Quality Improvement Experience Research Articles

Kindness: Poor cousin or equal kin to Compassion and Empathy in the Healthcare Literature? A Scoping Review

ObjectiveThis scoping review seeks to understand how kindness, compassion and empathy are defined and conceptualised within existing healthcare services literature.IntroductionLittle consensus exists on how healthcare literature defines and conceptualises kindness....

An interprofessional postgraduate quality improvement curriculum: results and lessons learned over a 5-year implementation

ABSTRACT Problem Quality Improvement (QI) is interprofessional by nature; however, most academic QI programs occur in silos and do not leverage the opportunity to bring interprofessional learners together. Intervention To evaluate QI competencies of physician, nursing, pharmacy, behavioral health, and social work residents after participating in a longitudinal QI curriculum. Lessons learned are shared to guide educators in developing QI curriculum for interprofessional learners. Context Cohorts of graduate students over 5 years participated in a QI curriculum that aligned with each professions’ core quality competencies. Residents engaged in didactics and experiential learning in primary care clinics. Impact All learners (N = 74) demonstrated improvement in QI knowledge measured by the QIKAT-R and applied their skills demonstrated by completion of a QI project presented at the Institute for Healthcare Improvement annual forums. Participation in QI curriculum resulted in knowledge and skill improvement. Lessons learned An experiential QI curriculum is a natural place to bring diverse post-graduate learners together to improve QI knowledge and skills. Successful QI curriculum goals are to (a) align projects with institutional and stakeholder goals, (b) include coaches to promote teamwork and project management, (c) narrow project scope, (d) develop an improvement mindset that failures are learning opportunities, and (e) address needs for data access.

Development of a Train-the-Trainer Quality Improvement Curriculum.

Quality improvement (QI) curricula are required for clinical disciplines at all training levels. Despite this, faculty educators often feel inadequately prepared to perform QI functions and thus lack the skills necessary to teach QI to learners. We aimed to improve faculty QI skills so they could oversee didactic curricula and experiential QI projects. We developed a train-the-trainer curriculum for faculty within medicine, nursing, and allied health that was delivered as a 2-hour interactive workshop. Core concepts included QI methodologies, measurement, implementation, and scholarship. Prior to the workshop, attendees completed a baseline knowledge test and a self-assessment of their confidence in teaching QI. Both assessments were repeated 1 month and 6 months postworkshop. Participants also completed a course evaluation. We report on our experience after two workshops with 23 participants total. Baseline median knowledge test percentage correct was 36%. This increased to 77% at 1 month and remained at 57% at 6 months. Self-assessment ratings of QI teaching skills increased consistently from baseline to 1 month to 6 months, with all respondents reporting feeling some confidence or very confident by the end of the study period. The course overall was rated very good or excellent by 91% of attendees. A focused QI train-the-trainer curriculum can sustainably improve faculty knowledge and self-ratings of QI teaching skills. Participants rated the interactive 2-hour workshop highly. Its materials can be easily adapted across disciplines and clinical departments to increase the number of faculty competent to facilitate didactic and experiential QI training.

Optimizing the Team Approach: Designing a Clinical Care Pathway for Functional Neurological Disorder.

Functional neurological disorder (FND) sits at the intersection of neurology and psychology and has a variety of presentations, severity, and symptomatology. It affects a considerable number of pediatric patients and overwhelmingly influences healthcare spending. Diagnosis, treatment, and outcomes are varied, challenging, and lack standardization, often leading to frustration from patients, caregivers, and providers. Multidisciplinary care is essential though communication is often complex and disjunct. Using quality improvement tools and experiences from one institution, a team was established to ameliorate these concerns. A clinical care pathway was designed for the diagnosis and treatment of FND in the pediatric inpatient setting. This pathway was the result of the multidisciplinary team effort and an outcome, highlighting the need for early and intentional diagnosis with diagnosing provider specified, provider education and consistent language, patient and caregiver education, and clear and thorough discharge planning. Through the implementation of this pathway, it is anticipated that patient and provider satisfaction will improve as will the outcomes and care given to affected individuals. This work can be applied to the global treatment of FND and raise awareness to effectively managed care as well as the opportunity for clinicians to drive institutional change.

