Improving Care in a Resident Practice for Patients With Diabetes

Salem, James K.; Jones, Rebecca; Sweet, David B.; Hasan, Sana; Torregosa-Arcay, Hope; Clough, Lynn

doi:10.4300/jgme-d-10-00113.1

Cited by 8 publications

(11 citation statements)

References 16 publications

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“…[11][12][13][14] Our findings were not consistent with the majority of studies that showed modest improvements in quality metrics, such as glycemic, lipid, and blood pressure control. 11,12,14 The lack of improvement in HbA1c may have been due to the small sample of patients who had HbA1c values in both the pre-and postintervention periods, the relatively low baseline mean HbA1c limiting room for improvement, and potentially inadequate amount of time until follow-up to show meaningful change in these values. Additionally, we collected HbA1c data for this analysis based on the presence of diabetes on patient problem lists, which may have underrepresented the true population in our resident clinic.…”

Section: Discussioncontrasting

confidence: 98%

“…[11][12][13][14] In our study, residents reported increased processes of care, which is concurrent with previous work. [11][12][13][14] Our findings were not consistent with the majority of studies that showed modest improvements in quality metrics, such as glycemic, lipid, and blood pressure control. 11,12,14 The lack of improvement in HbA1c may have been due to the small sample of patients who had HbA1c values in both the pre-and postintervention periods, the relatively low baseline mean HbA1c limiting room for improvement, and potentially inadequate amount of time until follow-up to show meaningful change in these values.…”

Section: Discussionsupporting

confidence: 91%

“…Few studies have looked at panel management curricula in residency. [11][12][13][14]18 Most focused on clinical outcomes based on health metrics and processes of care measures, such as completion of laboratory tests, vaccinations, or visits. [11][12][13][14] In our study, residents reported increased processes of care, which is concurrent with previous work.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13][14]18 Most focused on clinical outcomes based on health metrics and processes of care measures, such as completion of laboratory tests, vaccinations, or visits. [11][12][13][14] In our study, residents reported increased processes of care, which is concurrent with previous work. [11][12][13][14] Our findings were not consistent with the majority of studies that showed modest improvements in quality metrics, such as glycemic, lipid, and blood pressure control.…”

Section: Discussionmentioning

confidence: 99%

“…7 Panel management curricula in residency have the potential to meet population needs while addressing core competencies and training future physician team leaders. [8][9][10] Reports of residency panel management curricula have been encouraging, with statistically significant improvements in glycemic control, low-density lipoprotein, and blood pressure 11,12 ; more frequent completion of quality metrics 13 ; and improved self-reported practice behaviors among residents. 13,14 The optimal approach to integrating panel management into graduate medical education has not been determined.…”

Section: Introductionmentioning

confidence: 99%

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Internal Medicine Resident Experiences With a 5-Month Ambulatory Panel Management Curriculum

Strout

Landrey

MacLean

et al. 2018

Journal of Graduate Medical Education

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Background Panel management is emphasized as a subcompetency in internal medicine graduate medical education. Despite its importance, there are few published curricula on population medicine in internal medicine residency programs.Objective We explored resident experiences and clinical outcomes of a 5-month diabetes and obesity ambulatory panel management curriculum.Methods From August through December 2016, internal medicine residents at the University of Vermont Medical Center reviewed registries of their patients with diabetes, prediabetes, and obesity; completed learning modules; coordinated patient outreach; and updated gaps in care. Resident worksheets, surveys, and reflections were analyzed using descriptive and thematic analyses. Before and after mean hemoglobin A1c results were obtained for patients in the diabetic group.Results Most residents completed the worksheet, survey, and reflection (93%-98%, N¼42). The worksheets showed 70% of participants in the diabetic group had appointments scheduled after outreach, 42% were offered referrals to the Community Health Team, and 69% had overdue laboratory tests ordered. Residents reported they worked well with staff (95%), were successful in coordinating outreach (67%), and increased their sense of patient care ownership (66%). In reflections, identified successes were improved patient care, teamwork, and relationship with patients, while barriers included difficulty ensuring follow-up, competing patient priorities, and difficulty with patient engagement. Precurricular mean hemoglobin A1c was 7.7%, and postcurricular was 7.6% (P ¼ .41). ConclusionsThe curriculum offered a feasible, longitudinal model to introduce residents to population health skills and interdisciplinary care coordination. Although mean hemoglobin A1c did not change, residents reported improved patient care. Identified barriers present opportunities for resident education in patient engagement.

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Section: Discussioncontrasting

confidence: 98%

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Internal Medicine Resident Experiences With a 5-Month Ambulatory Panel Management Curriculum

Strout

Landrey

MacLean

et al. 2018

Journal of Graduate Medical Education

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Management of Point‐of‐Care Testing

Smy,

Apfeld,

Ampomah

et al. 2024

Clinical Laboratory Management

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A Mixed-Methods Program Evaluation of a Self-directed Learning Panel Management Curriculum in an Internal Medicine Residency Clinic

et al. 2022

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BACKGROUND: Panel management (PM) curricula in internal medicine (IM) residency programs often assign performance measures which may not address the varied interests or needs of resident-learners. AIM: To evaluate a self-directed learning (SDL)-based PM curriculum. SETTING: University-based primary care practice in Burlington, Vermont. PARTICIPANTS: Thirty-five internal medicine residents participated. PROGRAM DESCRIPTION: Residents completed a PM curriculum that integrated SDL, electronic health record (EHR)-driven performance feedback, mentorship, and autonomy to set learning and patient care goals. PROGRAM EVALUATION: Pre/post-curricular surveys assessed EHR tool acceptability, weekly curricular surveys and post-curricular focus groups assessed resident perceptions and goals, and an interrupted time series analysis of care gap closure rates was used to compare the pre-intervention and intervention periods. Majority of residents (28-32 or 80-91%) completed the surveys and focus groups. Residents found the EHR tools acceptable and valued protected time, mentorship, and autonomy to set goals. A total of 13,313 patient visits were analyzed. There were no significant differences between rates between the pre-intervention period and the first intervention period (p=0.44). DISCUSSION: A longitudinal PM curriculum that incorporated SDL and goal setting with EHR-driven performance feedback was well-received by residents, however did not significantly impact the rate of care gap closure.

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Improving Care in a Resident Practice for Patients With Diabetes

Abstract: The interventions resulted in statistically significant improvements in the proportion of patients with diabetes who attained goal for A(1c), LDL, and BP levels. Our redesign elements may be useful in enhancing resident education and in improving patient care.

Cited by 8 publications

References 16 publications

Internal Medicine Resident Experiences With a 5-Month Ambulatory Panel Management Curriculum

Internal Medicine Resident Experiences With a 5-Month Ambulatory Panel Management Curriculum

Management of Point‐of‐Care Testing

A Mixed-Methods Program Evaluation of a Self-directed Learning Panel Management Curriculum in an Internal Medicine Residency Clinic

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