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Techniques and Tools for Integrating Quality and Patient Safety Education across the Continuum: The University of Chicago ...
Outline of Our Journey <ul><li>Early Beginnings & Guiding Principles </li></ul><ul><li>Teaching Quality to  Residents : Qu...
Teaching QI at University of Chicago <ul><li>STRENGTHS </li></ul><ul><li>Structure of UME and GME under one roof  </li></u...
Early Beginnings 2004-2006   <ul><li>IHI Health Professions Collaborative </li></ul><ul><li>Networked with other faculty w...
Principles in Teaching QI <ul><li>Team-based projects that are driven by learners with faculty guidance </li></ul>
Principles in Teaching QI <ul><li>Core Components </li></ul><ul><li>Developing Aim Statement </li></ul><ul><li>Choosing me...
Principles in Teaching QI <ul><li>Core Components </li></ul><ul><li>Developing Aim Statement </li></ul><ul><li>Choosing me...
Principles in Teaching QI <ul><li>Core Components </li></ul><ul><li>Developing Aim Statement </li></ul><ul><li>Choosing me...
Principles in Teaching QI <ul><li>Core Components </li></ul><ul><li>Developing Aim Statement </li></ul><ul><li>Choosing me...
Principles in Teaching QI <ul><li>Core Components </li></ul><ul><li>Developing Aim Statement </li></ul><ul><li>Choosing me...
Teaching Residents  Quality Improvement Lessons Learned from the  Quality Assessment & Improvement Curriculum (QAIC) 2006-...
Curricular Development <ul><li>Review of ACGME PBLI & SBP requirements </li></ul><ul><li>Identified suitable time in resid...
Quality Curriculum Overview * Each block consists of four 90 minutes lecture/time slots Block 2 QI Project   Develop and i...
Blocks 1 and 2:  Practice Improvement Modules Block 1 -  Collect Data   Review Report Block 2 -   Plan to Improve   Aim St...
Residents Return in Small Groups during PGY3 Ambulatory Block to Sustain Project Block 2 – Jan 2007  10 residents review b...
PIMs at University of Chicago <ul><ul><li>July 2006 to May 2010 </li></ul></ul><ul><ul><li>94 IM Residents completed the 2...
Evaluation for QAIC: Pre-Post & PGY3 Historical Controls Using historical controls allows us to explore possibility that i...
Self-Assessment of QI Tasks:  Pre-Post and Post vs. Historical Controls (PGY3)  93 89 89 93 86 82 96 89 96 89 96 96 pgy2 p...
Results- QIKAT P<0.001 P<0.001 Vinci, QSHC, in press Ogrinc, JGIM, 2004
Curriculum Feedback <ul><li>“ I gained skills to make me feel less frustrated and helpless within the system I work” </li>...
University of Chicago Successes <ul><li>9 resident posters presented at national, regional, and local meetings </li></ul><...
Teaching Quality Improvement Obtained funding through internal competition for medical education grants  Funding Used hist...
Teaching the Teachers:  Spreading to Faculty  & Other Clinical Departments The Quality Scholars Faculty Development Course...
Quality Scholars: Curriculum <ul><li>Internal grant:  </li></ul><ul><ul><li>Excellence in Clinical Care and Education Awar...
Quality Scholars:  Faculty Projects <ul><li>Screening for delirium in geriatric inpatients </li></ul><ul><li>Increase pneu...
Quality Scholars: Successes <ul><li>Endocrinology faculty taught improvement skills to Endocrinology fellows and faculty <...
Quality Scholars: Challenges and Solutions Solutions Challenges Align people and projects with institutional goals Institu...
Quality Scholars: Pharmacists <ul><li>5 sessions with 5 inpatient pharmacists  </li></ul><ul><ul><li>Recent pharm graduate...
Faculty QI Education Evolving <ul><li>Including faculty in resident QAIC </li></ul><ul><ul><li>Complete an ABIM PIM </li><...
Expansion to Medical School Initially largely through student groups IHI Open School Chapter Improvehealth.org
Pritzker Initiative: Our Big Break  <ul><li>Launched 2005 </li></ul><ul><ul><li>Created an opportunity for innovation via ...
Components of QST  (started Aug 2009) <ul><li>10 week Elective in QI Methods & Safety for first years </li></ul><ul><ul><l...
Learn more about QST…  <ul><li>From one of our medical students </li></ul><ul><li>Panel on Student and Resident-Led QI Ini...
Lessons Learned <ul><li>Curricular change takes time </li></ul><ul><li>Persistence needed </li></ul><ul><li>Start small fo...