Research development needs of pharmacists in the North of England: a cross-sectional survey

Abstract Introduction Research drives safe and cost-effective practice, innovation and quality care. The national workforce directive calls for integration of research into healthcare roles1; however, pharmacist research is typically undertaken by a minority of highly motivated individuals2. Inclusion of research learning outcomes in all three Royal Pharmaceutical Society (RPS) curricula make it an essential component of pharmacist practice throughout career development; however, prospective consultant pharmacists may lack confidence in demonstrating capability3. Aim To describe research experience, perceptions of barriers and enablers, and confidence with meeting RPS research learning outcomes in pharmacists across all sectors and stages of career development in the North of England. Methods A cross-sectional survey, designed and piloted using Jisc Online Surveys, was circulated by email to Health Education England (HEE) North School of Pharmacy and Medicines Optimisation (SoPMO)* mailing list subscribers and posted on social media for completion during March 2023. Data were collected on demographics, research qualifications and research experience. Respondents were asked to prioritise barriers and enablers from existing literature according to personal experience. Confidence with meeting research learning outcomes in the Post-registration Foundation, Core Advanced and Consultant Pharmacist curricula was self-assessed using a 5-point Likert scale. Descriptive statistics were performed using Microsoft Excel®. The NHS Health Research Authority tool confirmed ethical approval was not required for this service evaluation. A Data Protection Impact Assessment was completed. *now North West SoPMO and North East and Yorkshire SoPMO, NHS England Workforce Training and Education Results There were 250 responses from pharmacists in all seven North of England Integrated Care Systems. Respondents had been practising for a median of 14 years. 54 (22%) had a postgraduate qualification with a research component and 162 (65%) had experience of research and/or quality improvement. 164 (67%) had no protected time for research and 200 (80%) did not routinely discuss research during annual appraisal. Lack of time within working hours was the most frequently reported ‘top three’ barrier (171, 68%), followed by prioritisation of clinical duties (128, 51%) and lack of knowledge (79, 32%). Key enablers were protected time (158, 63%) and access to mentorship (154, 62%). The proportion who self-assessed as ‘confident’ or ‘really confident’ that they could provide evidence to demonstrate all research learning outcome(s) in each curriculum was 106 (42%) for Post-registration Foundation; 52 (21%) for Core Advanced and 22 (9%) for Consultant Pharmacist. Discussion/Conclusion Despite 85% of respondents practising for 5 years or more, confidence in meeting the most fundamental research learning outcome in the Post-registration Foundation curriculum was low and decreased across the continuum of practice. Barriers and enablers were perceived around capability (knowledge and skills), opportunity (protected time; prioritisation of clinical duties) and motivation (access to mentorship). Limitations include a potential over-estimation of confidence, due to pharmacists with research experience being more likely to complete the survey, and the use of self-reporting, which relies on respondent introspection. Initial Education and Training (IET) reforms will better equip future pharmacists for research; however, coordinated strategies, simultaneously addressing identified barriers, are required to bridge the skill gap for much of the existing workforce.

Implementation strategies for large scale quality improvement initiatives in primary care settings: a qualitative assessment

