institutionalizing quality improvement in a family medicine residency
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Institutionalizing Quality Improvement in a Family Medicine Residency. Fred Tudiver, MD East Tennessee State University. BACKGROUND. ACGME competencies include quality improvement methods Current QI residency training: Seminars, lectures, and/or group activities - PowerPoint PPT PresentationTRANSCRIPT
Institutionalizing Quality Improvement in a Family Medicine Residency
Fred Tudiver, MDEast Tennessee State University
BACKGROUND
• ACGME competencies include quality improvement methods
• Current QI residency training:– Seminars, lectures, and/or group activities– Most do not use validated measures
• Systematic review of assessing QI teaching– Few if any validated measures– QIKAT; knowledge; commitment to change; audits
PCMH: Quality Measures
• Traditional non-PCMH model:– No systematic documentation for chronic disease
• Low Tech PCMH– Paper-based QI monitoring with flow charts of
disease outcomes; feedback to provider & patient
• High Tech PCMH– Automated QI monitoring with electronic
feedback of disease outcomes; feedback to provider & patient
PURPOSE
• Incorporate QI learning experiences into residents’ training
• Provide a standardized and reproducible QI curriculum during residency
• Develop and use validated measures for assessing QI training effectiveness
SETTING
• 3 College of Medicine affiliated residencies– 6-6-6; 6-6-7; 8-8-8
• No ongoing QI program at the start• Funding: HRSA BHPr 3-year residency training
grant
Method: Six one hour introductory training sessions Didactic and interactive small groups
Training Topics:1. Efficient Literature Searching2. Critical Appraisal3. Health Disparities4. Rural Health, Prevention & Healthy People 20105. Cultural Competency 6. Health Literacy7. Comprehensive - interactive teaming session
METHOD: TRAINING THE FACULTY
METHOD: TRAINING THE RESIDENTS
Method: Formal lesson plan Training workbook for Residents Interactive teamwork over year after training
workshop
Training Topics:1. Principles of evidence-based medicine2. Introduction to QI and tools: PDSA Cycle3. Researching evidence – intro to efficient literature
searching 4. Critically Appraising Literature5. Teaming: How to effectively work as a team6. Project development: small group sessions
RESULTS – 6 QI Projects1. Improvement diabetic BP control
– Intervention: in-service to all providers; patient education; regular chart reviews
2. Improve throughput time of outpatients– Intervention: decrease longest section to national
standard (decrease 35 min to 28min)
3. Improve Pap smear rates and follow-up rates for abnormal Paps
• Intervention: better/more visible documentation forms; in-service to all providers; disseminate guidelines
RESULTS – 6 QI Projects
4. Reduce the rate of hospital “bounce backs”5. Identifying/improving patient concerns re:
communication among IMGs6. Implementing a systematic method for
proper foot exams on all diabetics
OUTCOME MEASURE-1Knowledge & skills self-assessment survey
• Knowledge of current skills to develop and implement a QI project
• 9-item Likert 5 point scale; score range 9-45
Paired t-tests on overall scores:Pre-training = 26.20Post-training = 33.53 p = <.001.
Paired t-tests on overall scores:Pre-training = 24.72Post-training = 33.0 p = <.001.
OUTCOME MEASURE-2
• QIKAT Knowledge Assessment Tool– 3 clinical case scenarios with 3 questions:
• What is the aim?• What would you measure?• What change would you implement?
– Scoring based on identifying process and it is patient focused
DISCUSSION POINTS
• Challenges– Perceived as an “add-on”, not core curriculum– Teaming was a major challenge– QI topic perceived as the faculty’s topic
• Lessons Learned– Let them choose a leader at the start– Don’t assume they got it at the initial training– Lots of face time is critical