The Importance of a Good Team
Acknowledgements <ul><li>Marcus Dahlstrom, MSII, Co-Chapter Leader  </li></ul><ul><li>Caitlin Schaninger, MSIV, Co-Chapter...
Questions or Copies of Materials… <ul><li>University of Chicago Quality Website for curriculum materials & articles </li><...
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Teaching QI at University of Chicago

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Presented at Association of American Medical Colleges Integrating QI meeting in Chicago, IL June 2010. Chronicles journey incorporating QI education for students, residents, faculty, and allied health professions.

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Teaching QI at University of Chicago

  1. 1. Techniques and Tools for Integrating Quality and Patient Safety Education across the Continuum: The University of Chicago Journey Vineet Arora, MD, MAPP, Julie Oyler, MD, Lisa Vinci, MD Association of American Medical Colleges Integrating Quality: Linking Clinical and Educational Excellence Meeting June 3-4, 2010 (Chicago, IL)
  2. 2. Outline of Our Journey <ul><li>Early Beginnings & Guiding Principles </li></ul><ul><li>Teaching Quality to Residents : Quality Assessment & Improvement Curriculum (QAIC) </li></ul><ul><li>Spreading to Faculty & Other Clinical Departments: Quality Scholars Program </li></ul><ul><li>Creating Student Leaders & Lessons Learned </li></ul>2004- 2006- 2008- 2009-
  3. 3. Teaching QI at University of Chicago <ul><li>STRENGTHS </li></ul><ul><li>Structure of UME and GME under one roof </li></ul><ul><li>Located on an undergraduate campus with graduate programs in health administration </li></ul><ul><li>Culture of scholarship in medical education </li></ul><ul><ul><li>Funding for innovation </li></ul></ul><ul><li>Small institution </li></ul><ul><li>CHALLENGES </li></ul><ul><li>Limited faculty expertise </li></ul><ul><li>Lack of allied health professional schools (i.e. pharmacy, nursing, etc.) </li></ul><ul><li>Small faculty </li></ul><ul><li>Focus on biological sciences </li></ul><ul><li>Clinical quality infrastructure developing </li></ul>
  4. 4. Early Beginnings 2004-2006 <ul><li>IHI Health Professions Collaborative </li></ul><ul><li>Networked with other faculty who teach QI / safety </li></ul><ul><li>Attended IHI meetings </li></ul><ul><ul><li>Learned basics of QI/Safety </li></ul></ul><ul><ul><li>Learned of the importance of interprofessional learning </li></ul></ul>Linda Headrik, U Missouri Greg Ogrinc, Dartmouth Julie Johnson, U New South Wales Vineet Arora, MD MAPP Caitlin Schaninger, MS4 Mary Johnson, MSW at the IHI Forum
  5. 5. Principles in Teaching QI <ul><li>Team-based projects that are driven by learners with faculty guidance </li></ul>
  6. 6. Principles in Teaching QI <ul><li>Core Components </li></ul><ul><li>Developing Aim Statement </li></ul><ul><li>Choosing measures </li></ul><ul><li>Process mapping </li></ul><ul><li>Plan-Do-Study Act </li></ul><ul><li>Sustainability & Spread </li></ul>SMART AIMS S - Specific M - Measurable A - Attainable R - Relevant T - Timely <ul><li>Team-based projects that are driven by learners with faculty guidance </li></ul>
  7. 7. Principles in Teaching QI <ul><li>Core Components </li></ul><ul><li>Developing Aim Statement </li></ul><ul><li>Choosing measures </li></ul><ul><li>Process mapping </li></ul><ul><li>Plan-Do-Study Act </li></ul><ul><li>Sustainability & Spread </li></ul><ul><li>Team-based projects that are driven by learners with faculty guidance </li></ul>