Background and objectivesThe EvidenceNOW: Advancing Heart Health in Primary Care was designed to assist primary care practices in the US in implementing evidence-based practices in cardiovascular care and building capacity for quality improvement. EvidenceNOW, NCT03054090, was registered with ClinicalTrials.gov on 15/02/2017. The goals of this study were to gain a comprehensive understanding of perspectives from research participants and research team members on the value of implementation strategies and factors that influenced the EvidenceNOW initiative in Virginia.MethodsIn 2018, we conducted 25 focus groups with clinicians and staff at participating practices, including 80 physicians, advanced practice clinicians, practice managers and other practice staff. We also conducted face-to-face and telephone interviews with 22 research team members, including lead investigators, practice facilitators, physician expert consultants, and evaluators. We used the integrated-Promoting Action on Research Implementation in the Health Services (i-PARIHS) framework in our qualitative data analysis and organization of themes.ResultsImplementation strategies valued by both practice representatives and research team members included the kick-off event, on-site practice facilitation, and interaction with physician expert consultants. Remote practice facilitation and web-based tools were used less frequently. Contextual factors that influence quality improvement efforts include leadership support, access to resources, previous quality improvement experience, and practice ownership type (independent compared to health system owned). Many clinicians and staff were overwhelmed by day-to-day activities and experience initiative fatigue, which hindered their ability to fully participate in the EvidenceNOW initiative.ConclusionsThis study provides details on how the practice environment plays an essential role in the implementation of evidence-based practices in primary care. Future efforts to improve quality in primary care practices should consider the context and environment of individual practices, with targeted implementation strategies to meet the needs of independent and health system owned practices. Future efforts to improve quality in primary care practices require strategies to address initiative fatigue among clinicians and practice staff. External support for building capacity for quality improvement could help primary care practices implement and sustain evidence-based practices and improve quality of care.Trial registrationThis project was registered with ClinicalTrials.gov on 15/02/2017 and the identifier is NCT03054090.

QI Connect: Matching researchers to projects.

464 Background: At any given health system, there are often quality improvement (QI) projects without enough manpower to complete the work, and students and trainees who are looking for projects to work on but can’t find any. The question becomes how we connect these two groups in a win-win situation. Many job search websites use a “matching” function in which profiles of applicants are matched with requirements from employers to make connections. Our goal is to apply a similar software/data-basing solution to QI projects in healthcare systems to improve project completion rates, increase QI experience among medical students, residents, and fellows, and improve continuity of projects. Methods: We created a dual facing database, with one branch aimed at collecting projects, and the other side aimed at recruiting trainees/students. Faculty or QI departments approach the project side and are asked to provide the following types of data about their QI project: field, clinical vs basic, onsite vs virtual, role of the trainee, timing (business hours or flexible), IRB approval, description, and main point of contact. Trainees who are interested in matching a project, fill out a set of profile questions that mirror the project parameters. Trainees and projects are matched in an algorithmic order based on prioritization we have selected in discussion with faculty and student interests. One key is that the project point of contact is NOT made available until after a successful “match” to avoid “carpet bomb” emailing of faculty members. In order to fill the database we have networked with physicians, department chairs, interest group listservs, and chief residents across our hospital and medical school. Results: In our first year’s pilot run we collected 17 projects, and had profound student interest with 70 profiles filled. We limited the number of matched projects to just 5 that best fit, and received positive feedback from students and mentors. Since then we have grown the database to 47 projects and 153 students/trainee profiles. These initial promising results have also prompted the creation of a new elected position in the medical school for two Research VP’s in each class. Conclusions: We have built a clear proof of concept that virtual match making for QI projects can close the gap between unfilled projects, and trainees seeking opportunities. Although the metrics suggest that trainees seeking research are far outpacing available projects, we believe that far more projects currently exists, and a major area of improvement will be to continue to bring visibility to the database. Nonetheless without acquiring any additional funding or manpower, we are able to increase the scholarly profiles of trainees, and overall QI productive output at our institution.

Sustaining extended Kangaroo mother care in stable low birthweight babies in NICU: a quality improvement collaborative of six centres of Karnataka

BackgroundKangaroo mother care (KMC) is a proven intervention for intact survival in preterms. Despite evidence, its adoption has been low. We used a point of care quality improvement (QI) approach...

