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Author: Brian S McGowan, PhD

ABSTRACT: Improving Resident Engagement in Quality Improvement and Patient Safety Initiatives at the Bedside The Advocate for Clinical Education (ACE)

Quality improvement (QI) and patient safety (PS) are essential competencies in residency training; however, the most effective means to engage physicians remains unclear. The authors surveyed all medicine and surgery physicians at their institution to describe QI/PS practices and concurrently implemented the Advocate for Clinical Education (ACE) program to determine if a physician-centered program in the context of educational structures and at the point of care improved performance. The ACE rounded with medicine and surgery teams and provided individual and team-level education and feedback targeting 4 domains: professionalism, infection control, interpreter use, and pain assessment. In a pilot, the ACE observed 2862 physician-patient interactions and 178 physicians. Self-reported compliance often was greater than the behaviors observed. Following ACE implementation, observed professionalism behaviors trended toward improvement; infection control also improved. Physicians were highly satisfied with the program. The ACE initiative is one coaching/feedback model for engaging residents in QI/PS that may warrant further study.

via Improving Resident Engagement in Quality Improvement and Patient Safety Initiatives at the Bedside.

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ABSTRACT: Integrating Quality Improvement Into Continuing Medical Education Activities Within a Community Hospital System

The integration of the Mercy Health System’s quality improvement (QI) and continuing medical educational (CME) activities is described. With the implementation of computerized medical data, the opportunities for QI-focused CME are growing. The authors reviewed their regularly scheduled series and special CME programs to assess their impact on quality care processes. Clinical improvements were affected by combining national guidelines and advancements with local clinical data and interactions with physicians within interdisciplinary as well as specialty conferences. Case-based, multidisciplinary conferences lent themselves to this process to a greater extent than didactic conferences. The latter also could lead to QI when the topics were focused on specific quality initiatives that often are part of a national QI initiative. Although the authors consider these efforts to be at an intermediate stage of development, they have observed several QI/patient safety process improvements.

via Integrating Quality Improvement Into Continuing Medical Education Activities Within a Community Hospital System.

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ABSTRACT: Delivering Influenza Vaccine to High-Risk Adults Subspecialty Physician Practices

Influenza is responsible for significant morbidity and mortality in the United States. Despite long-standing national recommendations, only 47% of adults with a high-risk condition received the influenza vaccine in 2009-2010. Subspecialty practices provide a significant portion of ambulatory care visits for high-risk adults and understanding their role in the immunization infrastructure may increase immunization rates, decrease public health burden, and reduce influenza-associated disease. A cross-sectional survey of cardiology, pulmonology, and obstetrics/gynecology practices was conducted to assess influenza vaccination practices, plans, patient acceptance, frustrations, and reasons for not vaccinating. It was found that 51% of respondents planned to vaccinate patients. Plans differed significantly by practice type. Practices that do not vaccinate generally recommend vaccination and refer patients to public health clinics, primary care, and pharmacies.   Administrative and patient-related barriers affected most practices, but practices that vaccinate were able to overcome these barriers. Improvements in vaccination may be addressed by adapting practice support services for subspecialty practices.

via Delivering Influenza Vaccine to High-Risk Adults.

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ABSTRACT: Teaching Quality Essentials The Effectiveness of a Team-Based Quality Improvement Curriculum in a Tertiary Health Care Institution

A unique quality improvement (QI) curriculum was implemented within the Division of General Internal Medicine to improve QI knowledge through multidisciplinary, team-based education, which also met the QI requirement for the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) and the Mayo Quality Fellows program. Participants completed up to 4 QI learning modules, including pretest and posttest assessments. A participant who successfully completed all 4 modules received certification as a Silver Quality Fellow and credit toward the quality requirement for ABIM MOC. Of 62 individuals invited to participate, 33 (53%) completed all 4 modules and corresponding pretests and posttests. Participants substantially improved knowledge in all 4 quality modules. Study group participants’ pretest scores averaged 71.0%, and their posttest scores averaged 92.7%. Posttest scores of reference group participants compared favorably, averaging 89.2%. Initial assessments showed substantial knowledge improvements and successful implementation of staff-developed QI projects.

via Teaching Quality Essentials.

