From the 2022 HVPA National Conference
Jennifer Readlynn MD (University of Rochester School of Medicine and Dentistry), Meghan Train DO, Chris Jacob DO, Valerie Lang MD, MHPE
Quality improvement (QI) and high-value care (HVC) initiatives aim to improve overall health care quality while reducing harm to patients and eliminating wasteful practices. However, not all faculty possess the knowledge or skills to participate in and lead teams in QI projects. We recognized a need within our hospital medicine division to establish a HVC curriculum and increase hospitalist-led QI initiatives. This curriculum provided a unique interprofessional, collaborative educational opportunity for faculty, residents, and advanced practice providers (APP).
The objectives of this curriculum were three-fold:
– Increase interprofessional education and skills of hospitalist faculty and APPs in HVC.
– Incorporate internal medicine and medicine-pediatric residents as learners and educators in the HVC curriculum.
– Increase scholarship opportunities for hospitalists, APPs, and residents through increased QI projects in the inpatient setting.
Using the Journal of Hospital Medicine’s (JHM) “Things We Do for No Reason” series as a framework, the educator team selected topics relevant to adult hospital medicine in the fall of 2020. Seven residents, 14 hospitalists, and 21 local experts across professions co-led 20 presentations on the selected topics. Co-presenters reviewed the JHM article and primary literature in preparation. Guest experts provided updates from the literature and application to clinical practice. The series was given during noon conferences for residents, faculty, and APPs. Sessions were held in a hybrid format, both in-person and Zoom.
To evaluate the curriculum, participants completed questionnaires indicating their satisfaction with each presentation. Case vignettes followed by multiple-choice questions (2-4 questions per topic) were completed after each session to assess application of knowledge and earned maintenance of certification credit for faculty.
Hospitalist and APPs completed a total of 291 evaluations. This curriculum was well-received, with 272 (93.5%) indicating they were satisfied or very satisfied with the sessions. A total of 248 knowledge assessments were completed, with 90.9% of the vignettes answered correctly.
Prior to this curriculum, there were 3 hospitalist-led quality improvement projects that influenced our system beyond unit-based teams (2 on telemetry use and 1 on prescribing buprenorphine-naloxone at discharge), with only one including residents and APPs. Two projects, limiting vital signs at night for stable patients and liberalizing oral intake prior to orthopedic procedures, were implemented shortly after their presentations and have found widespread success across departments. There are ongoing quality improvement projects that include hospitalists working with residents and/or APPs to affect change across our healthcare system. Topics include removing a separate consent button for HIV screening and addressing food insecurity.
This curriculum proved to be an effective method to educate residents, faculty, and APPs on HVC with high satisfaction. There was a small increase in inpatient quality improvement projects after initiating this curriculum without specific interventions by the educator team.Our next step is to determine the clinical implications of this curriculum. We are in the process of reviewing what 2 changes participants planned to make after attending sessions. We will share themes with residents, hospitalists, and APPs and encourage groups to develop projects. We are also developing inpatient dashboards within the electronic health record that demonstrate costs associated with ordering habits.