A theoretical and practical approach to quality improvement education

Quality Improvement (QI) knowledge and skills are required at all levels of physician training. System improvement efforts need to include understanding of health disparities and design of interventions to reduce those disparities, thus health equity needs to be integrated into QI education. Payors, accreditation bodies and health systems’ emphases on QI result in the need for QI curricula that meet the needs of diverse learners. This article presents a theoretical background and practical tools for designing, implementing, and evaluating a QI educational program across the spectrum of physician training with an emphasis on competency-based education and a goal of continuous practice improvement. Practice-based learning and improvement and systems-based practice are two core domains of competencies for readiness to practice. These competencies can be met through the health systems science framework for studying improvement in patient care and health care delivery coupled with QI science. Curricula should incorporate interactive learning of theory and principles of QI as well as mentored, experiential QI project work with multidisciplinary teams. QI projects often develop ideas and implement changes but are often inconsistent in studying intervention impacts or reaching the level of patient outcomes. Curriculum design should incorporate adult learning principles, competency based medical education, environmental and audience factors, and formats for content delivery. Key QI topics and how they fit into the clinical environment and teaching resources are provided, as well as options for faculty development. Approaches to evaluation are presented, along with tools for assessing learner's beliefs and attitudes, knowledge and application of QI principles, project evaluation, competency and curriculum evaluation. If the goal is to empower the next generation of change agents, there remains a need for development of scientific methodology and scholarly work, as well as faculty development and support by institutions.

Impact of hospital characteristics on implementation of a Pediatric Early Warning System in resource-limited cancer hospitals.

Pediatric Early Warning Systems (PEWS) aid in identification of deterioration in hospitalized children with cancer but are underutilized in resource-limited settings. Proyecto EVAT is a multicenter quality improvement (QI) collaborative in Latin America to implement PEWS. This study investigates the relationship between hospital characteristics and time required for PEWS implementation. This convergent mixed-methods study included 23 Proyecto EVAT childhood cancer centers; 5 hospitals representing quick and slow implementers were selected for qualitative analysis. Semi-structured interviews were conducted with 71 stakeholders involved in PEWS implementation. Interviews were recorded, transcribed and translated to English, then coded using a priori and novel codes. Thematic content analysis explored the impact of hospital characteristics and QI experience on time required for PEWS implementation and was supplemented by quantitative analysis exploring the relationship between hospital characteristics and implementation time. In both quantitative and qualitative analysis, material and human resources to support PEWS significantly impacted time to implementation. Lack of resources produced various obstacles that extended time necessary for centers to achieve successful implementation. Hospital characteristics, such as funding structure and type, influenced PEWS implementation time by determining their resource-availability. Prior hospital or implementation leader experience with QI, however, helped facilitate implementation by assisting implementers predict and overcome resource-related challenges. Hospital characteristics impact time required to implement PEWS in resource-limited childhood cancer centers; however, prior QI experience helps anticipate and adapt to resource challenges and more quickly implement PEWS. QI training should be a component of strategies to scale-up use of evidence-based interventions like PEWS in resource-limited settings.

Understanding the State of Quality Improvement Education for Pediatric Infectious Diseases Trainees.

To the editor, Quality Improvement (QI) training and experience are mandated by the Accreditation Council for Graduate Medical Education for all physician trainees [1], but descriptions of QI training programs for subspecialty fellows are limited [2]. While relevant for all specialties, these skills are particularly useful in infectious diseases. For example, the Infectious Diseases Society of America (IDSA) emphasizes QI concepts such as process and outcome measures in antimicrobial stewardship [3]. To our knowledge, no publications describe the current state of QI education for pediatric infectious disease (PID) trainees. To better understand the current landscape and gauge interest in a potential QI training curriculum that could be offered through the Pediatric Infectious Diseases Society (PIDS), we surveyed PID program directors (PDs) in November 2022 through the official PIDS listserv. Question domains included high-level program demographics, local QI training opportunities, expectations around QI work products, and interest in a national curriculum. The survey was built in a secure REDCap (Research Electronic Data Capture, Vanderbilt, TN) [4] database. No identifying information was captured. This study was deemed exempt from full review by our local Institutional Review Board.

Development of the Illinois Surgical Quality Improvement Collaborative (ISQIC): Implementing 21 Components to Catalyze Statewide Improvement in Surgical Care.

