Quality Improvement Track

Director: Joyce Yang Koh, MD

While physicians typically treat individual patients, they also have a greater professional responsibility to improve systems of care. This concept has been affirmed by the American Board of Medical Specialties and the Institute of Medicine and is a required component for maintaining Board Certification. Quality Improvement is a systematic, data-guided methodology designed to bring about immediate, positive changes in the delivery of health care. Using quality improvement science and tools, physicians can play an active role in reducing medical errors, improving efficiency, and optimizing healthcare delivery.

Goals

  • To understand quality improvement theory and principles
  • To learn skills and knowledge for planning and implementing a successful longitudinal quality improvement project.
  • To be able to apply basic biostatistical methods, use run charts and control charts for analysis of quality data
  • To be able to critically assess the healthcare system/model of care and understand how changes to any process impact the whole system.

Curriculum

In addition to the core IMPACT curriculum, the Quality Improvement Track includes:

  • Core quality and patient safety didactics and skills sessions
  • Training in models of change, team building, and leadership skills
  • A longitudinal project focused on quality improvement, which can be focused on any clinical area of interest.
    • Trainees will have a faculty mentor with clinical expertise related to their quality improvement project, as well as mentorship from the QI track director.
  • Optional participation in hospital quality improvement committees and projects
  • Optional development or revision of a multidisciplinary clinical practice guideline

Recent Projects

Decreasing health care disparities through improved medication history accuracy and timeliness

Patients admitted to CHLA are given the opportunity to complete a patient experience survey, which includes a question about whether they were asked on the first day of their stay to list or review all medications, vitamins, and supplements being taken at home. The survey’s results indicate there is room for improvement to ensure all patients are asked this question, particularly those from Spanish-speaking families.

This IMPACT project aims to minimize health care disparities as they relate to the timeliness and quality of gathering a patient’s medical history upon admission to CHLA. Our goal is to improve the overall accuracy and completeness of a patient’s medication history, with the hope that it will lead to decreased errors and more equitable health care delivery.

Increasing HEADSS assessments at CHLA

HEADSS (Home, Education, Activities, Drugs, Sex, Suicide) is a confidential screening tool used in adolescent patients to evaluate risk factors such as domestic violence, depression/suicide, sexually transmitted infections, and drug use. Although organizations such as the American Academy of Pediatrics advocate using tools such as HEADSS, as many as 80% of health care encounters do not include such counseling or screening.

In a recent study evaluating the effectiveness of giving HPV vaccines in the inpatient setting at CHLA, only about 51% of adolescents had a HEADSS exam documented by pediatric residents. This IMPACT project analyzes the factors associated with HEADSS assessment completion. It aims to determine if various interventions, such as an automated pop-up in a patient’s electronic medical record or additional conference-time teaching, will increase HEADSS documentation.