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The Changing Face of Quality Improvement

Saint Joseph’s funds its QI efforts from its operating budget. Researchers also are in discussions with the hospital’s development office about possible donor funding. “There may be people who are interested in leaving as their legacy improvements in care, rather than having their name on a building,” Dr. Halasyamani says.

Partnerships with academic medical centers may advance quality improvement, says David Meltzer, MD, PhD, associate professor and chief of hospital medicine at the University of Chicago Pritzker School of Medicine. He also is director of the program on outcomes research training and chair of SHM’s research committee. “Community hospitals could share their data with academic medical centers to look at quality measurers across multiple settings,” he suggests.

SHM’s research committee is working on strategies to develop networks of institutions, starting with academic medical centers and then broadening to community hospitals, Dr. Meltzer says. The goal is collaborative research. It’s a win-win for both settings. “Academics would like data on patients in community hospitals and community hospitals would like resources to do research,” says Dr. Epstein, who founded KRE Consulting, LLC.

Some institutions are receiving funding for just this purpose. The medical school at the University of Chicago Medical, for example, received a grant from the Agency for Healthcare Research and Quality to help community hospitals develop quality improvement teams. The funds will pay for hospitalists from across the country to visit the school for a summer program in outcomes research. The hospitalists will then return to their institutions to begin QI research.

Calls for Training

Initiatives, such as the summer program at the University of Chicago, are just one aspect of the education necessary to move QI forward. Some hospitalists also see a need for increased training during residency. Dr. Stein, of Emory, is working with other academics to create a core competency in QI research for hospitalists, looking at systems issues and quality tools. “Hospitalists have to feel like they have the expertise in QI research if they are to respond to the increased QI demands,” he says.

There are several programs dedicated to making that happen. The Robert Wood Johnson Clinical Scholars Program at the University of Chicago trains physicians on health policy and outcomes research, preparing them for academic careers. Dr. Meltzer thinks a similar program could be designed for community-based hospitalists who want to conduct quality improvement research.

Intermountain Healthcare in Salt Lake City, Utah, also offers training in QI research for practicing hospitalists that “jams a lot into 12- and 20-day programs,” according to Dr. Stein.

Hospitalists have to be willing to invest in themselves to get additional training in QI research, Dr. Meltzer says. Taking a job at a lower salary in exchange for time off for QI training, or paying for their own training, will lead to advancement opportunities in the future, he says.

For patients, the QI work done by hospitalists already is paying off by raising expectations about the quality of care, Dr. Epstein says. “When hospitalists are involved with a hospital to improve the system of care, it raises the bar for all patients, whether or not they are cared for by hospitalists.” TH

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