Our new residents started the Leadership Preventive Medicine Program on June 30th, 2008. The residents will be focusing on learning more about the program goals and beginning small tests of change during our orientation lasting until June 18th. Here is a list of the new group!
Sharon Alroy-Preis - Infectious Disease
Chris Allen - Family Practice
Tracie Caller - Neurology
Erin Meyer - Pathology
Jessica Morgan - Child and Adolescent Psychiatry
Monday, June 30, 2008
Monday, June 16, 2008
followup of June 13th journal club
Great discussion on Friday. Just a few points that came up -
1. We found the OHRP definition rather frustrating - They define "exempt" category: only for de-identified (or publicly available) data that existed before IRB evaluation. If there is prospective collection of data, then it should be classified as “expedited.” This was difficult for us to understand because all quality improvement work necessitates the collection of prospective data. This is the only way to know if a change has made an improvement.
2. When is work considered "research" and when is it considered "quality improvement?" Some of us suggested that this distinction is whether the information learned is considered generalizable (research) or if it is focusing on the process and what we can learn from that (quality improvement)....
3. What would an oversight committee look like? We are not sure. We are looking forward to hearing back from others as they pursue quality improvement at other institutions.
1. We found the OHRP definition rather frustrating - They define "exempt" category: only for de-identified (or publicly available) data that existed before IRB evaluation. If there is prospective collection of data, then it should be classified as “expedited.” This was difficult for us to understand because all quality improvement work necessitates the collection of prospective data. This is the only way to know if a change has made an improvement.
2. When is work considered "research" and when is it considered "quality improvement?" Some of us suggested that this distinction is whether the information learned is considered generalizable (research) or if it is focusing on the process and what we can learn from that (quality improvement)....
3. What would an oversight committee look like? We are not sure. We are looking forward to hearing back from others as they pursue quality improvement at other institutions.
Wednesday, June 11, 2008
Saturday, June 7, 2008
Dartmouth Medical School Graduation
Shown from left to right; Lisa Pastel, Sarah Greer, Beth Prairie, Auden McClure, Mao FontanillaCongratulations to all the residents who received their Masters of Public Health from the Dartmouth Institute for Health Policy and Clinical Practice. They are listed below along with their future plans. Best of luck with your future endeavors.
Kristin Anderson -
Lora Council -
Mao Fontanilla - Mao will be working as Assistant Professor, Section of Infectious Diseases, Departmentof Medicine, at Marshall University in West Virginia.
Sarah Greer - Sarah will resume her Surgery Residency on the Trauma Service.
Hank Kutz - Hank will continue his residency training in the Harvard Plastic Surgery Program.
Kristin Anderson -
Lora Council -
Mao Fontanilla - Mao will be working as Assistant Professor, Section of Infectious Diseases, Departmentof Medicine, at Marshall University in West Virginia.
Sarah Greer - Sarah will resume her Surgery Residency on the Trauma Service.
Hank Kutz - Hank will continue his residency training in the Harvard Plastic Surgery Program.
Auden McClure - Auden will continue to work in General Academic Pediatrics, address obesity, and serve as a coach for the Leadership Preventive Medicine Residency.
Lisa Pastel - Lisa will start work in the Dartmouth-Hitchock General Internal Medicine Clinic as Assistant Professor of Medicine.
Beth Prairie - Beth will be starting a new job as Assistant Professor at University of Pittsburgh, Dept. of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Specialties.
Sally Ward -
Kisha Weiser -
Lisa Pastel - Lisa will start work in the Dartmouth-Hitchock General Internal Medicine Clinic as Assistant Professor of Medicine.
Beth Prairie - Beth will be starting a new job as Assistant Professor at University of Pittsburgh, Dept. of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Specialties.
Sally Ward -
Kisha Weiser -
Friday, June 6, 2008
Journal Club - June 13th
The next Leadership Preventive Medicine Residency Program JOURNAL CLUB is scheduled Friday, June 13, from 12:15 to 1:15 p.m.
The article selected for discussion is : Pronovost P., et al.: An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 355:2725–2732, Dec. 28, 2006. Erratum in: N Engl J Med 356:2660, Jun. 21, 2007."
The article selected for discussion is : Pronovost P., et al.: An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 355:2725–2732, Dec. 28, 2006. Erratum in: N Engl J Med 356:2660, Jun. 21, 2007."
Please consider the following questions:
1. Many of us are going to be going to institutions with less experienced IRBs and less experience in QI work. What regulatory oversight needs to be in place, if any?
2. Collecting data, especially when the data is not flattering poses some medicolegal risk. Of course, not collecting data does not protect either. How might a QI oversight committee provide some medicolegal protection?
3. What would a robust QI oversight committee look like? What would its function be?
Thursday, June 5, 2008
Final Practicum Presentations
The graduating residents have presented their final practicum presentations to the Practicum Review Board (PRB). Brief summaries of their work are listed below (awaiting summaries by residents...)
* Kristin Anderson - the prevention and management of teen pregnancy
* Mao Fontanilla - outpatient management of prosthetic joint infections
* Sarah Greer - improvement of DHMC trauma resuscitation process
* Hank Kutz - prevention of perioperative DVT in surgical patients
* Auden McClure - recognition, prevention, and management of obesity in General Academic Pediatrics at DHMC.
* Lisa Pastel - Lisa's practicum focused on improving the care of the patients with diabetes at Dartmouth-Hitchcock Lyme. The focus of this work was on the completion and documentation of process measures such as foot exams and pneumococcal vaccinations by empowering the LNAs with a flow-sheet tool. Subsequent efforts have focused on hypertension recognition and management.
* Beth Prairie - Beth's practicum in outpatient obstetrics used knowledge of local context and clinical processes to develop iterative interventions to improve the ordering of routine prenatal tests, with a particular focus on HIV screening. During the course of the practicum, prenatal HIV screening rates increased significantly to greater than 92%, with change sustained over 8 months. This represents an improved reliability in routine testing with a method that can be used to increase reliability of additional routine tests.
* Sally Ward - pediatric immunizations in Concord, NH
* Kisha Weiser - Improving adherence to >6 minute colonoscopic withdrawal times in the DHMC Gastroenterology Endoscopic Suite.
* Kristin Anderson - the prevention and management of teen pregnancy
* Mao Fontanilla - outpatient management of prosthetic joint infections
* Sarah Greer - improvement of DHMC trauma resuscitation process
* Hank Kutz - prevention of perioperative DVT in surgical patients
* Auden McClure - recognition, prevention, and management of obesity in General Academic Pediatrics at DHMC.
* Lisa Pastel - Lisa's practicum focused on improving the care of the patients with diabetes at Dartmouth-Hitchcock Lyme. The focus of this work was on the completion and documentation of process measures such as foot exams and pneumococcal vaccinations by empowering the LNAs with a flow-sheet tool. Subsequent efforts have focused on hypertension recognition and management.
* Beth Prairie - Beth's practicum in outpatient obstetrics used knowledge of local context and clinical processes to develop iterative interventions to improve the ordering of routine prenatal tests, with a particular focus on HIV screening. During the course of the practicum, prenatal HIV screening rates increased significantly to greater than 92%, with change sustained over 8 months. This represents an improved reliability in routine testing with a method that can be used to increase reliability of additional routine tests.
* Sally Ward - pediatric immunizations in Concord, NH
* Kisha Weiser - Improving adherence to >6 minute colonoscopic withdrawal times in the DHMC Gastroenterology Endoscopic Suite.
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