1. QI & Patient Safety Update
Department of Medicine
Unit Directors Meeting
April 25, 2016

2. QI Goals for Dept of Medicine
Create infrastructure and resources within the department to support scholarly QI activities
Develop faculty skills in QI methodology and cultivate a cadre of faculty experts in QI
Enhance innovation and scholarly productivity in QI and high value care
Align and promote collaboration in QI efforts across divisions

3. 1. Resources: Biostatistics Consultation
Initial funding for 100 hours of biostats
Focus = scholarly QI projects led by junior faculty as well as mentored resident and fellow QI projects
Application process
Simple, 1 page (handout)
Compels consideration of key elements for project
Identifies scholarly product
Submission to yours truly. Review by Renee Stapleton and me.
Based on initial demand, will determine need for dedicated %FTE for biostats

4. 1. Resources: Biostatistics Consultation
If application approved:
Forwarded to Dr. Ashikaga in Biostatistics
Assigned to a member of the biostatistics group, based on complexity and area of focus
Where possible, early initial consultation to review project design, measures, data formatting, and analyses

5. 1. Resources: Potential future directions
Dedicated biostats effort
Scholarly QI / research navigator
Administrative support – project tracking, forms assistance, database management

6. 4. Alignment: UVMMG FY2017 Metrics
Background
UVMMG comp plan:
1/3rd of adjustable comp (5% of clinical salary pool) is based on achievement of quality goal
Goals – specific metrics – can be established at division level (1 per division)
Submission to UVMMG Patient Care & Ops Committee for review and approval (Aug / Sept)
Ultimately approved by UVMMG Board
Barriers:
Short timeline for development
Uncertain requirements from UVMMG Patient Care & Ops
Coordinating efforts across divisions
Obtaining baseline data
Generating ongoing reports / feedback
$ is on the line – want achievable goals

7. 4. Alignment: UVMMG FY2017 Metrics
Medicine QA&I Committee
Generated approximately 30 potential “themes” - broad categories to align the FY2017 QI initiatives across divisions
Factors: current QI initiatives, UVMMC strategic goals, cross-divisional, measurable, meaningful
Identified 3 themes:
Transitions of Care
Advance Care Planning
Patient Experience

9. 4. Alignment: UVMMG FY2017 Metrics
Examples from recent or ongoing activities:
Transitions of care (inpatient to outpatient; outpatient to outpatient; inpatient to inpatient services)
Improving pre-op process for Mohs surgery patients (Derm)
Communication regarding colonoscopy follow-up (GI)
Diabetes pathway implementation and refinement (Endo & GIM)
Problem list reconciliation at discharge (Hospital Medicine)
Improve OR hand-offs to MICU/SICU (Pulm/Critical Care)
Advance care planning
Increasing % of primary care patients with advance care plan documents (GIM)
Increase % of HIV+ persons followed at Comprehensive Care Clinic at UVMMC with Advance Directive in place (ID)
Establish goals of care with patient before starting dialysis (Nephrology)
Patient experience*
MD Communication Quality Score (CG-CAHPS percent top box score) – (GIM)
Patient and Family Centered Care rounds in MICU (Pulm/Critical Care)
Nursing calls to patients with newly diagnosed RA (Rheumatology)
*consider using a process measure rather than the standard patient experience survey

10. Quality Metrics - Considerations
Two measurement periods
Measurement Period 1: October 1, March 31, 2017
Measurement Period 2: April 1, September 30, 2017
SMART Criteria:
Specific
Measurable
Attainable
Relevant
Time bound
Build on current initiatives, if possible
UVMMG required achievement of target performance (not just documentation of participation)
No such thing as perfect

11. 4. Alignment: UVMMG FY2017 Metrics
Next steps:
Each division to develop proposed UVMMG FY2017 initiative / metric
Cross divisional initiatives are great
e.g., advance care planning efforts may elevate all divisional metrics
Goal: divisional reps to bring proposed metric to June 17 Medicine QA&I Committee Meeting
Suggestions / refinement, if needed
If no baseline data available, can work with Jeffords to establish baseline metrics and reports
Final divisional metrics by August 19

12. Questions & suggestions