Plan-Do-Study-Act (PDSA)
Definition: The Plan-Do-Study-Act (PDSA) cycle is a continual, four-step model that is used in quality improvement efforts in order to test change.1
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)
There are 4 steps to a PDSA cycle:1,2
- The first step in the cycle is Plan. The plan is determined through outcome predictions and clearly stated tasks.
- The second step is Do. In this step, the plan is implemented to determine if modifications should be made to improve outcomes.
- The third step is Study. Once data and results are collected during the “Do” phase, they are analyzed and reviewed. It is important to reflect on the goals of the plan and what was learned during implementation.
- The final step is “Act.” During this step, it is determined if the plan should be applied in practice, modified, or rejected. If the plan is rejected, it is necessary to reflect on what can be done differently in the future. This can lead to another PDSA cycle, as it is common for the results of one cycle of a project to guide the development of the next.
How it relates to ACO/PCMH: High-quality patient care is an important aspect of ACOs and PCMH.3,4 The PDSA cycle is a recognized quality improvement tool that pharmacists can use in collaboration with their practice site to can enhance patient-centered care by standardizing processes to decrease discrepancies, achieve calculable results, and improve overall outcomes.5 Quality improvement and performance measurement documentation is required for recognition under the Annual Reporting for PCMH process.4
The PDSA cycle is an excellent process for showcasing what quality improvement and patient care initiatives have been implemented in a practice or system.
Involved organizations/oversight: Organizations that recognize the value and support the use of PDSAs include, but are not limited to, Agency for Healthcare Research and Quality, Institute for Healthcare Improvement, Centers for Medicare and Medicaid Services (CMS), and National Committee for Quality Assurance.
References
- Christoff P. Running PDSA cycles. Curr Probl Pediatr Adolesc Health Care. 2018;48(8):198–201.
- Agency for Healthcare Research and Quality. Health Literacy Universal Precautions Toolkit, 2nd Edition: Plan-Do-Study-Act (PDSA) directions and examples. Rockville, MD: Agency for Healthcare Research and Quality. Available at: https://www.ahrq.gov/health-literacy/improve/precautions/tool2b.html. Accessed February 7, 2023.
- National Committee for Quality Assurance. Annual reporting for PCMH recognition. Washington, DC: National Committee for Quality Assurance. Available at: https://www.ncqa.org/programs/health-care-providers-practices/patient-centered-medical-home-pcmh/current-customers/annual-reporting/. Accessed February 7, 2023.
- CMS. Accountable care organizations. N.p.: CMS. Available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO. Accessed February 7, 2023.
- CMS. Quality measurement and quality improvement. N.p.: CMS. Available at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Quality-Measure-and-Quality-Improvement-. Accessed February 7, 2023.
Contributing authors
Courtney Pos, PharmD candidate 2023
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
Aurora, CO
Katelyn Currier, PharmD, PGY2 Ambulatory Care Pharmacy Resident
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
Aurora, CO
Sara Wettergreen, PharmD, BCACP, BC-ADM
Assistant Professor
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
Aurora, CO
Last Updated 1/25/2023