Hospitalists, scholarly activity, quality improvement, and research

1. Hospitalists, scholarly activity, quality improvement, and research Hospitalists Best Practices Conference February 19, 2010 J Rush Pierce Jr, MD, MPH

2. Agenda • Are hospitalists interested in research? • What kind of research do (can) hospitalists do? • What is the IRB and how should hospitalists relate to it? • Questions for discussion

3. Predictors of selecting academic medicine as a career • Completion of graduate degree or fellowship training • Participation in research and publication while in medical school or fellowship • Desire to teach or conduct research • Influence of a mentor J Gen Intern Med 2006; 21:1222–1229.

4. Themes related to remaining an academic physician • Early exposure to research • Mentoring • Personal and social factors • Career support as junior faculty Medical Education 2009: 43: 335–341

5. Types of research by hospitalists • the hospitalist model itself • clinical approach to hospitalized patients • implementation of best practices • care transitions • improving patient safety J Gen Intern Med 2008; 23(8):1269–72

6. Strategies for success – SHARP model (Univ Michigan) • Protected time • Mentorship • Epidemiologic and statistical support • Collaborative opportunities with subspecialists • Recruitment of fellowship trained hospitalists Journal of Hospital Medicine 2008;3:308–313

7. Collaborative in-patient medical service (CIMS) - Hopkins Journal of Hospital Medicine 2008;3:314–318.

8. UNM Hospitalist research interest

9. UNM hospitalist researchexperience

10. UNM Hospitalist research confidence

11. Perceived UNM institutional support

12. What would help at UNM?

13. Case Reports • Resources (ACP Website) • What types of patients? • Rare conditions, unusual presentation of common illness, esp instructive, unusual complication, unusual aspect of management • Relative role of faculty • Where to present and where to publish

14. Case Reports - tips • Keep list of potential pts • Identify early who will take lead • Do brief literature review first • Draft an abstract early • Get the patient's permission • Get the patient's phone number • Bug the resident/student often! • Be aware of meeting deadlines for abstracts

15. Case reports - meetings MEETING • NM Chapter of ACP • SHM • SGIM • WAFMR/WSCI ABSTRACT DEADLINE mid-August early January early February late summer

16. Case reports – where to publish • General journals (South Med J, Amer J Med Science) • Specialty journals (J Amer Geriatrics Soc, etc) • Case report specific journals • J Medical Case Reports http://jmedicalcasereports.com/ • J Case Reports in Medicine http://www.hindawi.com/journals/crm/

17. Case reports – topics for discussion • Guidelines for order of authorship • Role of IRB • Meetings and travel • Section expectation

18. Curriculum Development • Type of projects: • New curriculum • New technique • New program • Resources • Where to present/publish • Usually coupled with survey of satisfaction, perceived confidence, and/or objective measures of knowledge transfer

19. Curriculum Development - tips • Keep a list of ideas • Keep records! • Decide on objective measurements before hand; think about a survey • Get library to help with lit review • Often involve several faculty – divide up roles

20. Surveys - tips • Demographics • Two basic types of questions: is there a difference, is there an association? • Look for surveys previously done • Get help early • Design strategies to improve participation • Plan on submitting to IRB

21. IRB • What is IRB and what is its role? • When do I need to submit to IRB? • What is HIPPA waiver and when do I need it? • Do I need to be trained? http://hsc.unm.edu/som/research/HRRC/HRRCHomePage.shtml

22. IRB submission • Exempt vs. expedited vs. full review • Getting ready: • Research protocol – on the wiki • Getting the correct forms • Submitting the forms • Your role as PI

23. Quality Improvement • The nature of QI • Measure “quality,” design an intervention, remeasure quality, refine the intervention • QI in medicine • What is scientific research and when is QI research?

24. QI projects in the hospital – getting started • Read lit beforehand (how to measure, what interventions have been done, problems) • Decide how you will get baseline measurements • Write down planned metrics and interventions • Discuss with management • Get necessary partners on board • Role of IRB

25. QI projects: resources • SHM http://www.hospitalmedicine.org/ • AHRQ http://www.ahrq.gov/ • ACEBP http://www.acestar.uthscsa.edu/Research.htm • UNMHSC CTSC for statistical support • http://hsc.unm.edu/research/ctsc/PSU.shtml

26. QI Projects - tips • Assume that you will publish • Keep good records! • Read the SQUIRE Guidelines • Work in a group and assign roles • Talk to the IRB; anticipate time for approval

27. IRB Practical Tips • Look at website to determine if your proposal is exempt. Key issues: • No interventions, just chart review • ‘De-identified data’ • Talk (in person) with a HRRC support person about your proposal • Listen to the HRRC support person • Write protocol • Fill out forms • Don’t argue, you will lose • Make all suggested changes

28. Discussion questions • QI and Role of IRB; PI training • Case reports: (guidelines for order of authorship, role of IRB, meetings and travel, Section expectation) • Statistical and epidemiologic help • Dept support for research activities (travel to meetings, infrastructure, seed grants) • How to provide mentoring