Transcript How Clinical Faculty can Develop Scholarship Out of
How Clinical Faculty Can Develop Scholarship Out of Clinical Work
Susan K. Pingleton, MD
Scholarship Out of Clinical Work
Why? What is Scholarship??
Resources – Mentor QI vs. Clinical Research How to develop a project
Where to get the data
Squire Guidelines
WHY ??
• You are faculty in an academic medical center • Scholarship is needed for promotion • It is the right thing to do for your students and trainees
Resources
• Mentor – Now School of Medicine Requirement for all Departments – clinical and basic science • Pediatrics • Dept of Medicine Mentoring Toward Promotion – Understanding Ranks and Tracks – Understanding Criteria for Promotion
Scholarship
• Discovery • • Traditional research – Basic and Clinical
Quality Improvement
• Educational curriculums • Health Policy • Dissemination • Presentations • Publications • Other Academic Medical Centers, Hospitals
Survey IM Chairs
• • • • 65 responses (55%) 80% have one or more faculty members spending 20% effort on QI 78% think faculty should be promoted based on QI 26% think evidence of scholarship or academic progress should be required; few consider it “service”
Differences between Traditional Research and Quality Improvement Traditional Research Innovative Local QI Routine Local QI Measure
Epidemiologic studies of quality problems Multi-dimensional ‘quality report card’
Intervene
Description of multiple root cause analyses, outlining common problems identified and changes made Modifying incident reporting system to better inform improvement efforts Performance data mandated by payors Membership on hospital critical incident review committee
Example
Rigorous evaluation of novel QI intervention Leading a complex QI undertaking (eg. implementing CPOE) Modifying a national practice guideline for local uptake
Routine Quality-Related Activities
• • • General internist who led the local adoption of national guidelines for peri operative care Chairs hospital P&T committee Also sits on critical incident review committee Counts as ‘Hospital Service’, expected of all faculty, but little to intrinsic academic merit
Clinician Engaged in Innovative QI
• • • Hospitalist who during his non-clinical time led development of an innovative program to improve the discharge process Successfully led hospital-wide implementation of medication reconciliation Based on above successes, hospital now supports part of his salary to lead new QI projects
Discovery and dissemination characteristics worthy of academic promotion
How to Develop a Project ?
• Assignment of a project by a mentor • Interesting clinical/educational/health policy question that you have and cannot find an answer • “Does routine phone call after discharge improved discharge planning”?
• “Does a serum lactate predict mortality in acute bowel obstruction?” • “What interventions in the EMR can improve core measure compliance?” • “What are the benefits of a Hospitalist Administrator on Duty?” • Requires literature search
DATA Role of data in quality improvement Sources/categories of data Characteristics of “good” data Administrative databases – pros &cons
Data Sources
Clinical Data Administrative Data Bases Proprietary UHC, Premier, HMO’s Government VAH, CMS Registries Specialty organizations Industry registries CDC, States Clinical Trials NIH funded Industry/FDA
Multiple types of Clinical registries: All afford data for
clinical research
• Specialty registries, e.g.
• CTS • Anesthesia Quality Institute (AQI) Data Registry • American College of Chest Physicians Bronchoscopy Registry • Disease registries, e.g.
• Cancer • Pulmonary Hypertension • Government/Organization registries, e.g.
• CDC • Veterans Administration CDB • State of Kansas Diabetes Registry
Differences between Abstracted Clinical Data and Administrative Data Bases for
Clinical Performance
• • – –
Clinical data
Program) (National Surgical Quality Improvement
Prospective data collection, chart abstraction Expensive, labor-intensive, but face validity among physicians • – –
Administrative data base
Thomson-Reuters) (UHC’s CDB, Premier,
Always retrospective, Claims data (medical record coding) Very efficient way to collect data –
Hybrid
(
CDB/Resource Manager )
Administrative clinical data supplemented with resource utilization
Where do the data elements come from ?
Physician: Documentation of patient care Coders: Assignment of codes to diagnoses and procedures Creation of a ‘CLAIM’ with patient demographics; DRG; diagnoses and procedures; LOS; charges; admission/discharge dates, status; physician; etc.
Payers (e.g. CMS, BCBS) State UHC Clinical Data Base (CDB)
Good Correlation between administrative clinical data and abstracted clinical data: 30 mortality AMI “
indicating strong agreement of the hospital risk standardized mortality estimates between the 2 data sources.” Circulation. 2006;113:1683-1692
Clinical Data must be risk adjusted
Low Risk Risk Model High Risk Died Survived A robust model should assign higher probability of death to patients who died than to those who survived, at least 70% of the time (i.e. c-index >= 0.70)
SQUIRE:
Standards for Quality Improvement Reporting Excellence
http://www.squire-statement.org/
Scholarship Out of Clinical Work
Scholarship is discovery and dissemination All departments will have mentoring program and web site QI vs. Clinical Research How to develop a project? What are you interested in?
Where to get the data – Registries, Clinical Data Base, O2