In 2014, 56 Illinois hospitals came together to form a unique learning collaborative, the Illinois Surgical Quality Improvement Collaborative (ISQIC). Our objectives are to provide an overview of the first three years of ISQIC focused on (1) how the collaborative was formed and funded, (2) the 21 strategies implemented to support quality improvement (QI), (3) collaborative sustainment, and (4) how the collaborative acts as a platform for innovative QI research. ISQIC includes 21 components to facilitate QI that target the hospital, the surgical QI team, and the peri-operative microsystem. The components were developed from available evidence, a detailed needs assessment of the hospitals, reviewing experiences from prior surgical and non-surgical QI Collaboratives, and interviews with QI experts. The components comprise 5 domains: guided implementation (e.g., mentors, coaches, statewide QI projects), education (e.g., process improvement (PI) curriculum), hospital- and surgeon-level comparative performance reports (e.g., process, outcomes, costs), networking (e.g., forums to share QI experiences and best practices), and funding (e.g., for the overall program, pilot grants, and bonus payments for improvement). Through implementation of the 21 novel ISQIC components, hospitals were equipped to use their data to successfully implement QI initiatives and improve care. Formal (QI/PI) training, mentoring, and coaching were undertaken by the hospitals as they worked to implement solutions. Hospitals received funding for the program and were able to work together on statewide quality initiatives. Lessons learned at one hospital were shared with all participating hospitals through conferences, webinars, and toolkits to facilitate learning from each other with a common goal of making care better and safer for the surgical patient in Illinois. Over the first three years, surgical outcomes improved in Illinois. The first three years of ISQIC improved care for surgical patients across Illinois and allowed hospitals to see the value of participating in a surgical QI learning collaborative without having to make the initial financial investment themselves. Given the strong support and buy-in from the hospitals, ISQIC has continued beyond the initial three years and continues to support QI across Illinois hospitals.

A narrative inquiry into healthcare staff resilience and the sustainability of Quality Improvement implementation efforts during Covid-19

BackgroundRecent research, which explored the use of Quality Improvement (QI) methods in the Covid-19 pandemic response, found that Quality Improvement principles were utilised during the crisis management period, albeit without direct intention. Following on from this work, the aim of this paper extends that study by investigating the sustainability and resilience of not only the changes implemented by healthcare staff during Covid-19 in Ireland, but the resilience of the wellbeing of healthcare staff themselves through the various waves of Covid-19.MethodsTo explore healthcare staffs experience of Quality Improvement and the sustainability and resilience of both Quality Improvement initiatives and healthcare staff, a qualitative design was implemented. Semi-structured interviews took place online over Zoom with 11 healthcare staff members from the Irish healthcare service in the Spring of 2022. An analysis of the narratives was conducted using thematic analysis supported by NVivo12.ResultsFour key themes were evident from the data: (i) From fear to exhaustion; (ii) maintaining person-centred approaches to care; (iii) Covid-19 as a medium for change, and; (iv) staff resilience and appetite for Quality Improvement.DiscussionThe results of this work identified three key learnings; (i) integrating learning into policies and practice: (ii) the role of collective leadership and devolving/sharing power; and (iii) key drivers/factors that promote sustainability of QI interventions. Despite the challenges in recruitment of research participants experienced during the pandemic, a narrative approach supported the collation of rich and nuanced insights into the experiences of healthcare staff during this time.ConclusionA growing body of literature currently exists on how healthcare staff felt during the Covid-19 pandemic. However, as the waves of Covid-19 have declined, it is vital to examine how the feelings of burnout and disillusionment will affect engagement with Quality Improvement in the future. It is also worth noting and examining the feeling of purpose and pride participants expressed from working through the Covid-19 pandemic. This study has helped to address this gap.

171 - Sustained reduction in cardiac arrest events in a cardiac intensive care unit: a single center quality improvement experience

171 - Sustained reduction in cardiac arrest events in a cardiac intensive care unit: a single center quality improvement experience

Factors That Affect Opioid Quality Improvement Initiatives in Primary Care: Insights from Ten Health Systems.

