Engaging our trainees in research and systems improvement and educational innovation at CHA

The Center for Professional and Academic Development seeks to nurture a learning community at CHA and works to link opportunities for personal and professional growth with institutional aims. 

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Evaluating  Pain/Addiction Curriculum for Family Medicine Residents

Project leader: Randi Sokol, Family Medicine

Project: Over the past 3 years, our Family Medicine residency program has implemented a robust pain and addictions curriculum for our residents. We'd like to formally evaluate it to publish resident feedback/evaluations to make suggestions and share best practices for other programs across the country looking to implement a pain/addictions curriculum.

Opportunities for collaboration with learners: I am looking for learners to help with data collection (survey design and administration and possibly interviews with residents) to understand the value of the curriculum and areas of growth. Learners could also participate in helping write a paper for publication, if they are interested.

How likely is it that the project will offer trainees opportunities for publication and/or presentation external to CHA? Highly likely


 

Tobacco Cessation

Project leader: Adrianne Frankel, Quality Management

Project: This is an on going improvement effort, but it is being re-booted due to recent low performance.

Opportunities for collaboration with learners: This opportunity requires Healthcare Quality Leadership skills, peer education, and collaboration with Quality and Informatics departments at CHA. Our goal is to achieve Massachusetts and National benchmarks for Inpatient Tobacco Cessation Measures. Best practices for achieving these goals include cessation education for all providers, optimization of documentation, and on going analysis and performance evaluation. Participation time would be (estimated) 1-2 hours/week for 1-2 months, and then 2-3 hours/month over a 6 month period.

How likely is it that the project will offer trainees opportunities for publication and/or presentation external to CHA? Uncertain


 

Commit to Sit

Project leader: Adrianne Frankel, Quality Management

Project: This is a new project but will expand on previous performance improvement efforts around improving the patient's experience of care by sitting down while talking with patients in a care area.

"From a patient perspective, 2 minutes of a clinician seated at the bedside feels like 15 minutes of personal attention. Conversely, 15 minutes of a clinician standing and talking over the patient's head can feel like no personal attention at all..." The scope of this project will start in the Inpatient Units and will hopefully expand to the Emergency Department, and Ambulatory Clinics.

Opportunities for collaboration with learners:

  • Collaborate with a multidisciplinary team including, Quality Management, Providers, Nurses, Pharmacists, Interpreter services, and others
  • Research and compile evidence based best practice models and articles on the topic with regards to Improving PEOC Outcomes, (HCAHPS scores)
  • Using PI tools, develop operational processes and workflows which enable providers to sit with patients in the care area
  • Develop and roll out internal learning tools related to proposed workflows
  • Document and analyze current and future state
  • Monitor and supervise implementation and spread of proposed workflows

How likely is it that the project will offer trainees opportunities for publication and/or presentation external to CHA?  Highly likely


 

Creation of Dyad between CHA Cancer Patients and Dedicated Interpreter

Project leader: Heidi Rayala, Cancer Committee

Project: We are submitting IRB protocol and proposing to begin September 2018:

We seek to determine whether pairing a newly diagnosed cancer patient with an interpreter will improve a patient’s experience of care as they move through their cancer treatment. We will begin with a Pilot program in the Cambridge Breast Center. The Breast Center Pilot will encompass 6-9 dyads (6-9 patients with corresponding interpreters) and will incorporate Spanish, Brazilian Portuguese, and Haitian Creole Languages.

We are in the process of determining appropriate outcome for analysis, and the hope is to publish the results in Cancer Literature.

Opportunities for collaboration with learners: We are looking for someone to help in monitoring ongoing project and analyzing results. We have a group dedicated to carrying out the project, and are looking for someone to take the lead in organizing meetings and writing up the results. We anticipate that during the time of study this will be ~2-3 hours per month (1-2 hour for organizing meetings, and a 1 hour meeting per month).

How likely is it that the project will offer trainees opportunities for publication and/or presentation external to CHA? Highly likely


 

Can We Engage Adults with Psychotic Illnesses Into Needed Care? Specialty Psychiatric Care Management Within the Health Integration Program

Project leader: Miriam Tepper, Psychiatry

Project: The Health Integration Program (HIP) is an outpatient treatment program for adults with psychotic disorders, designed to mitigate the stark health disparities faced by this population. While HIP has piloted use of population health tools, it was not designed/developed to mitigate acute service utilization, and the current population size is too large for effective care management. I am proposing to refine HIP's mission to include those with psychotic disorders with significant acute service utilization needs, and provided targeted interventions to see if these individuals can be engaged in outpatient services. This is a new project, and has institutional support through ACO leadership.

Opportunities for collaboration with learners: Could be done over the course of concentrated elective time, or with a smaller weekly time commitment spread out over the course of the year

How likely is it that the project will offer trainees opportunities for publication and/or presentation external to CHA? Likely


 

Effect of Immigration Policies at Primary Health Care Utilization in Two Massachusetts Safety Net Hospitals

Project leader: Lara Jirmanus, Family Medicine

Project: This project is already in progress and I am working with researchers at BMC to look at existing data to evaluate for changes in Healthcare utilization over time before and after immigration policy changes. We will be evaluating the missed appointment rates for patients whose language of care is Spanish, Portuguese and Haitian Creole as compared with English speakers before and after January 25, 2017 when immigration related policies were first changed via a Presidential Executive Order. The project has important policy implications as well as implications for patient health. Should we find a difference it may open the door to possible interventions which can be performed at Cambridge Health Alliance to increase access to care for vulnerable populations at CHA.

