Internal Medicine Residency – Strategically Adding Value to Healthcare

From the 2019 HVPAA National Conference

Mr. David Aufdencamp (Mount Carmel Health), Dr. John Weiss (Mount Carmel Health)

Background

Internal Medicine residency program at Mount Carmel has led the transformation of the Mount Carmel West Hospital to make significant progress on achieving its primary goal of “providing the greatest value by achieving the best quality & experience at an affordable cost.”

Objective

Attendees will gain insight on how GME created a strategy to lead the transformation and will get valuable ideas on how to implement these methods and strategies at their home institutions. Additionally, they will be able to see how to integrate residents into cost, quality and safety initiatives at their institution. Target audience members include DIO’s, Program Directors, Faculty, and Residents.

Methods

Four methods were utilized to achieve high value; resident education, resident driven cost reduction projects, reduction of preventable harm through error prevention methods training and case analysis, and tracking resident performance on hospital quality measures.

Results

As interns, all residents have completed the Institute for Healthcare Improvement (IHI) Open School to provide the basic essentials to quality improvement. As this is a long journey, the residency has been at 100% completion rate for 3 years in a row. Additionally, the residency has incorporated high value care and Choosing Wisely into the noon conference curriculum.

The healthcare quality improvement curriculum has initiated multiple resident led projects including the reduction daily labs by 20% and reduction of chest x-rays in critical care by 12.5%.

Mount Carmel began a journey to become a high reliable organization. The Program Director for internal Medicine is part of the system steering team and 100% of the residents have completed error prevention training. This has resulted in a reduction of serious safety events, higher reporting of safety incidents, and over 24 cases presented at PBLI conference with the identification of error prevention methods.

Graduate Medical Education has tracked resident performance on quality measures including actual versus expected length of stay, readmissions, and severity adjusted mortality index. While the IM resident service historically managed length of stay well, a focus resulted in a 26% reduction of patients with a length of stay longer than expected. Readmission rates for the IM resident service is consistently at or below the target for the system. Severity adjusted mortality index for the Internal Medicine has averaged 0.42 compared to a target of less than 0.85.

Conclusions

Key framework for the Internal Medicine to provide value to patients is through a strategy that includes resident education, resident driven projects, and tracking resident performance. Results prove that the Internal Medicine residency has begun the journey to not only provide high value care, but prepare our physicians of tomorrow to provide cost effective, high value care.

Clinical Implications

The patient expectation for high value care continues to escalate as rising costs and the prevalence of high deductible insurance plans persist. This session shows participants a strategy and method they can use in their clinical practice to improve the value of care that they deliver.

Figures

What are academic medical centers across the country doing to improve healthcare value?

Value improvement guides: Published reviews in JAMA Internal Medicine coauthored by experienced faculty from multiple leading medical centers, with safety outcomes data and an implementation blue print.

Review article detailing 25 labs to refine for high value quality improvement | July 2020

MAVEN campaign: Free 4 year high value care curriculum online.

Join the Alliance! Membership is free with institutional approval and commitment to improving value in your medical center.

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