To improve patient safety and pain management, the Centers for Disease Control and Prevention (CDC) released the Guideline for Prescribing Opioids for Chronic Pain (CDC Guideline). Recognizing that issuing a guideline alone is insufficient for transforming practice, CDC supported an Opioid Quality Improvement (QI) Collaborative, consisting of 10 health care systems that represented more than 120 practices across the United States. The research team identified factors related to implementation success using domains described by the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) implementation science framework. Data from interviews, notes from check-in calls, and documents provided by systems were used. The researchers collected data throughout the project through interviews, meeting notes, and documents. The iPARIHS framework was used to identify factors that affected implementation related to the context, innovation (implementing recommendations from the CDC Guideline), recipient (clinicians), and facilitation (QI team). Contextual characteristics were at the clinic, health system, and broader external context, including staffing and leadership support, previous QI experience, and state laws. Characteristics of the innovation were its adaptability and challenges operationalizing the measures. Recipient characteristics included belief in the importance of the innovation but challenges engaging in the initiative. Finally, facilitation characteristics driving differential outcomes included staffing and available time of the QI team, the ability to make changes, and experience with QI. As health care systems continue to implement the CDC Guideline, these insights can advance successful implementation efforts by describing common implementation challenges and identifying strategies to prepare for and overcome them.

Top Ten Tips Palliative Care Clinicians Should Know About Leveraging the Electronic Health Record for Data Collection and Quality Improvement.

As palliative care (PC) programs rapidly grow and expand across settings, the need to measure, improve, and standardize high-quality PC has also grown. The electronic health record (EHR) is a key component of these efforts as a central hub of care delivery and a repository of patient and system data. Deliberate efforts to leverage the EHR for PC quality improvement (QI) can help PC programs and health systems improve care for patients with serious illnesses. This article, written by clinicians with experience in QI, informatics, and clinical program development, provides practical tips and guidance on EHR strategies and tools for QI and quality measurement.

A Scoring Rubric for the Knowledge Section of the Systems Quality Improvement Training and Assessment Tool.

Quality improvement (QI) competencies for health professions trainees were developed to address health care quality. Strategies to integrate QI into curricula exist, but methods for assessing interdisciplinary learners' competency are less developed. We refined the Knowledge section scoring rubric of the Systems Quality Improvement Training and Assessment Tool (SQI TAT) and examined its validity evidence. In 2017, the SQI TAT Knowledge section was expanded to cover seven core QI concepts, and the scoring rubric was refined. Three coders independently scored 35 SQI TAT Knowledge sections (18 pretests, 17 posttests). Interrater reliability was assessed by percent agreement and Cohen's kappa for individual variables and by Lin's concordance correlation for total scores for knowledge and application. Concurrent validity was assessed by comparing responses from two groups with different QI exposure and evaluating whether differences in exposure were measured. Total-score interrater reliability average measures of concordance were .89 for all coders and >.70 for six of seven concept scores. The total score discriminated the two groups (p <. 05), and five of seven concept scores were higher for the group with more QI experience. Total scores were significantly higher posttest than pretest (p < .001), with improvement in posttest knowledge scores. The SQI TAT Knowledge section provides a comprehensive assessment of QI knowledge. The scoring rubric was able to discriminate QI knowledge along a continuum. The SQI TAT Knowledge section is not linked to a clinical context, making it useful for assessing interprofessional learners and varying education levels.

Baseline Quality Improvement Capacity of 33 Endocrinology Centers Participating in the T1D Exchange Quality Improvement Collaborative.

This article describes the evolution of the Type 1 Diabetes Exchange Quality Improvement Collaborative (T1DX-QI) and provides insight into the development and growth of a successful type 1 diabetes quality improvement (QI) program. Since its inception 8 years ago, the collaborative has expanded to include centers across the United States with varying levels of QI experience, while simultaneously achieving many tangible improvements in type 1 diabetes care. These successes underscore the importance of learning health systems, data-sharing, benchmarking, and peer collaboration as drivers for continuous QI. Future efforts will include recruiting additional small- to medium-sized centers focused on adult care and underserved communities to further the goal of improving care and outcomes for all people living with type 1 diabetes.

