~Family Medicine Residency Quality Improvement

The topical QI assignments may change each academic year depending on how far the projects get to resolving the identified problem areas. Since we are starting this curriculum change late in the year due to beginning our new IMPACT grant this July we may hold over the topic areas for 2 academic years. However, we will likely continue to have revisions and developments along the way that are requested by each of you as you have the experiences first hand.

To recap what has happened so far– Dr. Reichert gathered suggested topics from all residents and faculty about 2 months ago. We settled on 3 topics from these responses – continuity, lifestyle, and chronic pain. SACHS QI requested one team address Infectious disease screening and we want to be good practice partners with SACHS and therefore one topic is now ID screening.

Stacy Davis is the contact person at SACHS for ID screening and she states the following: “There are a number of opportunities for improvement at SACHS related to infectious disease screening, diagnosis, and disease management. Some ideas include increasing HIV screening rates and linkage to care (a UDS measure); increasing baseline screening for hepatitis C; implementing standardized screening for risk factors related to specific infectious disease epidemics or outbreaks such as Zika/measles, etc. and implementing appropriate prevention guidelines and recommendations clinic-wide; public health reporting, etc. I’m sure your residents will be able to generate a great list of ideas and we can work with them to find areas of highest need.”

Resident teams were asked to rank order preferences for topical assignments and those rankings were used to assign the teams to the topics. Faculty also requested their topical preferences and were assigned accordingly.

Our goal is to schedule QI team meetings at least monthly. This will obviously be a challenge. My plan is to add all residents, faculty and nurses to a canvas page where we will create folders and discussion boards for each team/topic. We will schedule all meetings at SACHS and all meetings will include a zoom video chat link so that you can attend from where ever you may be. Zoom will also allow us to record all meetings and upload the recording to the canvas site so that if you cannot attend you can still hear the discussion and add your comments to the discussion boards. This is a work in progress obviously; our goal with this curriculum is to create a relevant practice based QI curriculum for our trainees. When you are in practice you will continue to do QI activities to improve your job/practice/quality of care for your patients. This will be done within clinic, within clinic hours, with key stakeholders who are your clinic team members. We want to provide this experience for you in training to make it as similar as possible to what you will need to know for your career path in family medicine.

The IHI modules are offered to give us a shared language and skills regarding QI activities in clinic teams. The coursework in IHI has really picked up dramatically in the last few weeks! Dr. Shannon will be offering a keynote address on QI for all of us very soon – hopefully in mid December. When you have Health Management Systems time on your schedule now you can be doing IHI modules (we are hoping to offer some space in the QI department at SACHS if you are there at the time) or talking with your clinic team members about the most important problems to tackle on your projects. Stay tuned for upcoming team meetings and email me anytime with questions and ideas as we get this new curriculum rolling!

Finally, several senior residents have emailed me about having already completed an aspect of a scholarly project. In family medicine, our residency accreditation does require residents to complete TWO scholarly activities. If you have already completed a project or almost completed a project then that would count as ONE of those requirements if you turn in a published manuscript OR a manuscript and presentation of a project that included data collection and analysis.

The current requirements are to take a leadership role on at least one QI project and a lesser role on at least one QI project that is presented to the key stakeholders (SACHS team members or staff meeting, residency spring grand rounds, AND potentially the residency research conference if you are chosen to go forward). The NEW requirements are 2 presentations (greater and lesser roles depending on year of training) to spread QI throughout our organizations.

The OLD requirements are a written manuscript and academic presentation. During the transition those that are graduating may choose 1 from the old curriculum and 1 from the new curriculum to meet graduation requirements – OR you can choose to fully move to the new requirements. Just let me know how to make this transition work for you – I want everyone to have a good experience and value all of the work you have and will accomplish. Curriculum change can be difficult because we don’t want to leave anyone out of the innovation and we also don’t want anyone to feel penalized by the innovation – I will do everything I can to help along the way.

Dr. Shannon will be available to consult with every QI team and I will also be working with all of the QI teams as well. We are in the process of posting the job for an IMPACT grant care manager to help us to accomplish these important goals. Each team also includes a behavioral health student or faculty member as well. We think this new structure will be relevant and make a much bigger impact on the quality of care we provide our patients.