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The Life of a Task Force

From: The Hospitalist, October 2007

SHM’s Performance and Standards unit refines hospital medicine measures

by Jill Epstein, MA

The Performance and Standards Task Force (PSTF) was formed a little more than a year ago after SHM leadership recognized the need for a coordinated approach to working with external organizations in the performance and standards quality arena.

As SHM’s senior adviser for quality standards and compliance, I work with PSTF Chairman Patrick Torcson, MD, (medical director of hospital medicine at the St. Tammany Parish Hospital in Covington, La.) along with senior staff and leadership of the Public Policy Committee (PPC). We monitor the performance and quality landscape at national organizations charged with measuring development and building consensus. We also develop relationships with other professional medical societies and organizations.

Chapters Summary

Chicago

The Chicago Chapter of SHM met June 7. Attendees came from organizations such as Signature Healthcare Solutions, Advocate Healthcare, Northwestern University, and University of Chicago. The meeting began with an update from the SHM national annual meeting given by Chapter President Tarek Karaman, MD, lead hospitalist, Advocate Health Centers, and hospitalist program director, Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago. This was followed by a presentation on DVT/pulmonary embolism prophylaxis and treatment from SHM board member Alpesh Amin, MD, executive director of the hospitalist program and vice chair for clinical affairs and quality in the department of medicine at the University of California, Irvine. For the first time, the chapter had a panel discussion with two primary care physicians from Northwestern University. John Butter, MD, and Sean O’Conner, MD, shared their thoughts regarding the interaction between primary care physicians and hospitalists. Ideas were given on how to strengthen working relationships between the two.

St. Louis

St. LouisSHM’s St. Louis chapter met June 11. Michael Cox, MD, gave a presentation on DVT prevention and treatment followed by a presentation given by SHM CEO Larry Wellikson, MD, on the challenges and opportunities for hospital medicine. The meeting was attended by more than 50 hospitalists from the greater St. Louis area, as well as numerous hospital administrative personnel, vice presidents of medical affairs, and internal medicine residents. The presentation was well received, and numerous individuals spoke with Dr. Wellikson after the presentation. Dr. Wellikson also met with leaders of various hospitalist groups to discuss topics of interest and ways to energize the local chapter. Six hospitalist groups attended. The group discussed challenges in recruitment and in training internists to be true hospitalists.

The task force intends to be at the helm of the development of performance measures that more accurately reflect services provided by hospitalists.

HOSPITALIST MEASURES

Physician Quality Reporting Initiative measures with specifications allowing reporting by hospitalists.

  • ACE inhibitor or angiotensin receptor blocker therapy for left ventricular systolic dysfunction;
  • Oral antiplatelet therapy for patients with coronary artery disease;
  • Beta-blocker for patients with prior myocardial infarction;
  • Beta-blocker at time of arrival for acute myocardial infarction;
  • Stroke and stroke rehabilitation measures, including, deep-vein thrombosis, prophylaxis, discharge on antiplatelet therapy, anticoagulant therapy prescribed for atrial fibrillation at discharge, tissue plasminogen activator considered on arrival, screening for dysphagia, and consideration of rehabilitation services; and
  • Documentation of an advanced care plan.

Since its inception in spring 2006, the PSTF has become engaged in the American Medical Association’s (AMA) Physician Consortium for Performance Improvement (PCPI) and the National Quality Forum (NQF). The NQF is a nonprofit organization instructed by Congress to endorse consensus-based national standards for measurement and public reporting of healthcare performance data. Specifically, NQF aims to influence the development of physician-level performance measures as part of the Centers for Medicare and Medicaid Service’s (CMS) Physician Quality Reporting Initiative (PQRI).

By joining the PCPI, SHM has aligned with other medical specialties to develop performance measures in geriatrics, emergency medicine, outpatient parenteral antimicrobial therapy, and facets of anesthesiology such as perioperative normothermia and critical care.

