CEO: Appropriately use systems resources and assist patients in accessing health care that is safe, effective, patient-centered, timely, efficient and equitable.
As part of the LSI curriculum 3rd and 4th year students consider problems or potential for improvement within the healthcare system and develop a quality improvement. As part of the Primary Care Track program my project was developed for the Rardin Family Practice Clinic. Working with faculty and residents at the clinic we were able to identify hypertension control as a modifiable problem. This project focused on using system resources, considering quality improvement techniques and also interpersonal communication. Our project focused on promoting self-measured blood pressure monitoring for patients with hypertension to help increase the control rates. To improve the control rates for patients the area of intervention was with medical assistants who measure patient blood pressure during their visit. As part of the intervention we created a pre-test and post-test for the medical assistants as well as imaging in the room to remind them to encourage patients to utilize SMBP. The greatest success was the positive relationship with the clinic staff and the project. There was a great willingness from the clinic to allow us to implement our project and make an impact on clinic flow. In terms of barriers the greatest barrier to the project implementation has been the impact of the intervention on the clinic work flow. By adding another element to the medical assistant rooming process, we added time to the patient visit, and increased the time from patient arrival to being seen by the physician. Overall our AHSS project was successful. We were able to submit an abstract of the project to STFM for presentation at the upcoming conference in May.
Photo below of Process Map for the project AHSS : A Multidisciplinary Approach to Improving Blood Pressure Control in the Ambulatory Setting
Photo below shows the abstract of this project which was accepted to the STFM conference this May:
In addition to developing quality improvement, I was also able to engage in individual quality improvement through patient education and health promotion about health resources. I completed one month of ambulatory Pediatric ambulatory during 3rd year at the Northland Pediatric Primary Care. During this rotation I had the most opportunity to engage in teaching with families as well as working with other health care professionals. I enjoyed the outpatient setting and the variety in acuity of patients that we took care of. In addition to being able to diagnose and treat patients, every day there was an opportunity to engage in health education. This is meaningful to me because it allowed me to refresh my knowledge so that I would be able to present it in a manner that was understandable to patients and families. Additionally, through my pediatric ambulatory rotation I was able to utilize my previous graduate training in health education and health promotion. Unlike the family medicine clinic where I focused mostly on helping adults to change behaviors (e.g. smoking cessation) in the pediatric clinic the focus tended to be on developing positive health habits. With infants the focus was on educating parents about safety inside and outside the home. Inside the home the focus was on proper sleeping habits to avoid SIDS, and outside the home the focus was on proper car safety. I enjoyed reviewing these concepts with families and answering questions, as I think this helped me to review and gain better knowledge of the concepts. In addition to engaging in teaching, I learned quite a bit during my rotation about the role of social workers in pediatrics and resources available to families. We had various encounters in the clinic in which patients needed social support, and it was beneficial to see how the social worker was able to close the gap in care. I would not have known of various counseling and support agencies that will work with families in-home and even at school.
Evaluation from my pediatric ambulatory rotation:
As I have reflected on system-based practice I have appreciated how the work of medicine happens both inside and outside the clinical setting. That means that when considering quality improvement we have to think of systems beyond our healthcare and consider how transportation or food systems can impact a patients health. I have also reflected on the benefit of quality improvement projects on patients access and utility of the healthcare systems. These projects may range from individual patient intervention to wider systems based interventions. As a resident I will continue to be engaged with quality improvement efforts to improve efficiency, patient care and safety.