Quality And Safety Implications Of Emergency Department Information Systems
ehr; Emergency Medicine; errors; health-care; implementation; provider order entry; randomized controlled-trial; technology; unintended consequences
Farley H L; Baumlin K M; Hamedani A G; Cheung D S; Edwards M R; Fuller D C; Genes N; Griffey R T; Kelly J J; McClay J C; Nielson J; Phelan M P; Shapiro J S; Stone-Griffith S; Pines J M
Annals of Emergency Medicine
2013
2013-10
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.annemergmed.2013.05.019" target="_blank" rel="noreferrer noopener">10.1016/j.annemergmed.2013.05.019</a>
Playing With Curricular Milestones in the Educational Sandbox: Q-sort Results From an Internal Medicine Educational Collaborative
competence; Health Care Sciences & Services; Education & Educational Research; health-care; accreditation system; q-methodology
Purpose In competency-based medical education, the focus of assessment is on learner demonstration of predefined outcomes or competencies. One strategy being used in internal medicine (IM) is applying curricular milestones to assessment and reporting milestones to competence determination. The authors report a practical method for identifying sets of curricular milestones for assessment of a landmark, or a point where a resident can be entrusted with increased responsibility. Method Thirteen IM residency programs joined in an educational collaborative to apply curricular milestones to training. The authors developed a game using Q-sort methodology to identify high-priority milestones for the landmark Ready for indirect supervision in essential ambulatory care (EsAMB). During May to December 2010, the programs'ambulatory faculty participated in the Q-sort game to prioritize 22 milestones for EsAMB. The authors analyzed the data to identify the top 8 milestones. Results In total, 149 faculty units (1-4 faculty each) participated. There was strong agreement on the top eight milestones; six had more than 92% agreement across programs, and five had 75% agreement across all faculty units. During the Q-sort game, faculty engaged in dynamic discussion about milestones and expressed interest in applying the game to other milestones and educational settings. Conclusions The Q-sort game enabled diverse programs to prioritize curricular milestones with interprogram and interparticipant consistency. A Q-sort exercise is an engaging and playful way to address milestones in medical education and may provide a practical first step toward using milestones in the real-world educational setting.
Meade L B; Caverzagie K J; Swing S R; Jones R R; O'Malley C W; Yamazaki K; Zaas A K
Academic Medicine
2013
2013-08
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1097/ACM.0b013e31829a3967" target="_blank" rel="noreferrer noopener">10.1097/ACM.0b013e31829a3967</a>
A practice change model for quality improvement in primary care practice
Health Care Sciences & Services; behavior; physicians; health-care; rates; impact; sites; policy; clinical-practice; preventive service delivery
Faced with a rapidly changing healthcare environment, primary care practices often have to change how they practice medicine. Yet change is difficult, and the process by which practice improvement can be understood and facilitated has not been well elucidated. Therefore, we developed a model of practice change using data from a quality improvement intervention that was successful in creating a sustainable practice improvement. A multidisciplinary team evaluated data from the Study To Enhance Prevention by Understanding Practice (STEP-UP), a randomized clinical trial conducted to improve the delivery of evidence-based preventive services in 79 northeastern Ohio practices. The team conducted comparative case-study analyses of high- and low-improvement practices to identify variables that are critical to the change process and to create a conceptual model for the change. The model depicts the critical elements for understanding and guiding practice change and emphasizes the importance of these elements' evolving interrelationships. These elements are (1) motivation of key stakeholders to achieve the target for change; (2) instrumental, personal, and interactive resources for change; (3) motivators outside the practice, including the larger healthcare environment and community; and (4) opportunities for change-that is, how key stakeholders understand the change options. Change is influenced by the complex interaction of factors inside and outside the practice. Interventions that are based on understanding the four key elements and their interrelationships can yield sustainable quality improvements in primary care practice.
Cohen D; McDaniel R R; Crabtree B F; Ruhe M C; Weyer S M; Tallia A; Miller W L; Goodwin M A; Nutting P; Solberg L I; Zyzanski S J; Jaen C R; Gilchrist V; Stange K C
Journal of Healthcare Management
2004
2004-05
Journal Article or Conference Abstract Publication
n/a
Dermatoepidemiology
evidence-based medicine; Dermatology; Dermatology; health-care; clinical-trials; malignancy; malignant-melanoma; randomized controlled-trials; internal; skin-cancer; consort statement; cutaneous; disseminating systematic reviews; evidence-based
Barzilai D A; Freiman A; Dellavalle R P; Weinstock M A; Mostow E N
Journal of the American Academy of Dermatology
2005
2005-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.jaad.2004.09.019" target="_blank" rel="noreferrer noopener">10.1016/j.jaad.2004.09.019</a>