 2013 ACCF/AHA guideline for the management of heart failure: A report of the American college of cardiology foundation/American heart association task force on practice guidelines. Circulation, June 5, S0735-1097.