Michelle Johnson
I am a CHA geriatrician that currently practices exclusively in the skilled nursing facilities. I previously worked at Windsor clinic practicing primary care and geriatrics. In April 2019, I took on a new leadership position as the Clinical Quality Coordinator for the Geriatrics Nursing Home Program (NHP). In July 2019, I assumed the position of medical director for one of the skilled nursing facilities (SNF) of our CHA preferred network.
During my geriatric fellowship at Boston Medical Center, I co-led a project aimed to reduce polypharmacy in the geriatric clinic population which first involved surveys of patients and providers followed by an intervention where MA would print med lists, flag patients with 10 or more medications alerting providers to review during visit. I also helped lead a small hypertension project at CHA Windsor Clinic on with providers repeating any abnormal BPs and tracking etiologies of abnormal BP reading (cuff size, timing of it being checked, position). With my new role as leader of Quality Improvement in the NHP, I have been working with Jennifer Thiesen (the co-director of the CHA Population Health Management team), the NHP geriatricians and nurse practitioners, and the CHA preferred SNFs on improving the management of COPD in the post-acute and long term care setting. The COPD project aim is to improve patient care and reduce unnecessary hospital admissions via a multidimensional approach including education for SNF staff and patients/families to identify early signs of a COPD exacerbations, standardized order sets for COPD patients for monitoring of symptoms, and COPD exacerbation protocols for nurses to administer prednisone rescue pack plus antibiotics (if indicated) if the patient meets the specified criteria. Though the results are still preliminary, we have seen multiple potential COPD hospital admissions prevented by the initiation of rescue packs via our protocol in the facilities that have adopted the program.
I hope to lead the NHP in the development of many more projects that prioritize the quality of care of our patients and their experience of their care. I believe this naturally aligns with CHA’s institutional priorities to maintain short SNF length of stay and reduce unnecessary hospital readmissions. My goals are to publish any quality improvement work that we do as more evidence is needed in the care of older adults in the SNF setting as our population becomes more multimorbid and frail. I am seeking mentorship in this work to make these publications robust and extend the reach of this work to other geriatric practices across the country. I feel that my ability to produce and analyze data is limited and I desire to learn more about how to best measure interventions and their applicability. I have reviewed with my supervising chief, Dr.Chao, in my career goals of seeking out mentorship in QI at CHA and believe this fellowship will open these doors including more protected time to be mentored by Dr.Batalden.
We would like to target the management of CHF in the skilled rehab and long term care population next and the project for which I am applying for the CHA GOLD Innovation fellowship.
Click here to learn more about Michelle’s fellowship project.
