1. High Value Quality Improvement 2013-2014 Presentation 6 of 6

2. Learning Objectives Identify quality improvement resources in your institution Involve residents in local safety and quality programs Help residents design a project that focuses on of the following high value care themes: Reducing waste in the system (unnecessary testing and treatment or inappropriate setting of care) Minimizing harms (radiation exposure, medication side effects) Improving patient care through communication (incorporating patient values and concerns into care plans and/or improved communication with consultants)

3. Steps Toward High Value, Cost-Conscious Care 1 Step one: Understand the benefits, harms, and relative costs of the interventions that you are considering Step two: Decrease or eliminate the use of interventions that provide no benefits and/or may be harmful Step three: Choose interventions and care settings that maximize benefits, minimize harms, and reduce costs (using comparative-effectiveness and cost-effectiveness data) Step four: Customize a care plan with the patient that incorporates their values and addresses their concerns Step five: Identify system level opportunities to improve outcomes, minimize harms, and reduce healthcare waste

4. Tool Box for QI Projects Model for Improvement: PDSA – Plan/Do/Study/Act Road Map for QI: Guide for Doctors Workbook and Facilitator Guide Sample Products Written summary reports or abstracts Slide or poster presentations Submission to local/regional/national meetings (ACP chapters, ACP national meeting, regional SGIM, APDIM) Teachable Moment publication (JAMA Internal Medicine)

5. Commitment to Change Discuss with the large group how the curriculum will impact their practice Ask participants to write an email to themselves of an action plan that came out of the curriculum—send it to them after they complete the curriculum and again after 2 months to remind them of their plans

6. References 1)Adapted from Owens, D. Ann Intern Med. 2011;154:174-180 2)Landon BE et al. Improving the management of chronic disease at community health centers. N Engl J Med. 2007;356:921-934 3)Djuricich AM et al. A continuous quality improvement curriculum for residents. Acad Med. 2004;79:(suppl) S65-S67 4)Holmboe ES et al. Teaching and improving quality of care in a primary care internal medicine residency clinic. Acad Med. 2005;80:571-577 5)Shojania KG et al. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies. Vol 1. Rockville, MD: Agency for Healthcare Research and Quality; 2006:14-18