Additionally, SHM has given feedback during public comment periods on perioperative care, chronic kidney disease, and other measures. The task force continues to evaluate which workgroups it should appoint members to participate in, depending on the topic.

SHM leadership has continued to foster relationships with CMS by sending letters in support of the 2007 PQRI. SHM was able to influence changes to the 2007 measure specifications so hospitalists would have measures to report. Of the 74 measures included in the PQRI, 11 have specifications allowing reporting by hospitalists, underscoring the importance of SHM’s influence and participation in the PCPI process.

Dr. Torcson and Eric Siegal, MD, (regional medical director, Cogent Healthcare, Madison, Wis.) co-chaired a CMS-led SHM member conference call focused on PQRI and how it affects hospitalists. The program was well received by SHM members.

When SHM became a member of the NQF last summer, it nominated several members who were selected to participate on various technical advisory panels overseeing work on the development of consensus standards for hospital care. This project, sponsored by the Agency for Healthcare Research and Quality (AHRQ), is addressing patient safety, pediatrics, and inpatient care.

Last fall, SHM sent Mark Williams, MD (professor of medicine at Emory University School of Medicine in Atlanta and editor of The Journal of Hospital Medicine) to the NQF’s 7th Annual Meeting, a National Policy Conference on Quality. The meeting featured plenary sessions that focused on issues at the forefront of policy discussions, including incentivizing healthcare quality improvement, the role of policymakers, leading professional and trade associations in improving healthcare quality, and efforts under way in the federal government to foster healthcare improvements.

This fall, Greg Seymann, MD, will attend the 8th Annual Meeting. Dr. Seymann is an assistant professor with the Department of Medicine, Hospital Medicine Program, at the University of California San Diego Medical Center.

Goals for 2008, Beyond

By taking an active role in the performance and standard arena, SHM senior staff and leadership have been able to build key relationships. This has paved the way for influencing the current physician reporting program and taking the lead on developing measures that will most reflect hospital medicine in the future.

The task force intends to be at the helm of the development of performance measures that more accurately reflect services provided by hospitalists. Senior staff and leadership have discussed this goal with several national stakeholders including the PCPI and the NQF, whose senior staff have supported its agenda.

In July, SHM, along with the American College of Physicians (ACP), the Society of General Internal Medicine (SGIM), and the American Geriatrics Society (AGS), formed a steering committee to convene a transitions of care consensus conference. This multispecialty, multidisciplinary group reviewed the principles and standards that came from the ABIM Foundation’s Stepping Up to the Plate (SUTTP) Alliance, which met this spring. SHM and PCPI are working to form an expert workgroup that will develop six to eight care transitions measures for inclusion in the 2009 PQRI.

SHM also is exploring collaboration with the American Hospital Association and its Hospital Quality Alliance (HQA), which coordinates the promotion of quality measurement, transparency, and improvement in the hospital setting.

In addition to its work with these external national groups, task force members would also like to start a resource room on the SHM Web site, www.hospitalmedicine.org, which would be devoted to member efforts in research related to quality and performance standards, as well as the member go-to place for tools and references on best practices in performance standards and pay for reporting initiatives.

Finally, Dr. Torcson hopes to shape and disseminate a national research agenda for hospitalist performance measurement and reporting. TH

Hospital Medicine Fast Facts

Night Coverage

To order a full copy of SHM’s “Bi-Annual Survey on the State of the Hospital Medicine Movement,” visit www.hospitalmedicine.org/shmstore.

What type of night coverage do hospital medicine groups provide?
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For programs with on-site coverage, what types of clinicians provide hospitalist services?
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SHM Behind the Scenes

Quality is our Middle Name

By Geri Barnes

The Education and Quality Initiatives Department’s (EQID) mission is to lead and manage an integrative program that brings resources to improve patient care. With the help of many individuals and partner organizations, SHM is working toward improved care for inpatients. Let’s review our progress as we begin the second quarter of SHM’s fiscal year.

