Tablet use as a nonpharmacologic intervention for agitation in older adults, including those with severe dementia, appears to be feasible, safe, and of potential utility.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. Guideline-discordant care of COPD is not uncommon. Further, there is a push to incorporate quality improvement (QI) training into internal medicine (IM) residency curricula. This study compared quality of care of COPD patients in an IM residents’ clinic and a pulmonary fellows’ clinic and, subsequently, the results of a quality improvement program in the residents’ clinic. Pre-intervention rates of quality measure adherence were compared between the IM teaching clinic (n = 451) and pulmonary fellows’ clinic (n = 177). Patient encounters in the residents’ teaching clinic after quality improvement intervention (n = 119) were reviewed and compared with pre-intervention data. Prior to intervention, fellows were significantly more likely to offer smoking cessation counseling (p = 0.024) and document spirometry showing airway obstruction (p < 0.001). Smoking cessation counseling, pneumococcal vaccination, and diagnosis of COPD by spirometry were targets for QI. A single-cycle, resident-led QI project was initiated. After, residents numerically improved in the utilization of spirometry (66.5% vs. 74.8%) and smoking cessation counseling (81.8% vs. 86.6%), and significantly improved rates of pneumococcal vaccination (p = 0.024). One cycle of resident-led QI significantly improved the rates of pneumococcal vaccination, with numerical improvement in other areas of COPD care.

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PURPOSE: Misdiagnosis and guideline-discordant care of chronic obstructive pulmonary disease (COPD) is not uncommon in the primary care setting. Further, there has been a push to incorporate quality improvement (QI) training into internal medicine residency curricula. Our group sought to assess if a resident-led QI project could improve the rate of guideline-based care provided to COPD patients seen in an internal medicine resident teaching (AIM) clinic. DISCLOSURE:The following authors have nothing to disclose: