Building the Infrastructure to Enhance QI Research in the Health System Maria Danila, MD (Monika M. Safford, MD) February 12, 2015

Disclosures  Dr. Safford receives salary support from Amgen, Inc. for investigator-initiated research.  She also consults for diaDexus, a manufacturer of blood lipid assays.

Outline  Needs Assessment  Strategic Planning/Opportunity  Example of a First Project  Lessons Learned and Next Steps

Needs Assessment - Background  AAMC Learning Health System award  Support of CEO of Health System  Support of Dean, School of Medicine  Support of Chair, Department of Medicine  Proposal to use CME as a strategy to bridge two camps  CME to engage?  Performance Improvement CME  Engage QI leaders (non-researchers): challenge = physician engagement  Engage researchers: challenge = misaligned priorities  Research priority not necessarily = Health System priority

Needs Assessment Nominal group of leaders in QI in Health System, health services research  What are the biggest challenges to conducting QI research in the UAB Health System?  Which are the most difficult to overcome?

Needs Assessment -- Results Collaboration  No forum for regular communication and coordination of efforts  Differences in culture  Lack of common language/understanding  Lack of instruction on research methods  How to align investigator interests and health system priorities  What should be the scientific home for QI research

Needs Assessment -- Results System-related  Absence of coordinated analysis and interpretation of data  Budget for high quality QI projects not available  Communication of QI research being a priority and expectation by leadership  Lack of reliable centralized repository of institutional QI efforts  Turn over with trainees  Results that make UAB look bad – ability to publish

Needs Assessment -- Results Data-related  Lack of confidence in data veracity  Lack of coordinated data  Clinical data may not be research grade  Contamination due to multiple ongoing programs Time-related  Academic approach takes too long  Time availability  IRB  Operational time requirements

Needs Assessment -- Results Biggest barriers: (1)Aligning investigator and health system priorities (2)Lack of coordinated data (3)No forum for communication/coordination (4)Funds for high quality QI research (5)Communication of QI research as a priority by leadership

Strategic Planning  Met with each supporter (CEO, Dean, Chair)  Obtain insights, recommendations

Strategic Planning/Opportunity  Met with each supporter (CEO, Dean, Chair)  Obtain insights, recommendations  Request for partnership from Medscape (1)Aligning investigator and health system priorities (2)Lack of coordinated data (3)No forum for communication/coordination (4)Funds for high quality QI research (5)Communication of QI research as a priority by leadership

Example Project Improving the utilization of tPA in acute ischemic stroke at UAB  Genentech grant for QI CME to Medscape, UAB as subcontractor  UAB applying for Stroke Center certification – well-aligned Proposal:  Needs assessment with nominal groups of stakeholders  ED RNs, ED MDs, Neurologists, Neuroradiologists  Educational programs  QI program informed by nominal groups  Baseline and f/u data

Example Project – Lessons Learned (1)Partnership takes time! Medscape is a large organization CME team playing leading role UAB clinicians not used to CME in this role (2) QI CME projects: templated Not well suited to innovation required for research (3) Educational content concurrent with needs assessment (not after) Required reconfiguring educational content Needs assessment: ED MD community controversy about use of tPA Planned education: all Neurologists Modification: add ED MD as peer model

Next Steps  Medscape #2 Improving the quality of care in chronic lymphocytic leukemia  Medscape #3 Rheumatoid arthritis  Several proposal submitted (time)  Analyst to obtain data from health system (rapid turn around)  Refine model  Opportunity identified  Find champion  Data scan  Go/no go 48 hours

Summary: Using CME as a strategy to propel QI research Work in progress – stay tuned Pro’s :  Funding source - $250,000+ per year  Funding specifically for QI Con’s :  Lots of time  Rapid turn around – announcement to due date ~30 days  Health services researchers: learning curve  Highly focused opportunities (aligning researcher priorities?)

Thanks to  Ronan O’Beirne, PhD, Director UAB CME  Will Ferniany, PhD, CEO, UAB Health System  Selwyn Vickers, MD, Dean, UAB School of Medicine  Seth Landefeld, MD, Chair, UAB Department of Medicine