Successful Resident Engagement in Quality Improvement: The Detroit Medical Center Story

Hussain, Syed Ahmed; Arsene, Camelia; Hamstra, Corinne; Woehrlen, Tess; Wiese-Rometsch, Wilhelmine; White, Suzanne

doi:10.4300/jgme-d-15-00316.1

Cited by 12 publications

(13 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similar findings regarding incentive use and improved test performance have also been reported among school-going children [29]. In medicine, incentives have been used to improve trainee compliance with patient safety measures [30] and encourage faculty productivity in educational activities [31]. Furthermore, the recently introduced Merit-Based Incentive Payment System rewards U.S. physicians practicing higher-value care with higher fees [32].…”

Section: Discussionmentioning

confidence: 68%

Resident and program characteristics that impact performance on the Ophthalmic Knowledge Assessment Program (OKAP)

Zafar¹,

Wang²,

Srikumaran³

et al. 2019

BMC Med Educ

View full text Add to dashboard Cite

Background To determine which resident and program characteristics correlate with ophthalmic knowledge, as assessed by resident Ophthalmic Knowledge Assessment Program (OKAP) performance. Methods An online survey was sent in June 2017 to all US ophthalmology residents who took the OKAP in April 2017. Results The survey response rate was 13.8% (192/1387 residents). The mean respondent age was 30.4 years, and 57.3% were male. The mean [SD] self-reported 2017 OKAP percentile was 61.9 [26.7]. OKAP performance was found to have a significant positive correlation with greater number of hours spent/week studying for the OKAPs ( p = 0.007), with use of online question banks ( p < 0.001), with review sessions and/or lectures arranged by residency programs ( p < 0.001), and with OKAP-specific didactics ( p = 0.002). On multivariable analysis, factors most predictive of residents scoring ≥75th percentile were, higher step 1 scores (OR = 2.48, [95% CI: 1.68–3.64, p < 0.001]), presence of incentives (OR = 2.75, [95% CI: 1.16–6.56, p = 0.022]), greater number of hours/week spent studying (OR = 1.09, [95% CI:1.01–1.17, p = 0.026]) and fewer hours spent in research 3 months prior to examination (OR = 1.08, [95% CI: 1.01–1.15, p = 0.020]. Lastly, residents less likely to depend on group study sessions as a learning method tended to score higher (OR = 3.40, [95% CI: 1.16–9.94, p = 0.026]). Conclusions Programs wishing to improve resident OKAP scores might consider offering incentives, providing effective access to learning content e.g. online question banks, and adjusting the curriculum to highlight OKAP material. Step 1 scores may help educators identify residents who might be at risk of not performing as well on the OKAP. Electronic supplementary material The online version of this article (10.1186/s12909-019-1637-4) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionmentioning

confidence: 68%

Resident and program characteristics that impact performance on the Ophthalmic Knowledge Assessment Program (OKAP)

Zafar¹,

Wang²,

Srikumaran³

et al. 2019

BMC Med Educ

View full text Add to dashboard Cite

show abstract

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] The median duration of the interventions was 11 months with 7 projects having fewer than 12 months of follow-up, 9 projects having no follow-up beyond 1 year, and only 2 projects having more than 12 months of follow-up. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Sustainability was rarely cited as a clear aim, although multiple studies cite it as a limitation or challenge. [16][17][18] Furthermore, these studies actually may overestimate sustainability of resident QI given publication bias, with sustained interventions being more likely to be published and cited.…”

Section: Discussionmentioning

confidence: 99%

A Discharge Time-Out: A Case Study on Physician–Nurse Discharge Communication and the Challenge of Sustainability in Resident-Led Quality Improvement

et al. 2018

View full text Add to dashboard Cite

Resident-led quality improvement (QI) is an important component of resident education yet sustainability of improvement and impact on resident education have rarely been explored. This study describes a resident-led intervention to improve nursing (RN)–provider (MD) communication at discharge—the Discharge Time-Out (DTO)— and explores its uptake and sustainability. One year later, residents were surveyed regarding QI self-efficacy and planned QI involvement. Baseline verbal RN–MD communication at discharge was rare. During DTO implementation, rates of structured communication averaged 56% (341/608) with several months >70%. During the monitoring phase, this fell to 45% and did not recover (833/1852). Participating residents reported increased QI self-efficacy ( P < .05) and increased likelihood of participating in future QI ( P < .05). The DTO increased RN–MD communication but was not sustained. Resident-led QI should explicitly address sustainability to achieve improvement and educational objectives. To foster resident education and avoid short-lived, low-impact projects, increased attention should be given to sustainability of resident-led QI.

show abstract

“…Similar to questions raised by the UK experiment, with the intervention described by Hussain et al 1 there are issues to be considered on a local level. The achievement gap discussed in this article was extremely narrow, with compliance rates for VTE performance measures increasing from 88.5% at baseline, to 94.2% at 6 months, and an astounding 100% at 12 months.…”

mentioning

confidence: 99%

“…As we now know, the results were astounding, in that the payouts reached 83.4% of available incentive payments within the first year of the program and increased to 97.8% by 2007. 3 Hussain et al 1 have shown that resident behavior can similarly be altered by financial motivations.…”

mentioning

confidence: 99%

“…While we would all like to answer in the negative, previous experience with pharmaceutical influence on providers has shown that we are highly susceptible to commercial influences: what we believe to be true and what we know to be true can be on opposite ends of the spectrum. 6 In summary, Hussain et al 1 should be applauded for their success in integrating the contentiously related concepts of pay-for-performance and quality improvement into the educational schematic of their training programs. If the purpose of this endeavor was to expose trainees to the real world experience of incentivized medicine and to provide contextual relevance to quality improvement as its own discipline, then they have achieved success.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Does Money Really Talk? A Resident-Driven Pay-for-Performance Pilot

Augustine

2016

Journal of Graduate Medical Education

View full text Add to dashboard Cite

Successful Resident Engagement in Quality Improvement: The Detroit Medical Center Story

Abstract: Background In 2014, the Detroit Medical Center launched a new program to engage residents and fellows in a strategy to deliver optimal care within 1 year, focusing on quality at an earlier stage of their careers and preparing them for working posttraining.

Cited by 12 publications

References 9 publications

Resident and program characteristics that impact performance on the Ophthalmic Knowledge Assessment Program (OKAP)

Resident and program characteristics that impact performance on the Ophthalmic Knowledge Assessment Program (OKAP)

A Discharge Time-Out: A Case Study on Physician–Nurse Discharge Communication and the Challenge of Sustainability in Resident-Led Quality Improvement

Does Money Really Talk? A Resident-Driven Pay-for-Performance Pilot

Contact Info

Product

Resources

About