Candice Kim1, Steven Lin2, Amelia L Sattler3. 1. Stanford University School of Medicine, Stanford, CA. 2. Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine,Stanford, CA. 3. Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA.
Abstract
INTRODUCTION: Teaching quality improvement (QI) in undergraduate medical education to meet entrustable professional activities (EPA) requirements is a challenge. We describe a model where first-year medical students learn QI methods using online modules and then apply their knowledge by leading an interprofessional project in a clinical setting. This model project, set in an outpatient family medicine clinic, sought to improve patient compliance with the preventive care metric of annual serum potassium and creatinine monitoring for patients taking a diuretic, angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB) medication. METHODS: A first-year medical student joined an interprofessional team of one primary care physician and three pharmacy residents. The student led the team in reviewing patient charts to identify root causes and implementing a multifaceted strategy to improve patient outreach and refill policies. The effects of these interventions were monitored weekly using an electronic health record population health tool (Epic's Healthy Planet) over the course of 10 months. RESULTS: At baseline, 76.7% (477/622) of patients taking a diuretic and 79.4% (752/947) taking an ACEI or ARB were compliant with monitoring, approximately 10% below the Healthcare Effectiveness Data and Information Set (HEDIS) recommendations. Within 6 months, interventions resulted in both patient cohorts meeting the HEDIS metric with sustained success for the study duration of 10 months. CONCLUSION: This report demonstrates that a first-year medical student can make meaningful contributions to preventive care while gaining clinically relevant QI experience. Further evaluation is needed to determine generalizability and scalability of this model.
INTRODUCTION: Teaching quality improvement (QI) in undergraduate medical education to meet entrustable professional activities (EPA) requirements is a challenge. We describe a model where first-year medical students learn QI methods using online modules and then apply their knowledge by leading an interprofessional project in a clinical setting. This model project, set in an outpatient family medicine clinic, sought to improve patient compliance with the preventive care metric of annual serum potassium and creatinine monitoring for patients taking a diuretic, angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB) medication. METHODS: A first-year medical student joined an interprofessional team of one primary care physician and three pharmacy residents. The student led the team in reviewing patient charts to identify root causes and implementing a multifaceted strategy to improve patient outreach and refill policies. The effects of these interventions were monitored weekly using an electronic health record population health tool (Epic's Healthy Planet) over the course of 10 months. RESULTS: At baseline, 76.7% (477/622) of patients taking a diuretic and 79.4% (752/947) taking an ACEI or ARB were compliant with monitoring, approximately 10% below the Healthcare Effectiveness Data and Information Set (HEDIS) recommendations. Within 6 months, interventions resulted in both patient cohorts meeting the HEDIS metric with sustained success for the study duration of 10 months. CONCLUSION: This report demonstrates that a first-year medical student can make meaningful contributions to preventive care while gaining clinically relevant QI experience. Further evaluation is needed to determine generalizability and scalability of this model.
Authors: Kimberly S H Yarnall; Kathryn I Pollak; Truls Østbye; Katrina M Krause; J Lloyd Michener Journal: Am J Public Health Date: 2003-04 Impact factor: 9.308
Authors: Chen Amy Chen; Ryan J Park; John V Hegde; Tomi Jun; Mitalee P Christman; Sun M Yoo; Alisa Yamasaki; Aaron Berhanu; Pamela Vohra-Khullar; Kristin Remus; Richard M Schwartzstein; Amy R Weinstein Journal: Med Teach Date: 2014-11-17 Impact factor: 3.650
Authors: Kimberly Lomis; Jonathan M Amiel; Michael S Ryan; Karin Esposito; Michael Green; Alex Stagnaro-Green; Janet Bull; George C Mejicano Journal: Acad Med Date: 2017-06 Impact factor: 6.893
Authors: Iahn Gonsenhauser; Eliza Beal; Fadi Shihadeh; Hagop S Mekhjian; Susan D Moffatt-Bruce Journal: J Healthc Qual Date: 2012 Nov-Dec Impact factor: 1.095
Authors: Jed D Gonzalo; Kelly J Caverzagie; Richard E Hawkins; Luan Lawson; Daniel R Wolpaw; Anna Chang Journal: Acad Med Date: 2018-06 Impact factor: 6.893
Authors: Kristin E Remus; Michael Honigberg; Sri Lekha Tummalapalli; Laura P Cohen; Sara Fazio; Amy R Weinstein Journal: Acad Med Date: 2016-07 Impact factor: 6.893
Authors: Bruce E Gould; Michael R Grey; Charles G Huntington; Cynthia Gruman; Jonathan H Rosen; Eileen Storey; Lynn Abrahamson; Ann Marie Conaty; Leslie Curry; Michelle Ferreira; Karen L Harrington; Deborah Paturzo; Thomas J Van Hoof Journal: Acad Med Date: 2002-10 Impact factor: 6.893