  8. 8. Principles in Teaching QI <ul><li>Core Components </li></ul><ul><li>Developing Aim Statement </li></ul><ul><li>Choosing measures </li></ul><ul><li>Process mapping </li></ul><ul><li>Plan-Do-Study Act </li></ul><ul><li>Sustainability & Spread </li></ul><ul><li>Team-based projects that are driven by learners with faculty guidance </li></ul>
  9. 9. Principles in Teaching QI <ul><li>Core Components </li></ul><ul><li>Developing Aim Statement </li></ul><ul><li>Choosing measures </li></ul><ul><li>Process mapping </li></ul><ul><li>Plan-Do-Study Act </li></ul><ul><li>Sustainability & Spread </li></ul><ul><li>Team-based projects that are driven by learners with faculty guidance </li></ul>
  10. 10. Principles in Teaching QI <ul><li>Core Components </li></ul><ul><li>Developing Aim Statement </li></ul><ul><li>Choosing measures </li></ul><ul><li>Process mapping </li></ul><ul><li>Plan-Do-Study Act </li></ul><ul><li>Sustainability & Spread </li></ul><ul><li>Team-based projects that are driven by learners with faculty guidance </li></ul>
  11. 11. Teaching Residents Quality Improvement Lessons Learned from the Quality Assessment & Improvement Curriculum (QAIC) 2006- present
  12. 12. Curricular Development <ul><li>Review of ACGME PBLI & SBP requirements </li></ul><ul><li>Identified suitable time in residency training </li></ul><ul><ul><li>PGY2 and 3 ambulatory blocks </li></ul></ul><ul><li>Creation of Lectures for Core QI Principles </li></ul><ul><li>Developed Evaluation Plan </li></ul><ul><ul><li>QIKAT </li></ul></ul><ul><li>Without EHR, mechanism to collect data for practice assessment needed </li></ul><ul><ul><li>Contacted ABIM to adapt PIM to residency program </li></ul></ul><ul><li>Obtained funding through internal competition for medical education grants </li></ul><ul><ul><li>Graduate Medical Education Funding </li></ul></ul>
  13. 13. Quality Curriculum Overview * Each block consists of four 90 minutes lecture/time slots Block 2 QI Project Develop and implement a small QI project with group of 10 residents Block 1 Quality Assessment Complete data collection for ABIM PIM PGY-2 Block 4 Quality Summary Pay for Performance and Hospital Quality Measures Block 3 Sustainability and Spread Measure project sustainability, complete PIM PGY-3 Ambulatory Block Winter/Spring (1 month*) Ambulatory Block Summer/Fall (1 month*) Residency Year
  14. 14. Blocks 1 and 2: Practice Improvement Modules Block 1 - Collect Data Review Report Block 2 - Plan to Improve Aim Statement Process Mapping Stakeholder interviews Test Change
  15. 15. Residents Return in Small Groups during PGY3 Ambulatory Block to Sustain Project Block 2 – Jan 2007 10 residents review baseline data, implement QI project & collect early post data e.g. documentation of smoking counseling Block 3 – August 2007 3 of 10 residents review early post data & develop a plan for sustainability e.g. developed referral process to smoking clinic Block 3 – October 2007 3 of 10 residents revise plan for sustainability & collect late post data e.g. revised referral process, educated staff Block 3 – December 2007 4 of 10 residents develop summary/poster of QI project and finalize project e.g. project presented at Hospital Quality Fair Block 1 – July 2006 10 residents complete CPS PIM and review data
  16. 16. PIMs at University of Chicago <ul><ul><li>July 2006 to May 2010 </li></ul></ul><ul><ul><li>94 IM Residents completed the 2 year curriculum </li></ul></ul><ul><ul><li>30 IM Residents currently participating </li></ul></ul><ul><ul><li>9 group QI projects completed to date; 3 projects in process </li></ul></ul><ul><ul><li>Clinical Preventive Services and Preventive Cardiology PIM’s used </li></ul></ul>Oyler, JL et al. JGIM, 2008 Vinci LM et al. QSHC-In press Got BMI?
