scholarly journals Continuity Clinic Practice Feedback Curriculum for Residents: A Model for Ambulatory Education

2019 ◽  
Vol 11 (2) ◽  
pp. 189-195 ◽  
Author(s):  
Christine Haynes ◽  
Myrt Yamamoto ◽  
Cody Dashiell-Earp ◽  
Delani Gunawardena ◽  
Reshma Gupta ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Primary Care Clinic ◽  
Unmet Need ◽  
Performance Data ◽  
Resident Attitudes ◽  
Care Clinic ◽  
Level Data ◽  
Practice Performance ◽  
Clinic Practice ◽  
Feedback Data

ABSTRACT Background  There is an unmet need for formal curricula to deliver practice feedback training to residents. Objective  We developed a curriculum to help residents receive and interpret individual practice feedback data and to engage them in quality improvement efforts. Methods  We created a framework based on resident attribution, effective metric selection, faculty coaching, peer and site comparisons, and resident-driven goals. The curriculum used electronic health record–generated resident-level data and disease-specific ambulatory didactics to help motivate quality improvement efforts. It was rolled out to 144 internal medicine residents practicing at 1 of 4 primary care clinic sites from July 2016 to June 2017. Resident attitudes and behaviors were tracked with presurveys and postsurveys, completed by 126 (88%) and 85 (59%) residents, respectively. Data log-ins and completion of educational activities were monitored. Group-level performance data were tracked using run charts. Results  Survey results demonstrated significant improvements on a 5-point Likert scale in residents' self-reported ability to receive (from a mean of 2.0 to 3.3, P < .001) and to interpret and understand (mean of 2.4 to 3.2, P < .001) their practice performance data. There was also an increased likelihood they would report that their practice had seen improvements in patient care (13% versus 35%, P < .001). Run charts demonstrated no change in patient outcome metrics. Conclusions  A learner-centered longitudinal curriculum on ambulatory patient panels can help residents develop competency in receiving, interpreting, and effectively applying individualized practice performance data.

Su1604 QUALITY IMPROVEMENT CAMPAIGN LEAD TO HIGHER SURVEILLANCE RATE FOR HEPATOCELLULAR CARCINOMA IN PRIMARY CARE CLINIC

2020 ◽  
Vol 158 (6) ◽  
pp. S-1353-S-1354
Author(s):  
Kanit Bunnag ◽  
Amarat Kongsompong ◽  
Wit Jeamwijitkul ◽  
Worayon Chuerboonchai ◽  
Chutatip Charoenthanawut ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Primary Care ◽  
Quality Improvement ◽  
Primary Care Clinic ◽  
Care Clinic

Synchronizing advance directives among patients across a health system.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 233-233
Author(s):  
Sherri Rauenzahn Cervantez ◽  
Sadiyah Hotakey ◽  
Amanda Hernandez ◽  
Stephanie Warren ◽  
Jennifer Quintero ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Health System ◽  
Advance Care Planning ◽  
Primary Care Clinic ◽  
Care Planning ◽  
Care Clinic ◽  
Care Plans ◽  
Palliative Oncology ◽  
Advance Care

233 Background: Advance directives (ADs) are legal tools that direct treatment or decision making and appoint a surrogate decision-maker (health care proxy). The presence of ADs is associated with decreased rates of hospitalization, use of life-sustaining treatment, and deaths in a hospital setting. Additionally, completed ADs lead to increased use of hospice or palliative care, more positive family outcomes, improved quality of life for patients, and reduced costs for healthcare. Despite the benefits of advance care planning, only 18-36% of adults have completed advance care plans. The aims of our pilot study were to 1) implement a synchronized system for advance care planning across the UT Health San Antonio health system and 2) improve advance care planning rates in a primary care clinic and palliative oncology clinic. Methods: During a 10-month prospective period, system processes for advance care planning were reviewed with identification of three primary drivers for advance care plan completion: a) electronic/EMR processes, b) clinical workflows and training, and c) patient resources and education. As a result of this quality improvement initiative, standardized forms, resources, and processes for obtaining advance care plans were implemented in the selected clinics. Results: At baseline, the primary care clinic had 84/644 (13%) patients and the palliative oncology clinic had 25/336(7%) with completed advance care plans. With the implementation of a standardized process, 108 patients (23% increase in rate of completion) in the primary clinic and 56 patients (71% increase in rate of completion) in the palliative oncology setting completed advance care planning (ACP). Additionally, there was a 5-fold increase in billing of ACP CPT codes within the clinics during the first 6 months compared to the prior full year. Conclusions: While this quality improvement pilot initiative was limited to two clinics, the synchronized modifications suggest that the system changes could be expanded to other clinics in our UT health system to promote ACP discussions, completion of plans, and ultimately improved patient care.

scholarly journals Effectiveness of EHR-Depression Screening Among Adult Diabetics in an Urban Primary Care Clinic

2021 ◽  
Author(s):  
Filipina Schnabel ◽  
◽  
Danielle Aldridge
Keyword(s):  
Diabetes Mellitus ◽  
Quality Improvement ◽  
Depressive Disorders ◽  
Diabetes Management ◽  
Primary Care Clinic ◽  
Retrospective Chart Review ◽  
Mental Illnesses ◽  
Screening Tools ◽  
Depression Screening ◽  
Care Clinic

