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

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

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

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

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

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

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

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

Quality Metrics - Considerations Two measurement periods Measurement Period 1: October 1, 2016 - March 31, 2017 Measurement Period 2: April 1, 2017 - 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

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

Questions & suggestions