Successful quality improvement (QI) work, including the effective use of Key Driver Diagrams (KDDs), requires sound QI science methodology, appropriate resources, and ready access to reliable data. Key success factors necessary to achieve results are described in the QI strategies section of this toolkit.
KDDs can be used to help organize system-thinking around a Specific, Measurable, Achievable, Realistic and Timely (SMART) Aim to guide QI strategies. Development of KDDs is an iterative process to explore systems issues and possible interventions to impact the SMART Aim. For the KDDs in this toolkit, the SMART Aim was to reduce the number of ED visits for children with persistent asthma and impact the pediatric asthma ED measure.
This toolkit contains three KDDs: an overall KDD that summarizes key drivers that impact the measure, as well as two initiative-specific KDDs that demonstrate the specific drivers involved in the two primary care QI initiatives described in this toolkit.
The PQMP asthma measure is an outcome measure impacted by three distinct phases of care, which are highlighted in the two KDDs describing primary care initiatives: (I) Prevention, (II) Acute Episode Management, and (III) ED Care. The KDDs are available below:
- PQMP National Asthma Quality Metric Key Driver Diagram: This “overall” KDD includes examples of strategies that can be adapted and tailored for use by organizations. The interventions focus on various aspects of improving asthma care in primary care settings to support systematic and comprehensive asthma care delivery and monitoring. The KDD can be downloaded as a PDF (180 KB).
- PQMP National Asthma Quality Metric Key Driver Diagram (Vermont): This KDD demonstrates the subset of drivers used in the University of Vermont QI initiative. It was designed for practices with prior QI experience and already adhering to National Heart, Lung, and Blood Institute (NHLBI) guidelines. This initiative focused on improving clinical asthma management measures through improvement of office systems to support asthma care (e.g., management and follow-up of an acute episode, team-based asthma education). These strategies were aimed primarily at Acute Episode Management processes of care. The KDD can be downloaded as a PDF (236 KB). As an additional resource, the detailed strategies employed in the Vermont Learning Collaborative are also available (PDF, 237 KB).
- PQMP National Asthma Quality Metric Key Driver Diagram (San Francisco): This KDD demonstrates the subset of drivers used in the University of California San Francisco QI initiative. It was designed for a group of primary care practices with limited or no prior experience in QI and the strategies implemented focused on ensuring provider adherence to NHLBI guidelines for managing pediatric asthma patients (e.g., asthma control assessment, completion of asthma action plans, and severity documentation). These strategies were aimed primarily at Prevention processes of care. The KDD can be downloaded as a PDF (307 KB).
Although each initiative involved a different set of QI strategies, the global aim of each was to test and implement national performance measures that accurately assessed components of quality care for children with asthma, with a focus on reducing the number of ED visits/100 child‐years for children managed for persistent asthma.
