Developing a high value care programme from the bottom up: a programme of faculty-resident improvement projects targeting harmful or unnecessary care

Stinnett-Donnelly, Justin; Stevens, Pamela; Hood, Virginia L.

doi:10.1136/bmjqs-2015-004546

Cited by 21 publications

(30 citation statements)

References 9 publications

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“…In the Vermont example,5 by deploying project management, data analysis and electronic health record resources and support, senior leaders clearly backed up their stated endorsement of their organisational commitment towards high-value care with actual support to enable front-line teams to achieve success and project completion. Too often, senior leaders express support for a specific project or improvement goal, but do not provide concrete support to front-line staff 9…”

Section: Leadership Endorsement and Supportmentioning

confidence: 99%

“…Stinnett-Donnelly and colleagues propose a framework for selecting targets that are non-controversial and evidence-based; easily measured electronically; and that lend themselves to interventions that would not increase physician workload and would lead to a “meaningful outcome that would add value (reduce harm, reduce cost, improve patient outcome or experience)” 5. These are useful criteria for identifying pragmatic targets that can lead to early wins, which are critical to generating long-lasting change 18…”

Section: Identifying Appropriate High-value Care Targetsmentioning

confidence: 99%

“…Stinnett-Donnelly and colleagues describe a programme at their academic institution aimed at simultaneously reducing unnecessary or harmful care, improving patient experience and educating resident trainees about high-value care 5. Over the first two years of this comprehensive programme, this US academic medical centre (the University of Vermont) realised impressive reductions across dual-energy X-ray absorptiometry scans in non-elderly women, daily chest X-rays in the intensive care unit and routine serum creatinine measurements in patients undergoing chronic dialysis.…”

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confidence: 99%

“…Thus, bottom-up engagement may not actually be the hard part of implementing high-value care initiatives. In fact, so much of what was done in the programme described by Stinnett-Donnelly and colleagues was top-down ‘enabled’, that we should not lose sight of the fact that organisational support is critical to the success of initiatives like the one described 5. We would like to reflect on several key ways that organisations can support high-value care projects, drawing on what was done by the group in Vermont, as well as looking to other examples.…”

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confidence: 99%

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High-value care programmes from the bottom-up… and the top-down

Moriates¹,

Wong

2016

BMJ Qual Saf

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Section: Leadership Endorsement and Supportmentioning

confidence: 99%

Section: Identifying Appropriate High-value Care Targetsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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High-value care programmes from the bottom-up… and the top-down

Moriates¹,

Wong

2016

BMJ Qual Saf

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“…Although physicians play a critical role in the rise of health care use, 8 implementing and sustaining an HVC culture also requires multidisciplinary collaboration and education with role modeling of HVC practices. 9,10 Pharmacists, 11,12 nurses and nurse practitioners, 13 trainees, [14][15][16][17] and patients 18,19 may all influence and model HVC practices.…”

mentioning

confidence: 99%

Prospective Observational Study on High-Value Care Topics Discussed on Multidisciplinary Rounds

Beck¹,

McDaniel²,

Bradford³

et al. 2018

Hospital Pediatrics

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Despite a recent focus on improving health care value and educating trainees in the practice of HVC, our study demonstrated that bedside discussions of HVC are occurring with a limited frequency at our institution and that attending physicians initiate the majority of discussions. The capacity of the nonphysician team members to contribute to establishing and sustaining an HVC culture may be underused. Multi-institutional studies are necessary to determine if this is a national trend and whether discussions have an impact on patient outcomes and hospital costs.

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Promoting scholarship in improvement science: A model for academic clinical departments

DeVoe

Kennedy

Tompkins

et al. 2022

Learning Health Systems

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Introduction Clinical departments at academic medical centers strive to deliver clinical care, provide education and training, support faculty development, and promote scholarship. These departments have experienced increasing demands to improve the quality, safety, and value of care delivery. However, many academic departments lack a sufficient number of clinical faculty members with expertise in improvement science to lead initiatives, teach, and generate scholarship. In this article, we describe the structure, activities, and early outcomes of a program within an academic department of medicine to promote scholarly improvement work. Methods The Department of Medicine at the University of Vermont Medical Center launched a Quality Program with three primary goals: (a) improve care delivery, (b) provide education and training, and (c) promote scholarship in improvement science. The program serves as a resource center for students, trainees and faculty, offering education and training, analytic support, consultation in design and methodology, and project management. It strives to integrate education, research, and care delivery to learn, apply evidence and improve health care. Results Over the first 3 years of full implementation, the Quality Program supported an average of 123 projects annually, including prospective clinical quality improvement initiatives, retrospective assessment of clinical programs and practices, and curriculum development and evaluation. The projects have yielded a total of 127 scholarly products, defined as peer‐reviewed publications and abstracts, posters, and oral presentations at local, regional, and national conferences. Conclusions The Quality Program may serve as a practical model for promoting care delivery improvement, training, and scholarship in improvement science while advancing the goals of a learning health system at the level of an academic clinical department. Dedicated resources within such departments offer the potential to enhance care delivery while promoting academic success for faculty and trainees in improvement science.

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Developing a high value care programme from the bottom up: a programme of faculty-resident improvement projects targeting harmful or unnecessary care

Cited by 21 publications

References 9 publications

High-value care programmes from the bottom-up… and the top-down

High-value care programmes from the bottom-up… and the top-down

Prospective Observational Study on High-Value Care Topics Discussed on Multidisciplinary Rounds

Promoting scholarship in improvement science: A model for academic clinical departments

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