2. Hospitalists, scholarly activity, quality improvement, and research Hospitalists Best Practices Conference February 19, 2010 J Rush Pierce Jr, MD, MPH

3. Agenda Are hospitalists interested in research? What kind of research do (can) hospitalists do? What is the IRB and how should hospitalists relate to it? Questions for discussion

4. Predictors of selecting academic medicine as a career Completion of graduate degree or fellowship training Participation in research and publication while in medical school or fellowship Desire to teach or conduct research Influence of a mentor J Gen Intern Med 2006; 21:1222–1229.

5. Themes related to remaining an academic physician Early exposure to research Mentoring Personal and social factors Career support as junior faculty Medical Education 2009: 43: 335–341

6. Types of research by hospitalists the hospitalist model itself clinical approach to hospitalized patients implementation of best practices care transitions improving patient safety J Gen Intern Med 2008; 23(8):1269–72

7. Strategies for success – SHARP model (Univ Michigan) Protected time Mentorship Epidemiologic and statistical support Collaborative opportunities with subspecialists Recruitment of fellowship trained hospitalists Journal of Hospital Medicine 2008;3:308–313

8. Collaborative in-patient medical service (CIMS) - Hopkins Journal of Hospital Medicine 2008;3:314–318.

9. UNM Hospitalist research interest

10. UNM hospitalist research experience

11. UNM Hospitalist research confidence

12. Perceived UNM institutional support

13. What would help at UNM?

14. Case Reports Resources (ACP Website) What types of patients? – Rare conditions, unusual presentation of common illness, esp instructive, unusual complication, unusual aspect of management Relative role of faculty Where to present and where to publish

15. Case Reports - tips Keep list of potential pts Identify early who will take lead Do brief literature review first Draft an abstract early Get the patient's permission Get the patient's phone number Bug the resident/student often! Be aware of meeting deadlines for abstracts

16. Case reports - meetings MEETING NM Chapter of ACP SHM SGIM WAFMR/WSCI ABSTRACT DEADLINE mid-August early January early February late summer

17. Case reports – where to publish General journals (South Med J, Amer J Med Science) Specialty journals (J Amer Geriatrics Soc, etc) Case report specific journals – J Medical Case Reports http://jmedicalcasereports.com/ http://jmedicalcasereports.com/ – J Case Reports in Medicine http://www.hindawi.com/journals/crm/ http://www.hindawi.com/journals/crm/

18. Case reports – topics for discussion Guidelines for order of authorship Role of IRB Meetings and travel Section expectation

19. Curriculum Development Type of projects: – New curriculum – New technique – New program Resources Where to present/publish Usually coupled with survey of satisfaction, perceived confidence, and/or objective measures of knowledge transfer

20. Curriculum Development - tips Keep a list of ideas Keep records! Decide on objective measurements before hand; think about a survey Get library to help with lit review Often involve several faculty – divide up roles

21. Surveys - tips Demographics Two basic types of questions: is there a difference, is there an association? Look for surveys previously done Get help early Design strategies to improve participation Plan on submitting to IRB

22. IRB What is IRB and what is its role? When do I need to submit to IRB? What is HIPPA waiver and when do I need it? Do I need to be trained? http://hsc.unm.edu/som/research/HRRC/HRRCHomePage.shtml

23. IRB submission Exempt vs. expedited vs. full review Getting ready: – Research protocol – on the wiki – Getting the correct forms Submitting the forms Your role as PI

24. Quality Improvement The nature of QI – Measure “quality,” design an intervention, remeasure quality, refine the intervention QI in medicine What is scientific research and when is QI research?

25. QI projects in the hospital – getting started Read lit beforehand (how to measure, what interventions have been done, problems) Decide how you will get baseline measurements Write down planned metrics and interventions Discuss with management Get necessary partners on board Role of IRB

26. QI projects: resources SHM http://www.hospitalmedicine.org/http://www.hospitalmedicine.org/ AHRQ http://www.ahrq.gov/http://www.ahrq.gov/ ACEBP http://www.acestar.uthscsa.edu/Research.htm http://www.acestar.uthscsa.edu/Research.htm UNMHSC CTSC for statistical support http://hsc.unm.edu/research/ctsc/PSU.shtml

27. QI Projects - tips Assume that you will publish Keep good records! Read the SQUIRE Guidelines Work in a group and assign roles Talk to the IRB; anticipate time for approval

28. IRB Practical Tips Look at website to determine if your proposal is exempt. Key issues: – No interventions, just chart review – ‘De-identified data’ Talk (in person) with a HRRC support person about your proposal Listen to the HRRC support person Write protocol Fill out forms Don’t argue, you will lose Make all suggested changes

29. Discussion questions QI and Role of IRB; PI training Case reports: (guidelines for order of authorship, role of IRB, meetings and travel, Section expectation) Statistical and epidemiologic help Dept support for research activities (travel to meetings, infrastructure, seed grants) How to provide mentoring