An Active-Learning Quality Improvement Curriculum for Faculty in Hospital Medicine.

INTRODUCTION: Despite the growing importance of quality improvement (QI) training in medical education, there is a lack of faculty with expertise in QI at many academic medical centers. In this report, we describe the design, implementation, and evaluation of a QI training program for faculty in hospital medicine at an academic medical center aimed at increasing faculty capacity in QI. METHODS: With input from an initial focus group of hospital medicine faculty, we developed a 12-session, active-learning curriculum incorporating core concepts in QI applied to a real-life QI problem. We used a survey instrument to assess changes in self-reported confidence, the Quality Improvement Knowledge Application Tool-Revised to assess changes in applied knowledge, and a second focus group to obtain qualitative feedback regarding the curriculum. RESULTS: Self-reported confidence in numerous QI skills increased after completion of the curriculum; however, concurrent improvement in applied knowledge was not observed. Qualitatively, participants not only described improved understanding of QI methodology and greater confidence contributing to QI initiatives but also a sense they were not prepared to lead a QI project independently. DISCUSSION: An active-learning faculty training program is feasible with limited resources and was associated with increased faculty confidence in QI skills.

Partnering With Patients in a Quality Improvement Curriculum for Internal Medicine Residents.

Patient experience is a core component of the Institute for Healthcare Improvement Triple Aim for health care improvement. Although resident physicians must meet quality improvement (QI) competencies prior to graduation, QI training during residency may not adequately prepare residents to improve patient and family experience. We describe an active learning QI curriculum engaging 3 Patient and Family Advisors as partners alongside 15 resident physicians. This partnership proved to be a meaningful experience for both groups, with the development of mutual respect and insight into the contributions that patients and families bring to solving problems in health care quality.

Improving Management of Type 2 Diabetes Mellitus in Hospitalized Adults: A Quality Initiative.

ABSTRACT: The American Diabetes Association recommends scheduled basal and nutritional insulin doses as the preferred treatment for noncritically ill hospitalized patients with type 2 diabetes; however, the adoption of these practices remains suboptimal. We sought to understand current diabetes management practices and improve glycemic control in patients with type 2 diabetes on the Hospital Medicine Services at our academic medical center. We surveyed resident and attending physicians to understand barriers to guideline-based practice. We conducted educational sessions, developed pocket-card decision aids, encouraged discussion on rounds, and provided periodic performance feedback to attending physicians. Results of the barriers survey identified "fear of causing hypoglycemia" as the most common barrier to guideline-based practice. Compared with the preintervention 12-month period, these interventions were associated with doubling of the use of guideline-based insulin therapy regimens, a significant reduction in the rate of severe hyperglycemia days, and a nonsignificant reduction in the rate of hypoglycemia days over a 12-month period. These results demonstrate that a simple, low-cost intervention can be associated with an increase in guideline-concordant insulin ordering with improvement in glycemic outcomes for patients with type 2 diabetes.

"I Think I Was Losing the Forest for the Trees": Evaluation of an Internal Medicine Residency Quality Improvement Curriculum.

INTRODUCTION: Quality improvement (QI) training during residency may not be adequately preparing physicians for achieving Accreditation Council for Graduate Medical Education goals and the Institute for Healthcare Improvement (IHI) Triple Aim. The purpose of this evaluation was to identify residents' perceptions and impact of their QI curriculum. METHODS: We conducted a mixed-methods evaluation of an active-learning QI curriculum for internal medicine residents at one academic medical center. Data from 2017 to 2018 included a focus group, pre-post survey, project data, and curricular materials. Results were categorized using Kirkpatrick's model of evaluation. RESULTS: All second-year internal medicine residents completed the curriculum (N = 14). Residents were satisfied with the structure and perceived accomplishment with the curriculum, however were dissatisfied by the impact of inconsistent attendance due to clinical conflicts. Their confidence in QI increased; however, they reported difficulty retaining knowledge and skills. Survey scores related to usefulness and anticipated application of QI were unchanged from baseline. CONCLUSIONS: This applied QI curriculum appeared to improve short-term learning. However, the curriculum did not promote long-term understanding of QI. Finding ways to promote skills and retention beyond the curriculum requires further study.

Oral inflammatory burden and preterm birth.

BACKGROUND: Earlier studies on the association between oral inflammation and preterm birth limited the inflammation source to periodontal disease. This might have caused an underestimation of the total inflammatory burden from the oral cavity. METHODS: We conducted a postpartum cross-sectional study of 328 Finnish women with singleton births, of whom 77 had preterm births and 251 had full-term births. Gingival bleeding on probing, probing depth, and the presence of dental calculus and mouth ulcers were recorded; the oral inflammatory burden index (OIBI) was constructed based on these clinical findings. A data-driven oral inflammation score (OIS) was also created by stochastically combining the same parameters assessed independently. We used the t, Mann-Whitney, and chi(2) tests for univariate analyses and multivariate logistic regression methods to examine the association between OIBI/OIS and preterm birth. The confounders adjusted for were age, smoking (past, present, and never), diabetes (type 1, type 2, and gestational), primiparity, antimicrobial treatment as a proxy for systemic infection, infertility treatment, and weight gain during pregnancy. RESULTS: OIBI was significantly associated with preterm birth after adjusting for confounding factors (odds ratio [OR], 1.85; 95% confidence interval [CI]: 1.10 to 3.10; P = 0.02). Without adjusting for weight gain, OIS was significantly associated with preterm birth (OR, 1.97; 95% CI: 1.09 to 3.57; P = 0.03); however, this association became non-significant after adding weight gain to the model. CONCLUSION: The combined effects of multiple oral infections were significantly associated with preterm birth.