A-TRIP Model

PPRNet - TRIP Model

Putting A-TRIP into your Practice: The PPRNet-TRIP Model

One of the main goals of A-TRIP was to disseminate the PPRNet-TRIP quality improvement model to a greater number of practices. (Click here to view a peer review article from this project.) The improvement model incorporated evidence-based strategies of teamwork, organizational change, patient activation, individualized and population-based medicine, and electronic medical record (EMR) tools. This model, derived from literature, best practices' approaches, and PPRNet-TRIP data, has the following components:

Prioritize Performance:

lLearn and accept current clinical guidelines
lEstablish project leader(s)
lUse PPRNet reports to guide improvement activities
Actively supervise project roles and performance
lMotivate the practice for improvement, using positive reinforcement and incentives
lAdvertise the project to patients and other providers

Involve All Staff:

lTrain staff on guidelines and practice improvement objectives
lHave staff attend regular improvement meetings
lEncourage all staff to participate in improvement efforts
Arrange communication loops between doctors and staff for quality improvement measures
lExtend staff roles in care delivery
lHave staff systematically reinforce information from the guidelines to patients
lHave staff participate in outreach to patients using inquiries and reminders
lMinimize staff turnover by including staff in improvement efforts, motivating staff, and providing incentives

Delivery System Redesign:

lUse tests at the point-of-care (e.g., cholesterol, A1C)
lSchedule lab before office visits
lExtend staff’s role in testing (e.g., create standing orders)
lAssign routine monitoring to staff (e.g., BP checks, lab visit or f/up)
lAssign routine care management to FNP or PA
lEstablish protocols for periodic disease management visits
lMake follow-up scheduling easy (advance scheduling or reminders)
lReach out to patients due for follow-up (reminder call, tickler system, recall letter)
lTrack whether follow-up occurs
lContact “no-shows”
lLimit phone refills when visits or labwork is needed
lEstablish protocols for follow-up of pts not at goal

Patient Activation:

Provide written information re: guidelines and patient’s status
Distribute the A-TRIP patient education handout to patients to make patients more aware of guidelines
lReinforce messages with office posters, patient handouts
lReinforce messages and reach “absent” patients with practice newsletters
lProvide incentives to meet guidelines (discounted screening, rewards, recognition)

Population-based Medicine

Outreach or reminders to sub-groups identified by inquiries or other data lists with subsequent follow-up (e.g., generate lists of diabetic patients not at goal A1C and contact these patients to schedule office visits)

EMR Tools:

lPlanned Visits – templates with guideline prompts

lDecision Aids - flow sheets, results tables, summaries, Knowledge Base

lTeam Coordination - internal messaging, flags

lSelf-Reminders - internal messaging, flags, notes

lPatient Education - personalized letters, links to handouts

lFollow-Up - advance scheduling or billing recalls

lOutreach – letters, addressing, phone calls

lLab Information – use interface integrated into EMR

lSpeed & Capacity - maximize computer hardware and software (upgrades, licenses)