Educational Programs

Our focus over the past few months has been the development of “Hospital Medicine 2008,” which will be held April 3-5 in San Diego. Under the leadership of Sylvia McKean, MD, head of the hospitalist service at Brigham and Women’s Hospital and assistant professor of medicine at Harvard Medical School in Boston, the Annual Meeting Committee has developed an innovative program. The session will include a new evidence-based rapid fire track and a new teaching skills pre-course for academic and clinical educators. EQID obtains CMEs, communicates with faculty, and fine-tunes logistical efforts.

Leadership Academy Level I is a mainstay of SHM’s educational efforts. EQID supports Eric Howell, MD, chair of the Leadership Committee, as it focuses on addressing attendee input and encouraging the revision of the program in a continuous quality improvement effort. Dr. Howell is director of the Collaborative Inpatient Medicine Service and director of the Zieve Medical Services for Johns Hopkins Bayview Medical Center in Baltimore.

Along with Level I, Leadership Academy Level II will be presented again this year Nov. 5-8 in San Antonio. It builds on the success of last fall’s first offering by expanding on the concepts presented in the Level I academy.

A new educational initiative, supported by Sanofi-Aventis, provides three training sessions at regional chapters or other designated meetings across the country. The meetings educate hospitalists on best practices for glycemic control, prevention of venous thromboembolism, and transitions of care. Meetings will highlight successful interventions as outlined in the respective quality improvement (QI) implementation guides and resource rooms. Meetings will aim to include 20 to 50 participants.

The last piece of the SHM Heart Failure Quality Improvement Initiative is in its final planning stages, and a third CME module for Team Communications as it relates to the heart failure patient will be developed in the coming months. This initiative is supported in part by Scios Inc. and led by Lakshmi Halasyamani, MD, associate chairperson of the Department of Internal Medicine at St. Joseph Mercy Hospital in Ann Arbor, Mich.

SHM Initiatives

  • An Advisory Board charged primarily with conducting gap analysis to determine strategies for and provide management of initiatives primarily addressing disease states (e.g., heart failure, VTE) or population groups (e.g., geriatrics);
  • A collection of clinical tools (such as standardized order sets, charting tools, guidelines) to support QI implementation and definition of measures, metrics, and related tools for capturing data essential to a specific disease state or population;
  • A Web-based QI resource room that provides easy access to the educational materials and decision support tools endorsed or developed by the Advisory Board. Resource rooms address antimicrobial resistance, glycemic control, heart failure, stroke, care transitions for older adults, and VTE. A resource room is being developed for acute coronary syndrome;
  • Education targeted at hospitalists, including face-to-face instruction through workshops or symposia at annual meetings, as well as interactive Web-based modules such as a video round table discussion (Point/Counterpoint);
  • Outreach to the hospitalist community, to foster use of the resource rooms, educational materials, and decisions tools;
  • A mentored implementation program that uses the resources developed by SHM and others to mentor hospitalists in leading a QI program relative to a specific disease state or condition. The VTE Mentored Implementation Program will roll out over the next two years. Proposals submitted to the John A. Hartford Foundation and Kettering Foundation will expand the program;
  • On-site consultation and technical assistance to institutions working to implement, evaluate, and sustain QI interventions; and
  • Demonstration projects that add examples of hospitalist-led QI efforts to the medical literature, providing the evidence needed to persuade local clinical and administrative leaders to support such programs and motivate individuals to launch local QI programs.

