Jodi F. Abbott, MD12.15.15

Essentials of Public Health: Intro to Quality and Safety Methodology

Learning Objectives• Define health care value• Understand where the money comes from for

health care and where it is spent• Discuss which elements of health care costs are

impacted by physicians • Give examples that you have seen when the

process of health care delivery appears to work against the education of the patient about their care or their health.

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Requirements QI Elements of Course• Turn in IHI Open School

Certificates 101 & 102 Jan 5 2015• Complete Family Member Adverse

Healthcare experience surveyPost to Blackboard Site by January 5

• Complete ICM Site QI project interviewPost to Blackboard Site (Spring)

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Expectations QI Elements of Course• Do the reading/video watching• Come to class and hear medical students

and resident talk about their QI project• Participate in the in class group work to

learn the process of QI• Learn how to be a member of a QI team

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ESCAPE FIRE: WHAT DID WE LEARN? 5

ESCAPE FIRE: WHAT DID WE LEARN? 6

WHERE DO WE WANT TO GO? 7

Six Aims of Healthcare • Safe Medical Care • Effective Care • Patient-Centered• Timely• Efficient• Equitable

Crossing the Quality Chasm: A New Health System for the 21st Century 2002

My experience with Quality Improvement is: A. I have had a paid position in

quality or safety workB. I have experience doing the

work of quality and safety C. I have taken classes on

PSQID. I watched the movie

Escape FireE. I am in this room right now

Response Counter

Watching this movie I feel the most connection to:A. Current (traditional)

healthcare providersB. The patients whose stories are

toldC. The providers swimming

upstream (innovators in health care delivery)

D. I am thinking about my family and their healthcare

E. I’m wondering why I am going into debt to join this profession

Today we will talk about how you can personally impact safe and effective care from your first

clinical experience

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What is Safe Care? • Freedom from:

Accidental Injury Unintended Outcomes

• Reliable care= Failure Free Performance Over Time

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13Healthcare Associated Infections

• What is the incidence of C Difficile infection at BMC (per month)?

15 infections per month

• What is the incidence of MRSA infection at BMC (per month)?

9 infections per month

BUT WHAT CAN A 1st YEAR DO?

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15Hand Hygiene

Effective Care

• Consistent Evidence Based practices

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% Patients Receiving Interventions to Prevent Recurrent Preterm Delivery

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EFFECTIVE CARE FOR 1st YEARS• Be committed to being a lifelong learner• Work to identify whether “best practices” exist • Become involved in IHI Open School• Participate in Quality Improvement Initiatives &

Projects

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Patient Centered Care • Care based on continuous healing relationships• Customization based on patient needs and values• The patient as the source of control • Shared knowledge and free flow of information• Transparency• Anticipation of needs

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CENTERING PREGNANCY 21

CENTERING PREGNANCY 22

PATIENT CENTERED CAREFOR 1st YEARS: ADVOCACYLearn about your patients life:

who does he/she live withwho are his/her supportsdoes he/she have a church/mosque/temple

Make sure your patient is engaged in their caredoes he/she understand the plando he/she think they can follow itwrite down (in his/her language) diagnosis

Ask about material resourcesfood or housing insecurity

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Timely• Timely care is related both to effectiveness and

cost• Delay time from Emergency Room to hospital

admission is both dangerous and costly• Delay in getting prescriptions at hospital discharge

and for outpatients increases hospital admissions and readmissions

• Many quality improvement initiatives are needed and are being done to diminish delays

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Median Total 31hr

Efficient Care

Decrease care delays for 1st years• Ask patients at their visits:

1) do you need any refills today?2) if you need medications what pharmacy

would you like us to use? 3) who will pick up the medications for you?4) do you have money for a copay?

• Participate in a Quality Improvement Initiative

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EFFICICIENT MEDICAL CARE FOR 1st YEARS• Any duplication of care increases cost• Always watch the time • Make sure you are an accurate documenter

– Review patients meds and allergies– Make sure your preceptor has access to the information

that you have gathered

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Equitable Medical Care 29

What are the Four Elements in Blum’s Paradigms of Health (Shi & Singh)

A. Heredity, Health Care, Environment, Behavior

B. Heredity, Culture, Behavior, Impairment

C. Health, Healthcare, Environment, Behavior

D. Heredity, Social, Culture, Education

EQUITABLE CARE FOR 1st YEAR MED STUDENTS• Become an active member of the BMC and

Boston Medical Communities• Consider joining a group/ service learning• Summer programs next year

– Global Heatlh– Primary Care – Participate in Research or QI projects

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Organizational Supports for Change• Redesign care processes to effectively serve the

needs of the chronically ill• Making effective use of information technology• Manage growing knowledge base & training all

healthcare workforce• Coordination of care across patient conditions• Continually advance the effectiveness of teams• Incorporating care process and outcome

measures into their daily work

• Crossing the Quality Chasm: A New Health System for the 21st Century 2002

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PM rounds

BMC Mortality Data

38BMC Mortality Data

Goal--To reduce observed mortalities by 10% and focus on unexpected deaths.

Process- • Weekly review of all deaths• Detailed review of unexpected• Action items to reduce probability of recurrence.

39BMC Mortality Reduction Project

ACTION PLAN

• Reduced barriers to ICU • PM rounds• Attending triggers for notification• Vitals in SCM (Inpatient Electronic Health Record)• Sepsis mortality project

DESIGNING AN IMPROVEMENT PROJECT: WHERE DO WE WANT TO GO?

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SETTING OUR AIMS• What are we trying to accomplish? • How will we know a change is an improvement?

• What?• For Whom ?• By How Much?• By When?

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You can personally impact safe and effective care from your first

clinical experience

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