1. Resident Chart Audit and QI Project Everyoneand Larry Ward, MD

2. Chart Audits Ultimate goal is to improve quality of care Ultimate goal is to improve quality of care Adherence to guidelines for therapeutic and preventive measures Adherence to guidelines for therapeutic and preventive measures Also a method for measuring prevalence Also a method for measuring prevalence Newly mandated by the ACGME Newly mandated by the ACGME Mandated as part of IM recertification Mandated as part of IM recertification

3. Resident Chart Audits Performed for at least 3 of the last 4 years Performed for at least 3 of the last 4 years Method changed last year: Method changed last year: 2 nd and 3 rd years choose 15 charts to review between January and March 2 nd and 3 rd years choose 15 charts to review between January and March Cancer screening Cancer screening Diabetes management Diabetes management HTN management HTN management CAD management CAD management

4. Resident Chart Audits Data for the entire practice is collated Data for the entire practice is collated Over 900 charts reviewed this year Over 900 charts reviewed this year Reviewed during Preclinic conference in April Reviewed during Preclinic conference in April Each individual is given the following: Each individual is given the following: Their own raw and collated data Their own raw and collated data Entire practice data for 2008 and 2009 Entire practice data for 2008 and 2009 National data National data IBC data for Jones Hall and MGP IBC data for Jones Hall and MGP

6. Results Compared with 2008: Compared with 2008:Prevention 74% Flu vaccine (+ 5%) 74% Flu vaccine (+ 5%) 79% Pneumovax (+10%) 79% Pneumovax (+10%) 72% Mammogram (+ 1%) 72% Mammogram (+ 1%) Colorectal screening (unreliable) Colorectal screening (unreliable) PAP smears (- 7%) PAP smears (- 7%)

7. Results Compared with 2008: Compared with 2008: CAD CAD 79% B-blocker (+3%) 79% B-blocker (+3%) 84% on Anti-platelet (+5%) 84% on Anti-platelet (+5%) 61% LDL <100 (+9%) 61% LDL <100 (+9%)

8. Results Compared with 2008: Compared with 2008: Diabetes Diabetes 73% A1c check in last 6 months (0%) 73% A1c check in last 6 months (0%) 75% A1c <9.0 (New) 75% A1c <9.0 (New) 59% seen Ophtho (+ 9%) 59% seen Ophtho (+ 9%) 61% LDL <100 (+ 9%) 61% LDL <100 (+ 9%) 60% at BP goal <130/90 (- 1%) 60% at BP goal <130/90 (- 1%) 86% on ACE/ARB (+ 0%) 86% on ACE/ARB (+ 0%)

9. Conclusion Improvements in most areas compared with 2008. Improvements in most areas compared with 2008. Compares favorably with national data. Compares favorably with national data. Residents to develop personal, data driven QI plans this upcoming year. Residents to develop personal, data driven QI plans this upcoming year. Mid year review with faculty Mid year review with faculty Repeat chart audit (?by peers?) next spring Repeat chart audit (?by peers?) next spring QI initiatives in the practice this year targeting deficiencies QI initiatives in the practice this year targeting deficiencies