Clinical Quality and Patient Safety Training Using an Outcomes-Based Approach

1. Clinical Quality and Patient Safety Training Using an Outcomes-Based Approach Eric J. Scher, MD, FACP Vice Chair and Program Director Department of Internal Medicine Henry Ford Health System APDIM EIP Launch Session April 4, 2006

2. GOALS • To integrate quality improvement theory and practice into existing ambulatory curriculum • To underscore the concept of patient safety and make it a central theme in the inpatient training environment • To develop resident portfolios and study the predictive validity of these and other educational outcomes measures in all six competencies utilizing clinical outcome data imbedded in our post-graduate survey tool

3. TIME LINE • Practice Improvement Modules • piloted in 2005/2006 academic year • formally integrate into curriculum in July, 2006 • Collaborative Practice Model • piloted in 2005/2006 academic year • formally integrate into curriculum in July, 2006 • Continuum of Care (“hand-off”) • pilot in January, 2007 • Simulator Training • piloted in 2005/2006 academic year • Resident Portfolio Development/Outcome Measure Analysis • July, 2008

4. How Will These Innovations Affect Care As Perceived By Patients? Outpatient Setting • More proactive approach in secondary preventive measures • More emphasis on patient education • Fewer complications and debilitation • Greater shared decision-making

5. How Will These Innovations Affect Care As Perceived By Patients? Inpatient Setting • More emphasis on safety through collaborative rounds • Improved coordination of care between providers • Less discomfort (i.e. fewer IV lines, catheters) • Better continuity of care during off-hours (hand-offs) • Fewer unanticipated ICU transfers • Shorter length of stay

6. METHODS-Quality Improvement Curriculum • Utilizes the ABIM Practice Improvement Modules (PIM) • Chart Audits • Patient Surveys • Practice Survey • Administrative Databases • PIM Intervention Tools

7. METHODS-Patient Safety Curriculum • Utilizes a Collaborative Practice Model • Daily Multidisciplinary Rounds • Safety Checklists • Administrative Databases • Patient and Care Provider Surveys • Continuum of Care (Hand-Offs) • OSCE Stations Simulating Effective Hand-Offs • Patient and Care Provider Surveys • Simulator Instruction on Invasive Procedures

8. METHODS-Predictive Validity • Statistical Correlation and Factor Analysis Utilizing: • Existing Educational Outcome Measures • Future Portfolio Artifacts • Postgraduate Resident Surveys • Employer Surveys • ABIM Board Scores

9. Innovation “Products” Anticipated:Education Outcome Measures • PIM Project • PDSA and FEMA worksheets • Documentation of Resident’s QI Project • Reflective Exercises • System-Based Practice Portfolio • OSCE for Hand-Offs • Knowledge • PIM pre- and post-test • Communication and Interpersonal Skills • Patient Satisfaction Surveys

10. Innovation “Products” Anticipated:Clinical Outcome Measures • PIM data • Achieve standard outcomes for chronic disease and preventive services • Simulator Training • Central line complications • Rate of Blood Stream Infection • Collaborative practice measures • Attain IHI inpatient quality improvement initiatives • Achieve several of the inpatient NQF measures • Patient satisfaction survey scores

11. How These Innovations Will Affect Learning As Perceived By Residents? • Portfolios • More learner-centered • More relevant to clinical practice • Allows self-reflection on learner’s needs • Allows more participation in developing learning/remediation plans • Greater ownership of evaluation process • Better understanding of concepts in practice-based learning/ improvement and systems-based practice

12. ANTICIPATED BARRIERS • The outpatient PIM curriculum will require substantial faculty and resident buy-in with regards to time, effort and a willingness to participate in continuous quality improvement • The safety initiatives will require faculty time for teaching and evaluation. We also anticipate some resistance from faculty members in participating in our collaborative practice model given the additional time commitment • The hand-off curriculum will require alignment of resident and nursing sign-out times between shift changes which may prove to be onerous from a scheduling prospective