Sample Application Form

Self-Directed Practice Improvement Project Submission Form (Sample)

  • Title of Project: a succinct description of the care process, or outcome you intend to improve, e.g. Reduction of Waiting Times for Scheduled Appointments)
  • Project Description: describe the quality concern being addressed in 100 words or less
  • Background Information: provide any additional information that may be pertinent
  • Project Setting: Group Practice, Multi-Specialty Group Practice, Healthcare Network, Solo Practice, Hospital, Surgical Center, Other
  • Study Population: describe the type of patient for whom the care process will be improved, e.g., all patients in your practice, patients with diabetes, patients presenting for emergency care, patients under undergoing cataract surgery.

Quality Indicators / Performance Measures:It is important to carefully define outcome or performance measures that will be quantified at baseline (before the care process is changed) and at re-measurement (after you have implemented the proposed improvement) to quantify the impact of your care process change. There are two basic types of performance measures - process of care measures and outcomes of care measures.

  • Process of care measures (e.g. timely treatment of diabetic retinopathy) can influence outcome measure (e.g. decreased risk of severe vision loss);
  • Outcome measures can be linked to processes of care that can be improved.

Generally, performance measures are expressed as rates, often as percentage rates. For example, if the intent of a project is to improve the quality of glaucoma care in your practice, you may choose to improve your rate of establishing a goal IOP in patients with newly diagnosed glaucoma, measured over a 3 month period.

  • The numerator of this process measure would be the number of newly diagnosed patients during this time who have a goal IOP recorded in the medical record.
  • The denominator would be the total number of patients diagnosed during that same time period.

Continuous variables (e.g. the refracted spherical equivalent after cataract surgery) can often be simplified and transformed then into percentage rates by setting a quality threshold (within 0.5 diopters in the intended spherical equivalent) which, if attained, would qualify the patient to be in the numerator (e.g. number of patients within 0.5 diopters / total number of patients).

It can be advantageous but not mandatory to have more than one quality measure in order to gauge the impact of your process change. In the example above, an additional outcome measure might be the percentage of patients in whom the goal IOP is attained within the first 6 months after diagnosis. If possible, measure quality indicators for at least 30 individual patients or data points during the baseline and again during the follow up period.

We realize that this may not be feasible or appropriate for all projects. Please indicate at least one measure below; either a process or outcome measure:

Process or Outcome Measure (e.g. patient pain level during intravitreal injection):

  • Numerator statement (e.g. number of patients in who pain levels decreased by 2 points on a 0-10 scale):
  • Denominator statement (e.g. 30 consecutive patients undergoing intravitreal injection):

Project Interventions: Quality improvement requires that you analyze your care delivery processes and identify changes, which if implemented, will improve care and outcomes. Generally, educational interventions are thought to be weak and demonstrate little impact. The introduction of tools, strategies or systematic approaches to care delivery is more powerful. A tool is a thing, for example a preoperative checklist, or written standardized process or protocol. Strategies include changes in procedures or policies like the introduction of a surgical time out before surgery is initiated. Systematic approaches to care delivery involve a comprehensive analysis of care process and the introduction of a combination of tools and strategies designed as a complete process. Describe the changes to your care processes you intend to introduce.

Project Team (include roles for yourself and all members of your team): List the individuals who will be involved in your quality improvement project (i.e., solo project, partners in practice, office staff, OR personnel, anesthesiologists) and the roles they will contribute.

Project Summary Form
Prepare a brief summary of the project highlighting the data collected, effectiveness of your measurement approach, interventions, and the overall impact of the project.

Baseline & Follow-up Data: Quantify each of the quality indicators / performance measures described in the initial proposal for the baseline period (before interventions for improvement we4re introduced, and for the re-measurement period (the period following implementation of the interventions for improvement). Report the numerator, denominator, and the calculated percentage rate for each measure.

Project Impact: Compare the baseline data to the re-measurement / follow-up data and quantify the impact of the process of care changes (your project interventions). The project hopefully resulted in improvement; however, some projects may result in a diminution in quality. If a lack of improvement or reduction in quality occurred, suggest other strategies that might be more effective.

Project Reflection

  • Do you feel that the project was worthwhile, effective?
  • How might you have performed the project differently?
  • Please offer suggestions for other ophthalmologists undertaking a similar project.

Project Release
The ABO would like to share your successful project with other ABO Diplomates seeking to improve the same care processes. Please answer the following questions:May the ABO share this Project Document with other Diplomates? (if yes, please include five searchable keywords):

  • Would you be willing to serve as a resource to other Diplomates seeking to improve in this area?
  • The ABO may be interested in transforming your Self Directed Project into a standardized Process Improvement Module. Would this be acceptable to you? 
  • The ABO may be interested in transforming your Self Directed Project into a standardized Process Improvement Module. Would this be acceptable to you?