Opportunities for collaboration with learners:  The collaborator would help with literature review as well as with writing of an academic manuscript for publication. We are currently seeking funding to subsidize data analysis which would be performed by data analysts at the Institute for Community Health. If a trainee were comfortable performing a difference in differences analysis for a large database of 300,000 patients with approximately 2 million observations, they could also help with the data analysis.

How likely is it that the project will offer trainees opportunities for publication and/or presentation external to CHA?   Highly likely


 

Unity Forums: Discussions about Race and Difference

Project leader: Xenia Johnson Bhembe and Miriam Tepper, Psychiatry

Project: Xenia Johnson Bhembe and Miriam Tepper have begun a conversation about race and difference at CHA and in our communities. We are interested in extending this conversation to psychiatry trainees (adult residents and child fellows) by holding a series of dinner gatherings in order to provide opportunities to discuss race, diversity, and difference as it emerges in psychiatry training. We believe that trainees can be a powerful catalyst for improvement within the department, and see opportunities to support increased dialogue and shared learning about these critical areas of our professional lives. Specific topics for discussion will include race and other differences as they emerge in supervision, in patient encounters, in the design and delivery of mental health services, and in our personal lives. We hope that these discussions will serve to open up our collective capacity for conversations around race and difference.

Opportunities for collaboration with learners:  We are in the early stages of planning this effort, and see opportunities for trainees in 1) developing content/vision for the discussions, 2) organizing and planning the dinners, 3) planning and executing an assessment of the discussions' impact on trainees, and 4) anticipating next steps.

How likely is it that the project will offer trainees opportunities for publication and/or presentation external to CHA?  Uncertain


 

Implementing Bedside Shift Reporting in the Cambridge Hospital Emergency Department

Project leader: Margaret Buckley

Project: This is a new project sponsored by a Gold Fellowship. The Emergency Department is a high risk setting for patients due to numerous factors. Nursing assignments may change several times per shift and patients are frequently moved within the department to accommodate flow which further complicates communication and adds risk.
My goal is to implement bedside shift report at each assignment change to provide a warm hand-off between the on-coming and off-going RNs and the patient and family. This initiative would provide the care team the opportunity to communicate all pertinent information related to the patient needed to safely assume care of the patient and ensure the patient meets their care team, is informed or updated, and can ask questions or voice concerns related to their ED visit. 

Examples of how implementing bedside shift report could benefit the ED include a chance to notice and correct patient mis-identification, accurate and timely recognition of change in patient status, address concerns with IVs, medications, or environmental condition, and actively involve the patient and family in their care which could impact patient safety and improve patient experience of care scores. Timely notification of any issues or concerns to provider staff could impact care delivery and patient experience of care. 
This project will include interviews with Emergency Department patients being admitted to inpatient setting to rate their experience of what went well, opportunities for improvement, and what would be beneficial to them.

Opportunities for collaboration with learners: This could be accomplished over a concentrated time frame or smaller weekly time commitments. The experience would include observation within the ED to measure compliance with the intervention during hand-off.

How likely is it that the project will offer trainees opportunities for publication and/or presentation external to CHA? Likely


 

Improving Colorectal Cancer Screening Rates

Project leader: Lorky Libaridian, Primary Care

Project: One of the main measures that primary care has decided to focus on for the coming year is improving colorectal cancer screening rates. There are some plans and projects underway to help improve our rates, but we there is opportunity to join us in working on any of the following areas: further development, implementation, PDSA'ing, work on sustaining and spreading change.

Opportunities for collaboration with learners: Depending on how the project is scoped, it can be done over a shorter or longer period of time. Work will range from understanding clinic workflows and obstacles to screening, to chart reviews, basic data analysis, and talking to and learning from clinical teams in the clinics.

How likely is it that the project will offer trainees opportunities for publication and/or presentation external to CHA? Uncertain


 

Race Recovery Project

Project leader: Xenia Johnson Bhembe, Pyschiatry

Project: The Race Recovery Project is scheduled to have its first Race Recovery Panel discussion on August 23, 2018. The focus of this project and potential future community engagements are to provide an opportunity for members of the CHA service area community to examine the impact of racial stress and explore effect ways of managing this stress. The current Panel series is scheduled to occur once per month through the fall and winter and then resume again in the late spring. We look to tackle topics such as violence, generational trauma, policing and identity to a community audience through a forum with black clinical panelists. The opportunity for a trainee to facilitate the organization and design of these forums would foster learning community engagement, mechanisms of access to care, increased dialogue guiding patient need based treatment and means for promoting good mental health/preventative care. We anticipate these forums and subsequent discussions will develop leadership in the area of race in the black community.

Opportunities for collaboration with learners: The number of hours per week would be 1) 1-2hrs with a time frame of 2) early spring to complete all planning for the remaining winter and late spring panels. We expect this project to foster learning community engagement, mechanisms of access to care, increased dialogue guiding patient need based treatment and means for promoting good mental health/preventative care. We anticipate these forums and subsequent discussions will develop leadership in the area of race distress management in the black community and provide an opportunity for assessment of impact of such panels/interventions on attendees.

How likely is it that the project will offer trainees opportunities for publication and/or presentation external to CHA? Uncertain


Do you have a learning opportunity for a trainee you'd like to share?

Submit your project here.

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