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ABSTRACT: Impacts of Organizational Context on Quality Improvement

Abstract

Variation in how hospitals perform on similar quality improvement (QI) efforts argues for a need to understand how different organizational characteristics affect QI performance. The objective of this study was to use data-mining methods to evaluate relationships between measures of organizational characteristics and hospital QI performance. Organizational characteristics were extracted from 2 surveys and analyzed in 3 separate decision-tree models. The decision trees did not find any predictive associations in this sample of 100 hospitals participating in a national QI collaborative. Further model review identified that measures of QI Experience were associated with an ability to make improvements, whereas measures of Staffing and Culture were associated with an ability to sustain improvements. A key area for future research is to understand the challenges faced as QI teams transition from improving care to sustaining quality and to ascertain what organizational characteristics can best overcome those challenges.

via Impacts of Organizational Context on Quality Improvement.

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ABSTRACT: Data-Driven Interdisciplinary Interventions to Improve Inpatient Pain Management

Abstract

Pain during hospitalization and dissatisfaction with pain management are common. This project consisted of 4 phases: identifying a pain numeric rating scale (NRS) metric associated with patient satisfaction, identifying independent predictors of maximum NRS, implementing interventions, and evaluating trends in NRS and satisfaction. Maximum NRS was inversely associated with favorable pain satisfaction for both efficacy (n = 4062, χ2 = 66.2, P < .001) and staff efforts (n = 4067, χ2 = 30.3, P < .001). Independent predictors of moderate-to-severe maximum NRS were younger age, female sex, longer hospital stay, admitting department, psychoactive medications, and 10 diagnostic codes. After interventions, moderate-to-severe maximum NRS declined by 3.6% per quarter in 2010 compared with 2009. Satisfaction data demonstrated improvements in nursing units meeting goals (5.3% per quarter, r 2 = 0.67) and favorable satisfaction answers (0.36% per quarter, r 2 = 0.31). Moderate-to-severe maximum NRS was an independent predictor of lower likelihood of hospital discharge (likelihood ratio = 0.62; 95% confidence interval = 0.61-0.64). Targeted interventions were associated with improved inpatient pain management.

via Data-Driven Interdisciplinary Interventions to Improve Inpatient Pain Management.

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ABSTRACT: Psychiatrists’ use of electronic communication and social media and a proposed framework for future guidelines

Abstract
Background. Recent and ongoing advances in information technology present opportunities and challenges in the practice of medicine. Among all medical subspecialties, psychiatry is uniquely suited to help guide the medical profession’s response to the ethical, legal, and therapeutic challenges-especially with respect to boundaries-posed by the rapid proliferation of social media in medicine. Ironically, while limited guidelines exist for other branches of medicine, guidelines for the responsible use of social media and information technology in psychiatry are lacking. Objective. To collect data about patterns of use of electronic communications and social media among practicing psychiatrists and to establish a conceptual framework for developing professional guidelines. Methods. A structured survey was developed to assess the use of email, texting, and social media among the active membership of the Group for the Advancement of Psychiatry (GAP) to gain insight into current practices across a spectrum of the field and to identify areas of concern not addressed in existing guidelines. This survey was distributed by mail and at an annual meeting of the GAP and a descriptive statistical analysis was conducted with SPSS. Results. Of the 212 members, 178 responded (84% response rate). The majority of respondents (58%) reported that they rarely or never evaluated their online presence, while 35% reported that they had at some time searched for information online about patients. Only 20% posted content about themselves online and few of these restricted that information. Approximately 25% used email to communicate with patients, and very few obtained written consent to do so. Conclusion. Discipline-specific guidelines for psychiatrists’ interactions with social media and electronic communications are needed. Informed by the survey described here, a review of the literature, and consensus opinion, a framework for developing such a set of guidelines is proposed. The model integrates four key areas: treatment frame, patient privacy, medico-legal concerns, and professionalism. This conceptual model, applicable to many psychiatric settings, including clinical practice, residency training, and continuing medical education, will be helpful in developing discipline-wide guidelines for psychiatry and can be applied to a decision-making process by individual psychiatrists in day-to-day practice. (Journal of Psychiatric Practice 2013;19:254-263).

via Psychiatrists’ use of electronic communica… [J Psychiatr Pract. 2013] – PubMed – NCBI.