Background Diabetes mellitus (DM) and depression are important comorbid conditions that can lead to more serious health outcomes. The American Diabetes Association (ADA) supports routine screening for depression as part of standard diabetes management. The PHQ2 and PHQ9 questionnaires are good diagnostic screening tools used for major depressive disorders in Type 2 diabetes mellitus (DM2). This quality improvement study aims to compare the rate of depression screening, treatment, and referral to behavioral health in adult patients with DM2 pre and post-integration of depression screening tools into the electronic health record (EHR). Methods We conducted a retrospective chart review on patients aged 18 years and above with a diagnosis of DM2 and no initial diagnosis of depression or other mental illnesses. Chart reviews included those from 2018 or prior for before integration data and 2020 to present for after integration. Sixty subjects were randomly selected from a pool of 33,695 patients in the clinic with DM2 from the year 2013-2021. Thirty of the patients were prior to the integration of depression screening tools PHQ2 and PHQ9 into the EHR, while the other half were post-integration. The study population ranged from 18-83 years old. Results All subjects (100%) were screened using PHQ2 before integration and after integration. Twenty percent of patients screened had a positive PHQ2 among subjects before integration, while 10% had a positive PHQ2 after integration. Twenty percent of patients were screened with a PHQ9 pre-integration which accounted for 100% of those subjects with a positive PHQ2. However, of the 10% of patients with a positive PHQ2 post-integration, only 6.7 % of subjects were screened, which means not all patients with a positive PHQ2 were adequately screened post-integration. Interestingly, 10% of patients were treated with antidepressants before integration, while none were treated with medications in the post-integration group. There were no referrals made to the behavior team in either group. Conclusion There is no difference between the prevalence of depression screening before or after integration of depression screening tools in the EHR. The study noted that there is a decrease in the treatment using antidepressants after integration. However, other undetermined conditions could have influenced this. Furthermore, not all patients with positive PHQ2 in the after-integration group were screened with PHQ9. The authors are unsure if the integration of the depression screens influenced this change. In both groups, there is no difference between referrals to the behavior team. Implications to Nursing Practice This quality improvement study shows that providers are good at screening their DM2 patients for depression whether the screening tools were incorporated in the EHR or not. However, future studies regarding providers, support staff, and patient convenience relating to accessibility and availability of the tool should be made. Additional issues to consider are documentation reliability, hours of work to scan documents in the chart, risk of documentation getting lost, and the use of paper that requires shredding to comply with privacy.

Measuring Perceived Level of Integration During the Process of Primary Care Behavioral Health Implementation

2017 ◽  
Vol 33 (3) ◽  
pp. 253-261 ◽  
Author(s):  
Erin M. Staab ◽  
Mara Terras ◽  
Pooja Dave ◽  
Nancy Beckman ◽  
Sachin Shah ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Behavioral Health ◽  
Primary Care Clinic ◽  
Health Clinic ◽  
Care Clinic ◽  
Primary Care Behavioral Health ◽  
Item Level ◽  
Levels Of Integration

Provider- and staff-perceived levels of integration were measured during implementation of a primary care behavioral health clinic; these data were used to tailor and evaluate quality improvement strategies. Providers and staff at an urban, academic, adult primary care clinic completed the 32-item Level of Integration Measure (LIM) at baseline and 7 months. The LIM assesses 6 domains of integrated care. Overall and domain scores were calibrated from 0 to 100, with ≥80 representing a highly integrated clinic. Response rate was 79% (N = 46/58) at baseline and 83% (N = 52/63) at follow-up. Overall, LIM score increased from 64.5 to 70.1, P = .001. The lowest scoring domains at baseline were targeted for quality improvement and increased significantly: integrated clinical practice, 60.0 versus 68.4, P < .001; systems integration, 57.0 versus 63.8, P = .001; and training, 56.7 versus 65.3, P = .001. Ongoing quality improvement, including organizational and financial strategies, is needed to achieve higher levels of integration.

scholarly journals A quality improvement project aimed at adapting primary care to ensure the delivery of evidence-based psychotherapy for adult anxiety

2018 ◽  
Vol 7 (1) ◽  
pp. e000066 ◽  
Author(s):  
Mark D Williams ◽  
Craig N Sawchuk ◽  
Nathan D Shippee ◽  
Kristin J Somers ◽  
Summer L Berg ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Controlled Trial ◽  
Primary Care Clinic ◽  
Data Entry ◽  
Care Practice ◽  
Original Research ◽  
Improvement Project ◽  
Care Clinic ◽  
Primary Care Patients

Primary care patients frequently present with anxiety with prevalence ratios up to 30%. Brief cognitive–behavioural therapy (CBT) has been shown in meta-analytic studies to have a strong effect size in the treatment of anxiety. However, in surveys of anxious primary care patients, nearly 80% indicated that they had not received CBT. In 2010, a model of CBT (Coordinated Anxiety Learning and Management (CALM)) adapted to primary care for adult anxiety was published based on results of a randomised controlled trial. This project aimed to integrate an adaptation of CALM into one primary care practice, using results from the published research as a benchmark with the secondary intent to spread a successful model to other practices. A quality improvement approach was used to translate the CALM model of CBT for anxiety into one primary care clinic. Plan-Do-Study-Act steps are highlighted as important steps towards our goal of comparing our outcomes with benchmarks from original research. Patients with anxiety as measured by a score of 10 or higher on the Generalized Anxiety Disorder 7 item scale (GAD-7) were offered CBT as delivered by licensed social workers with support by a PhD psychologist. Outcomes were tracked and entered into an electronic registry, which became a critical tool upon which to adapt and improve our delivery of psychotherapy to our patient population. Challenges and adaptations to the model are discussed. Our 6-month response rates on the GAD-7 were 51%, which was comparable with that of the original research (57%). Quality improvement methods were critical in discovering which adaptations were needed before spread. Among these, embedding a process of measurement and data entry and ongoing feedback to patients and therapists using this data are critical step towards sustaining and improving the delivery of CBT in primary care.

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