Implementation of a longitudinal quality improvement curriculum for hematology/oncology fellows.

315 Background: Quality improvement (QI) is an integral part of healthcare systems and an essential skill for trainees to develop. Education and engagement in QI activities is an ACGME core competency for GME trainees regardless of program or post-graduate year (PGY). There are many ways in which these competencies may be fulfilled and often vary widely between programs and institutions. Here we present the implementation of a longitudinal QI curriculum for hematology/oncology fellows at our institution. Methods: In July 2020 we implemented a 3-year longitudinal QI curriculum to meet criteria set forth by ACGME regarding QI training to improve fellow engagement in QI activities. The curriculum consists of 3 components: 1) introductory lectures on QI concepts and methodology including PDSA cycle and Lean Six Sigma, 2) monthly morbidity &amp; mortality conferences utilizing root cause analysis to identify opportunities for improvement, and 3) fellow-initiated QI projects with regular feedback sessions. Fellows are encouraged to participate in ASCO’s Quality Training Program (QTP) for further project development. A senior QI fellow is appointed to organize didactics and oversee project development. Milestones are set per training year. PGY1 fellows participate in didactics and feedback sessions to gain understanding of QI methodology and application to ongoing and future projects. PGY2 fellows develop and implement a project utilizing core QI principles. PGY3 fellows complete their longitudinal QI project, culminating in presentation and conference submission. At the conclusion of the curriculum, fellows are expected to achieve competency in 1) identifying clinical and institutional opportunities for QI, 2) understanding and applying QI concepts and methodology to project development, and 3) designing and implementing a QI project utilizing core concepts and methodology. Pre- and post-curriculum self-assessments will be used to evaluate knowledge of QI principles. Results: Since implementation fellows have actively participated in all components of the QI curriculum resulting in improved fellow satisfaction in QI education and engagement. Four fellow-initiated QI projects have been developed, resulting in 1 participation in ASCO QTP, 3 presentations at departmental grand rounds, and 3 abstract presentations at national meetings including ASH Annual Meeting, ASCO Annual Meeting, and ASCO Quality Symposium. Two projects have been completed, leading to interventions that have been implemented into routine practice at our institution. Conclusions: Implementation of a longitudinal QI curriculum at our institution has resulted in improved fellow experience in QI and successful implementation and presentation of QI projects at both the local and national levels. This curriculum has been well received by both fellows and faculty and has led to improved engagement in QI education and practices.

Augmented Intelligence to Identify Patients With Advanced Heart Failure in an Integrated Health System

BackgroundTimely referral for specialist evaluation in patients with advanced heart failure (HF) is a Class 1 recommendation. However, the transition from stage C HF to advanced or stage D HF often goes undetected in routine care, resulting in delayed referral and higher mortality rates. ObjectivesThe authors sought to develop an augmented intelligence-enabled workflow using machine learning to identify patients with stage D HF and streamline referral. MethodsWe extracted data on HF patients with encounters from January 1, 2007, to November 30, 2020, from a HF registry within a regional, integrated health system. We created an ensemble machine learning model to predict stage C or stage D HF and integrated the results within the electronic health record. ResultsIn a retrospective data set of 14,846 patients, the model had a good positive predictive value (60%) and low sensitivity (25%) for identifying stage D HF in a 100-person, physician-reviewed, holdout test set. During prospective implementation of the workflow from April 1, 2021, to February 15, 2022, 416 patients were reviewed by a clinical coordinator, with agreement between the model and the coordinator in 50.3% of stage D predictions. Twenty-four patients have been scheduled for evaluation in a HF clinic, 4 patients started an evaluation for advanced therapies, and 1 patient received a left ventricular assist device. ConclusionsAn augmented intelligence-enabled workflow was integrated into clinical operations to identify patients with advanced HF. Endeavors such as this require a multidisciplinary team with experience in design thinking, informatics, quality improvement, operations, and health information technology, as well as dedicated resources to monitor and improve performance over time.