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MANUSCRIPT: Diagnosis and Management of Lung Cancer, 3rd edition

Diagnosis and Management of Lung Cancer, 3rd edition: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines includes:

  • More than 275 recommendations for the diagnosis, treatment, and management of patients with lung cancer, covering the full spectrum of care from initial evaluation to palliative and end-of-life care.
  • Additional recommendations for screening, chemoprevention, and treatment of tobacco use in patients with lung cancer.
  • The guidelines are published as a May 2013 of CHEST supplement, with a corresponding editorial in the May 2013 issue of of CHEST. They are available in print or online.

via Diagnosis and Management of Lung Cancer, 3rd edition | More Guidelines – American College of Chest Physicians.

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ABSTRACT: A Global Model for Effective Use and Evaluation of e-Learning in Health

Healthcare systems worldwide face a wide range of challenges, including demographic change, rising drug and medical technology costs, and persistent and widening health inequalities both within and between countries. Simultaneously, issues such as professional silos, static medical curricula, and perceptions of “information overload” have made it difficult for medical training and continued professional development (CPD) to adapt to the changing needs of healthcare professionals in increasingly patient-centered, collaborative, and/or remote delivery contexts. In response to these challenges, increasing numbers of medical education and CPD programs have adopted e-learning approaches, which have been shown to provide flexible, low-cost, user-centered, and easily updated learning. The effectiveness of e-learning varies from context to context, however, and has also been shown to make considerable demands on users’ motivation and “digital literacy” and on providing institutions. Consequently, there is a need to evaluate the effectiveness of e-learning in healthcare as part of ongoing quality improvement efforts. This article outlines the key issues for developing successful models for analyzing e-health learning.

via A Global Model for Effective Use and Evaluation of e-Learning in Health | Abstract.

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MANUSCRIPT: An electronic portfolio for quantitative assessment of surgical skills in undergraduate medical education

Background
We evaluated a newly designed electronic portfolio (e-Portfolio) that provided quantitative evaluation of surgical skills. Medical students at the University of Seville used the e-Portfolio on a voluntary basis for evaluation of their performance in undergraduate surgical subjects.

Methods
Our new web-based e-Portfolio was designed to evaluate surgical practical knowledge and skills targets. Students recorded each activity on a form, attached evidence, and added their reflections. Students self-assessed their practical knowledge using qualitative criteria (yes/no), and graded their skills according to complexity (basic/advanced) and participation (observer/assistant/independent). A numerical value was assigned to each activity, and the values of all activities were summated to obtain the total score. The application automatically displayed quantitative feedback. We performed qualitative evaluation of the perceived usefulness of the e-Portfolio and quantitative evaluation of the targets achieved.

Results
Thirty-seven of 112 students (33%) used the e-Portfolio, of which 87% reported that they understood the methodology of the portfolio. All students reported an improved understanding of their learning objectives resulting from the numerical visualization of progress, all students reported that the quantitative feedback encouraged their learning, and 79% of students felt that their teachers were more available because they were using the e-Portfolio. Only 51.3% of students reported that the reflective aspects of learning were useful. Individual students achieved a maximum of 65% of the total targets and 87% of the skills targets. The mean total score was 345 +/- 38 points. For basic skills, 92% of students achieved the maximum score for participation as an independent operator, and all achieved the maximum scores for participation as an observer and assistant. For complex skills, 62% of students achieved the maximum score for participation as an independent operator, and 98% achieved the maximum scores for participation as an observer or assistant.

Conclusions
Medical students reported that use of an electronic portfolio that provided quantitative feedback on their progress was useful when the number and complexity of targets were appropriate, but not when the portfolio offered only formative evaluations based on reflection. Students felt that use of the e-Portfolio guided their learning process by indicating knowledge gaps to themselves and teachers.

via BMC Medical Education | Abstract | An electronic portfolio for quantitative assessment of surgical skills in undergraduate medical education.

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