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Building the Infrastructure to Enhance QI Research in the Health System

This presentation discusses the needs assessment, strategic planning, and opportunities for improving quality improvement (QI) research in the health system. It includes an example project, lessons learned, and next steps.

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Building the Infrastructure to Enhance QI Research in the Health System

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  1. Building the Infrastructure to Enhance QI Research in the Health System Maria Danila, MD (Monika M. Safford, MD) February 12, 2015

  2. Disclosures • Dr. Safford receives salary support from Amgen, Inc. for investigator-initiated research. • She also consults for diaDexus, a manufacturer of blood lipid assays.

  3. Outline • Needs Assessment • Strategic Planning/Opportunity • Example of a First Project • Lessons Learned and Next Steps

  4. Needs Assessment - Background • AAMC Learning Health System award • Support of CEO of Health System • Support of Dean, School of Medicine • Support of Chair, Department of Medicine • Proposal to use CME as a strategy to bridge two camps • CME to engage? • Performance Improvement CME • Engage QI leaders (non-researchers): challenge = physician engagement • Engage researchers: challenge = misaligned priorities • Research priority not necessarily = Health System priority

  5. Needs Assessment Nominal group of leaders in QI in Health System, health services research • What are the biggest challenges to conducting QI research in the UAB Health System? • Which are the most difficult to overcome?

  6. Needs Assessment -- Results Collaboration • No forum for regular communication and coordination of efforts • Differences in culture • Lack of common language/understanding • Lack of instruction on research methods • How to align investigator interests and health system priorities • What should be the scientific home for QI research

  7. Needs Assessment -- Results System-related • Absence of coordinated analysis and interpretation of data • Budget for high quality QI projects not available • Communication of QI research being a priority and expectation by leadership • Lack of reliable centralized repository of institutional QI efforts • Turn over with trainees • Results that make UAB look bad – ability to publish

  8. Needs Assessment -- Results Data-related • Lack of confidence in data veracity • Lack of coordinated data • Clinical data may not be research grade • Contamination due to multiple ongoing programs Time-related • Academic approach takes too long • Time availability • IRB • Operational time requirements

  9. Needs Assessment -- Results Biggest barriers: • Aligning investigator and health system priorities • Lack of coordinated data • No forum for communication/coordination • Funds for high quality QI research • Communication of QI research as a priority by leadership

  10. Strategic Planning • Met with each supporter (CEO, Dean, Chair) • Obtain insights, recommendations

  11. Strategic Planning/Opportunity • Met with each supporter (CEO, Dean, Chair) • Obtain insights, recommendations • Request for partnership from Medscape • Aligning investigator and health system priorities • Lack of coordinated data • No forum for communication/coordination • Funds for high quality QI research • Communication of QI research as a priority by leadership

  12. Example Project Improving the utilization of tPA in acute ischemic stroke at UAB • Genentech grant for QI CME to Medscape, UAB as subcontractor • UAB applying for Stroke Center certification – well-aligned Proposal: • Needs assessment with nominal groups of stakeholders • ED RNs, ED MDs, Neurologists, Neuroradiologists • Educational programs • QI program informed by nominal groups • Baseline and f/u data

  13. Example Project – Lessons Learned • Partnership takes time! Medscape is a large organization CME team playing leading role UAB clinicians not used to CME in this role (2) QI CME projects: templated Not well suited to innovation required for research (3) Educational content concurrent with needs assessment (not after) Required reconfiguring educational content Needs assessment: ED MD community controversy about use of tPA Planned education: all Neurologists Modification: add ED MD as peer model

  14. Next Steps • Medscape #2 Improving the quality of care in chronic lymphocytic leukemia • Medscape #3 Rheumatoid arthritis • Several proposal submitted (time) • Analyst to obtain data from health system (rapid turn around) • Refine model • Opportunity identified  Find champion  Data scan  Go/no go 48 hours

  15. Summary: Using CME as a strategy to propel QI research Work in progress – stay tuned Pro’s: • Funding source - $250,000+ per year • Funding specifically for QI Con’s: • Lots of time • Rapid turn around – announcement to due date ~30 days • Health services researchers: learning curve • Highly focused opportunities (aligning researcher priorities?)

  16. Thanks to • Ronan O’Beirne, PhD, Director UAB CME • Will Ferniany, PhD, CEO, UAB Health System • Selwyn Vickers, MD, Dean, UAB School of Medicine • Seth Landefeld, MD, Chair, UAB Department of Medicine

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