No abstract

Background: The Accreditation Council for Graduate Medical Education (ACGME) has defined six core competencies that reflect changing needs of health care delivery. One of these competencies, practice-based learning and improvement (PBLI), is essential for improving processes and outcomes of care. As an initial step, incorporating a standardized method for data collection is required and helps physicians monitor the quality of their work, identify learning and QI needs and positively change practice behavior. Methods: The PINNACLE Registry is an outpatient practice-based QI program designed to optimize quality of care through the standardized collection and reporting of clinical data on CAD, atrial fibrillation, heart failure and hypertension. Twelve cardiac fellows participate in the PINNACLE Registry at St. John Hospital and Medical Center in Detroit. At each clinic encounter, a data collection form (DCF) which captures patient demographics, history/risk factors, and current therapies were recorded and transmitted to the ACC to generate comparative feedback reports about the quality of care delivered to patients. Use of the DCF was piloted from September 2009 through November 2009 and expanded to all patient encounters from December 1, 2009 through January 31, 2010. Impressions from the first 60 encounters are reported. Results: Fellows reported that the DCF improved their knowledge, though the initial process of collecting data impacted clinic workflow. Utilization of the DCF initially resulted in longer patient visits which decreased over time (average 7 minutes reduced to 4 minutes per patient). As a checklist connecting patient workflow to best cardiology evidence, residents reported that diagnostic and therapeutic decisions were not simply monitored, but guided by the DCF. Conclusions: The DCF was found be a useful tool for data collection and clinical decision support. Participation in the PINNACLE Registry has provided the opportunity to further the ACGME core competencies of patient care and practice-based learning and improvement in a cardiology fellow outpatient clinic.