Background Although many residency programs are instituting quality improvement (QI) curricula in response to both institutional and external mandates, there are few reports of successful integration of resident initiated projects into these QI curricula with documented impact on health care processes and measures. Intervention We introduced a multifaceted curriculum into an Obstetrics-Gynecology continuity clinic. Following a needs assessment, we developed a didactic session to introduce residents to QI tools and the how to of a mentored resident-initiated project. Resident projects were presented to peers and faculty and were evaluated. A postgraduation survey assessed residents' satisfaction with the curriculum and preparedness for involvement in QI initiatives after residency. We also assessed whether this resulted in sustained improvement in health care measures. Results The curriculum was presented to 7 classes of residents (n  =  25) and 17 resident initiated projects have been completed. Twenty-one residents (84%) completed the preintervention survey and 12 of 17 (71%) residents who completed the entire curriculum completed the postintervention survey. Sustained change in surrogate health measures was documented for 4 projects focused on improving clinical measures, and improvement in clinical systems was sustained in 9 of the remaining 13 projects (69%). Most of the respondents (75%, n  =  9) agreed or strongly agreed that the projects done in residency provided a helpful foundation to their current QI efforts. Conclusion This project successfully demonstrates that a multifaceted program in QI education can be implemented in a busy Obstetrics-Gynecology residency program, resulting in sustained improvement in surrogate health measures and in clinical systems. A longitudinal model for resident projects results in an opportunity for reflection, project revision, and a maintenance plan for continued clinical impact.

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INTRODUCTION: Universal screening for substance abuse during pregnancy including brief intervention and referral to treatment (SBIRT) is recommended by ACOG. Here we present the implementation of SBIRT to facilitate clinical intervention and collect data about substance abuse during prenatal care. METHODS: A literature-based SBIRT instrument was developed and approved by regional clinicians. An EPIC team integrated the tool into the electronic health record (EHR) and built reports to display aggregate data. SBIRT is performed by a clinical social worker in a resident clinic and at nursing intake in a separate generalist and maternal fetal medicine (MFM) practice. Data reports included substance use by parents, partners, and patient (past and present use); a positive screen was defined as a “yes” response to any question from patients screened for the first time from June 2017 to September 2017. RESULTS: As of September 2017, 49% and 72% of all patients were screened in the MFM and generalist practice, respectively. Forty-six percent of new patients were screened in the resident clinic. In the resident clinic, MFM, and generalist practice from June 2017 to September 2017, 43% (n=34), 41% (n=35), and 32% (n=29) screened positive, respectively. Thirty-eight percent (n=30), 10% (n=9), and 10% (n=9) reported past or present substance abuse. CONCLUSION: Integrating universal SBIRT into prenatal care at disparate locations using EHR requires a multi-disciplinary approach. The SBIRT tool facilitates universal, reportable substance abuse screening. The tool has been expanded to quantify use and report interventions. Future reports will characterize substance abuse in our prenatal practices and inform intervention strategies in this population.