  17. 17. Evaluation for QAIC: Pre-Post & PGY3 Historical Controls Using historical controls allows us to explore possibility that increased QI knowledge is the result of accumulation of resident experience (and not QAIC ) Pre - test Post - test PGY2 Historical Control PGY3 QAIC PGY2 pre vs. post PGY2 post vs. PGY3 control
  18. 18. Self-Assessment of QI Tasks: Pre-Post and Post vs. Historical Controls (PGY3) 93 89 89 93 86 82 96 89 96 89 96 96 pgy2 post- n=26 54 21 13 42 58 22 54 25 58 54 67 71 pgy3 control n=24 p values 0.001 0.001 26 Build next improvement 0.001 0.001 18 Identify how data is linked to processes 0.001 0.001 9 Use PDSA cycle 0.001 0.001 18 Implement structured plan to test a change 0.03 0.001 44 Identify best practice/ compare local practice 0.001 0.001 11 Use small cycles of change 0.001 0.001 32 Identify if a change leads to improvement 0.001 0.001 24 Make changes in a system 0.001 0.001 21 Study the process 0.001 0.001 41 Use measurement to improve 0.01 0.001 53 Apply the best professional knowledge 0.01 0.01 71 Write a clear aim pgy2 post vs pgy3 control pgy2 Pre- post pgy2 pre- n=26 % Residents reporting comfortable with QI task
  19. 19. Results- QIKAT P<0.001 P<0.001 Vinci, QSHC, in press Ogrinc, JGIM, 2004
  20. 20. Curriculum Feedback <ul><li>“ I gained skills to make me feel less frustrated and helpless within the system I work” </li></ul><ul><li>“ It is important to have an objective way to evaluate if a change is made” </li></ul><ul><li>“… .the ability to focus an aim and design and implement quality improvement projects in a measurable fashion” </li></ul>
  21. 21. University of Chicago Successes <ul><li>9 resident posters presented at national, regional, and local meetings </li></ul><ul><li>2 faculty publications on curriculum </li></ul><ul><li>1 resident publication submitted as a result of ABIM PIM curriculum </li></ul><ul><li>APDIM Educational Innovations Award 2008 </li></ul><ul><li>Midwest SGIM Innovation </li></ul><ul><li>Award 2009 </li></ul><ul><li>SGIM Clinical Innovations </li></ul><ul><li>Award 2009 </li></ul>
  22. 22. Teaching Quality Improvement Obtained funding through internal competition for medical education grants Funding Used historical control group Evaluation plan Solutions Challenges Choose their own projects for their clinic Resident engagement 3 team projects per year Feasibility of individual resident QI project Partner with faculty experienced in QI & evaluation Faculty expertise Use pre-existing tool- ABIM Practice Improvement Module Lack of practice assessment tools Ambulatory block Team of 4 faculty Time constraints for residents and faculty
  23. 23. Teaching the Teachers: Spreading to Faculty & Other Clinical Departments The Quality Scholars Faculty Development Course 2008-present
  24. 24. Quality Scholars: Curriculum <ul><li>Internal grant: </li></ul><ul><ul><li>Excellence in Clinical Care and Education Award </li></ul></ul><ul><li>Curriculum based on QAIC </li></ul><ul><ul><li>Aims </li></ul></ul><ul><ul><li>Process mapping </li></ul></ul><ul><ul><li>Choosing measure </li></ul></ul><ul><ul><li>PDSA cycles </li></ul></ul><ul><li>Course Structure </li></ul><ul><ul><li>6 faculty and 1 RN </li></ul></ul><ul><ul><li>Twice weekly for 1 month </li></ul></ul><ul><ul><li>Faculty brought projects to the group </li></ul></ul><ul><ul><li>Lunch! </li></ul></ul>
  25. 25. Quality Scholars: Faculty Projects <ul><li>Screening for delirium in geriatric inpatients </li></ul><ul><li>Increase pneumonia vaccination rates on the inpatient medicine service </li></ul><ul><li>QI curriculum for endocrinology fellows </li></ul>
  26. 26. Quality Scholars: Successes <ul><li>Endocrinology faculty taught improvement skills to Endocrinology fellows and faculty </li></ul><ul><ul><li>Designed and implemented a diabetes specific progress note </li></ul></ul><ul><li>Pediatrics faculty taught improvement skills to pediatrics residents and faculty </li></ul><ul><ul><li>Improved clinic process for completing age appropriate screening </li></ul></ul>
  27. 27. Quality Scholars: Challenges and Solutions Solutions Challenges Align people and projects with institutional goals Institution chosen vs faculty chosen projects Spread course over 6 months Intensity of course (8 sessions in 1 month) Spread course over 6 months/focus on educational value Need to produce scholarly work Obtain letter of support from chairmen Protecting faculty time
  28. 28. Quality Scholars: Pharmacists <ul><li>5 sessions with 5 inpatient pharmacists </li></ul><ul><ul><li>Recent pharm graduates have training in QI </li></ul></ul><ul><li>Project: </li></ul><ul><ul><li>Medication reconciliation at admission </li></ul></ul><ul><li>Challenging to work </li></ul><ul><li>outside own area </li></ul><ul><li>Highlights the need for </li></ul><ul><li>and challenge of interdisciplinary QI </li></ul>
  29. 29. Faculty QI Education Evolving <ul><li>Including faculty in resident QAIC </li></ul><ul><ul><li>Complete an ABIM PIM </li></ul></ul><ul><ul><ul><li>Learn basic QI skills </li></ul></ul></ul><ul><ul><ul><li>Meet ABIM Maintenance of Certification requirements </li></ul></ul></ul><ul><ul><li>Faculty bring clinical expertise </li></ul></ul><ul><ul><li>Aligns with departmental needs </li></ul></ul><ul><ul><li>Flexible and accessible (3 courses/year) </li></ul></ul><ul><ul><li>Efficient use of faculty time </li></ul></ul>
  30. 30. Expansion to Medical School Initially largely through student groups IHI Open School Chapter Improvehealth.org
  31. 31. Pritzker Initiative: Our Big Break <ul><li>Launched 2005 </li></ul><ul><ul><li>Created an opportunity for innovation via “blue sky” approach </li></ul></ul><ul><ul><li>Implemented Aug 2009 </li></ul></ul><ul><li>Scholarship & Discovery </li></ul><ul><ul><li>Research </li></ul></ul><ul><ul><ul><li>Basic, Clinical, Social Sciences </li></ul></ul></ul><ul><ul><li>Global Health </li></ul></ul><ul><ul><li>Community Health </li></ul></ul><ul><ul><li>Medical Education </li></ul></ul><ul><ul><li>AND…Quality & Safety Track </li></ul></ul>“ For medical education to flourish from one generation to the next, it has to reconfigure itself in response to changing scientific, social, and economic circumstances.” -Abraham Flexner Jordan Cohen, MD, former President, AAMC at launch of Pritzker Initiative
  32. 32. Components of QST (started Aug 2009) <ul><li>10 week Elective in QI Methods & Safety for first years </li></ul><ul><ul><li>Practical experience learning </li></ul></ul><ul><li>IHI Open School </li></ul><ul><ul><li>Online courses written by world-renowned faculty </li></ul></ul><ul><ul><li>Case studies, podcasts, videos, featured articles </li></ul></ul><ul><li>Clinical Training </li></ul><ul><ul><li>Department specific M&M/patient safety conferences  </li></ul></ul><ul><li>Mentored Projects </li></ul><ul><ul><li>Mentors with QI/safety interests identified </li></ul></ul><ul><ul><li>Students encouraged to seek them out </li></ul></ul><ul><ul><li>Start a mentored QI project during their 1 st year & finish prior to graduation </li></ul></ul><ul><ul><li>Funding for summer work </li></ul></ul><ul><ul><li>Dissemination at a local, regional or national conference </li></ul></ul>
  33. 33. Learn more about QST… <ul><li>From one of our medical students </li></ul><ul><li>Panel on Student and Resident-Led QI Initiatives </li></ul><ul><li>Marcus Dahlstrom </li></ul><ul><ul><li>Friday session </li></ul></ul><ul><ul><li>8:00-9:30am </li></ul></ul>
  34. 34. Lessons Learned <ul><li>Curricular change takes time </li></ul><ul><li>Persistence needed </li></ul><ul><li>Start small for an early win </li></ul><ul><li>Use that early win to get noticed </li></ul><ul><li>Scale up when ready </li></ul><ul><li>Support from leadership critical </li></ul><ul><ul><li>Moral & financial </li></ul></ul>
  35. 35. The Importance of a Good Team
  36. 36. Acknowledgements <ul><li>Marcus Dahlstrom, MSII, Co-Chapter Leader </li></ul><ul><li>Caitlin Schaninger, MSIV, Co-Chapter Leader </li></ul><ul><li>Megan Moore, GPHAP Student </li></ul><ul><li>Laura Botwinick, Director, Graduate Program Health Administration & Policy (GPHAP) </li></ul><ul><li>Gregg Kauffman, MSI, Soon-to-be Co-Chapter Leader </li></ul><ul><li>Holly Humphrey, MD, Dean of Medical Education </li></ul><ul><li>Jim Woodruff, MD, Internal Medicine Residency Director </li></ul><ul><li>Halina Brukner, MD, Associate Dean of Medical Education </li></ul><ul><li>Mike Simon, MD, Dean for Graduate Medical Education </li></ul><ul><li>Sandy Smith, PhD, Senior Learning Specialist </li></ul><ul><li>Lou Portugal, MD, Director of Quality for Department of Surgery </li></ul><ul><li>Andrew Davis, MD, Director of Quality for Department of Medicine </li></ul><ul><li>U of C RIME attendees </li></ul>
  37. 37. Questions or Copies of Materials… <ul><li>University of Chicago Quality Website for curriculum materials & articles </li></ul><ul><ul><li>http:// www.tinyurl.com / UChicagoQAIC </li></ul></ul><ul><li>For Quality Assessment and Improvement Curriculum Toolkit </li></ul><ul><ul><li>Email [email_address] . uchicago.edu </li></ul></ul>

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