Quality Initiatives

Over the past several years, SHM has developed initiatives that range from convening a panel to assess the state of the art of a QI intervention to developing a Web-based resource room. Projects EQID is involved with:

  • SHM is in the early stages of a three-year effort to develop resources and programs for improving hospital care transitions for older adults. This is supported through a major grant from the John A. Hartford Foundation in New York City, under the leadership of Mark Williams, MD, and Eric Coleman, MD, MPH. Dr. Williams is chief of the new Division of Hospital Medicine at Northwestern Memorial Hospital in Chicago and editor of the Journal of Hospital Medicine. Dr. Coleman is associate professor of medicine within the divisions of healthcare policy and research and geriatric medicine at the University of Colorado Health Sciences Center in Aurora.
  • “The Heart Failure Quality Improvement Implementation Guide” has been updated. The Heart Failure Resource Room on SHM’s Web site has been redesigned to make it easier for visitors who wish to follow the process of developing a QI intervention related to care of the hospitalized heart failure patient. We are communicating these changes to the hospital medicine community. Supported in part by Scios Inc., based in Mountain View, Calif., this effort includes presentations at regional meetings. This project was led by Nurcan Ilksoy, MD, assistant professor of Medicine at Emory University School of Medicine in Atlanta.
  • The VTE Prevention Colla­borative is open to all members implementing a QI program to combat venous thromboembolism in the hospitalized patient. The Sanofi-Aventis-supported collaborative uses seasoned QI leaders as mentors. Greg Maynard, MD, MS, and Jason Stein, MD, lead the enrollees through the QI process. The mentees have the benefit of regularly scheduled calls to ask questions and receive instant feedback on their process and progress. An add-on to this program, funded by the Kettering Foundation of Dayton, Ohio, provides the opportunity for on-site consultations. Dr. Maynard is head of the Division of Hospital Medicine and associate clinical professor of medicine at the University of California-San Diego. Dr. Stein is a hospitalist at Atlanta’s Emory University Hospital, assistant professor of Medicine at Emory University School of Medicine, and director of Quality Improvement for the Emory Hospital Medicine Unit.
  • An expert panel convened in July to kick off development of an Acute Coronary Syndrome Resource Room and determine the content the resource room will cover. Content address diagnosis and risk stratification, medication, interventional procedures, patient education, transitions, and care coordination. This initiative is being led by Chad Whelan, MD, and is supported in part by Bristol-Myers Squibb Company, New York City. Dr. Whelan is an academic hospitalist and an assistant professor of medicine at University of Chicago in the Section of General Internal Medicine.
  • SHM often studies strategies to improve patient satisfaction, outcomes, length of stay, and other important metrics. An expert panel assesses observation units as they contribute to improved treatment of patients with acute decompensated heart failure, chest pain, and other clinical conditions such as asthma. A white paper is pending on the use and value of observation units. Support for the meeting and development and distribution of the white paper was provided by Scios Inc.

Committee Support

A major staff role is the support of the Education and Hospital Quality and Patient Safety (HQPS) committees, the groups that direct and drive SHM in these important areas. The Education Committee, led by Chairman Bill Rifkin, MD, assistant professor of medicine at Yale University School of Medicine in New Haven, Conn., is focusing on:

  • Developing the teaching skills pre-course that will be presented at the 2008 Annual Meeting;
  • Defining a workable strategy to promote The Core Competencies in Hospital Medicine;
  • Developing educational and/or communication modalities that support maintenance of certification; and
  • Further defining the direction of the committee to meet members’ educational needs.

Janet Nagamine, MD, leads the HQPS Committee in the following priorities:

  • Planning and holding a quality summit to define goals and priorities for the next three to five years;
  • Submitting a grant application to AHRQ to support a multidisciplinary conference in the area of medication reconciliation;
  • Developing SHM’s role in care transitions;
  • Reviewing quality pre-course information and determining the curriculum for ‘‘Hospital Medicine 2008”; and
  • Developing the Quality track for ‘‘Hospital Medicine 2008.”

This copy is for your personal, noncommercial use only. No part of this article can be reproduced without the written permission of the publisher. Order presentation-ready copies for distribution to your colleagues, clients, or customers by contacting our reprints department at reprints@wiley.com. Copyright © 2009 Society of Hospital Medicine, administered by John Wiley & Sons Inc.

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