Needs/Resource Assessment: Diabetic Foot Infection

When you embark on a DFI quality improvement project at your institution, the goals of your project must align with the institution’s overall quality improvement objectives. Sponsorship by an executive leader will facilitate your garnering of resources to complete and sustain the program. Once you have institutional support, developed aims, and stakeholder approval, the next step is to define the operational needs for the project.

If you are working under the sponsorship of an executive leader, you must be very clear at the onset of you project regarding the amount of support you will need to complete and sustain your endeavor. Consideration should be given to the following issues before starting a project.

1. Basic operations budget
   1. Data management — Allocate time for data abstraction and management.
      
      
   2. Statistical analysis — Consultation with a biostatistician will allow you to pick, track, and report the appropriate metrics, but will require financial support.
      
      
   3. Information technology support — Building reports and tools in an electronic record system will ideally minimize costs and enhance data management but will require resources to build up front.
      
      
   4. Paper/printing — In a paper system, define who will pay for the printing costs of order sets, flow sheets, patient information documents, and so forth; they will add up over time
      
      
   5. Meetings — Will you feed your team? Who will pay for lunch?
      
      
   6. Clinical FTEs — Will your project require new clinical FTEs (i.e., NPPs, clinical nurse specialists, therapists, pharmacists, physicians)?
      
      
2. Incentives and gain sharing
   1. Does your team have an incentive for achieving the objectives of the project? DFI is not a CMS core measure and is not a PQRI metric; however, many of the CMS mandates and PQRI measures fall under the rubric of diabetic management. Hence, an institutional QI project in this population may help to achieve some of the QI goals your institution may already report to CMS.
      EXAMPLES
      Hospital-acquired condition — Extremes in Glycemic Control — Will the work of your group help to achieve local compliance with this present on admission POA measures? Will the pathways you develop for DFI dovetail with other local efforts to improve diabetic care?
      Readmission rates — Will the processes your team implements help to lower the readmission rates to your institution? Can the processes be generalized across the institution?
      Methicillin-resistant Staphylococcus aureus (MRSA) — Will your efforts help with surveillance and/or control of MRSA in your institution? Can the process be carried to other patients in the hospital?
      
      
   2. Align the gains made by your team to be the incentive package for your group. Allow the success of your project to be tied to the institutional support your group may already be negotiating. Gain sharing can be an effective method for achieving quality goals while recognizing clinicians’ involvement in the process. Local executives should always adhere to federal regulations around gain sharing and consult with the state’s quality improvement organization before a gain-sharing arrangement is undertaken.
      
      
3. Clinical “carve out”
   1. Will you and the clinicians involved in your project be remunerated for their effort, either with direct payment or by adjusting their clinical responsibilities to accommodate them for the time devoted to the team?
      
      
   2. Have the clinical leads “signed off” on the proposal for their employees to work on your team?
      
      
   3. What is a reasonable remuneration, and is there a local precedent?
      
      
4. Durability
   1. ACCOUNT FOR GROWTH: As the project gains steam, will your group be able to manage the volume?
      
      
   2. BALANCED TEAM: Is any 1 member of your team so essential to the success of the project that his or her absence would lead to the project’s failure? How easily can team members be recruited or replaced?
      
      
   3. PERPETUITY: Educate staff and providers such that processes and standards self-perpetuate. Seek feedback from end users regularly. Promote a culture of excellence in order to sustain your gains.