Reducing inappropriate oxygen use in hospitalized medicine patients.

Introduction: Evidence suggests inappropriate oxygenation may be harmful to patients. To improve oxygen use in our hospital, we initiated a quality improvement project with a goal to reduce the percentage of inappropriate utilization of oxygen by 50% within a year.

Methods: Nasal cannula (NC) oxygen use data for medicine inpatients was abstracted weekly for chart review.

Ambulatory Intensive, Multidisciplinary Telehealth for High-Risk Discharges: Program Development, Implementation, and Early Impact.

Introduction: Creating and implementing programs aimed at reducing readmissions for high-risk patients is critical to demonstrate quality and avoid financial penalties. Intensive, multidisciplinary interventions providing care to high-risk patients utilizing telehealth have not been explored in the literature. This study seeks to explain the quality improvement process, structure, intervention, lessons learned, and early outcomes of such a program.

Why did you come back to the hospital? A qualitative analysis of 72-hour readmissions.

Objectives: Readmissions occurring within a few days of discharge are more likely due to a problem from the patient's original admission and may be preventable by interventions in the hospital setting. As part of a quality improvement project intended to reduce readmissions within 72 hours of discharge our objective was to explore patient and physician perspectives of reasons for readmissions and to identify potential indicators of readmission during the index admission.

Methods: A retrospective chart review of all readmissions within 72 hours between 2/1/2019 and 6/7/2019 in our healthcare system comprised of an academic medical center and 2 smaller community hospitals.

Self-reflection as a Tool to Increase Hospitalist Participation in Readmission Quality Improvement.

Background: Reducing 30-day readmissions is a national priority. Although multipronged programs have been shown to reduce readmissions, the role of the individual hospitalist physician in reducing readmissions is not clear.

Objectives: We evaluated the effect of physicians' self-review of their own readmission cases on the 30-day readmission rate.

A Scholarly Pathway in Quality Improvement and Patient Safety.

Problem: There are several challenges to teaching quality improvement (QI) and patient safety material to medical students, as successful programs should combine didactic and experiential teaching methods, integrate the material into the preclinical and clinical years, and tailor the material to the schools' existing curriculum.

Approach: The authors describe the development, implementation, and assessment of the Quality Improvement and Patient Safety (QuIPS) Scholarly Pathway-a faculty-mentored, three-year experience for students interested in gaining exposure to QI and patient safety concepts at the Medical College of Wisconsin (MCW). The QuIPS pathway capitalized on the existing structure of scholarly pathways for MCW medical students, allowing QI and patient safety to be incorporated into the existing curriculum using didactic and experiential instruction and spanning preclinical and clinical education.

Octreotide for the Management of Gastrointestinal Bleeding in a Patient with a HeartWare Left Ventricular Assist Device.

HeartWare is a third generation left ventricular assist device (LVAD), widely used for the management of advanced heart failure patients. These devices are frequently associated with a significant risk of gastrointestinal (GI) bleeding. The data for the management of patients with LVAD presenting with GI bleeding is limited.

Publicly reported quality-of-care measures influenced Wisconsin physician groups to improve performance.

Public reporting of how physicians and hospitals perform on certain quality of care measures is increasingly common, but little is known about whether such disclosures have an impact on the quality of care delivered to patients. We analyzed fourteen publicly reported quality of ambulatory care measures from 2004 to 2009 for the Wisconsin Collaborative for Healthcare Quality, a voluntary consortium of physician groups. We also fielded a survey of the collaborative's members and analyzed Medicare billing data to independently compare members' performance to that of providers in the rest of Wisconsin, neighboring states, and the rest of the United States.

Public reporting helped drive quality improvement in outpatient diabetes care among Wisconsin physician groups.

Public reporting on the quality of ambulatory health care is growing, but knowledge of how physician groups respond to such reporting has not kept pace. We examined responses to public reporting on the quality of diabetes care in 409 primary care clinics within seventeen large, multispecialty physician groups. We determined that a focus on publicly reported metrics, along with participation in large or externally sponsored projects, increased a clinic's implementation of diabetes improvement interventions.

Long-term opioid contract use for chronic pain management in primary care practice. A five year experience.

Background: The use of opioid medications to manage chronic pain is complex and challenging, especially in primary care settings. Medication contracts are increasingly being used to monitor patient adherence, but little is known about the long-term outcomes of such contracts.

Objective: To describe the long-term outcomes of a medication contract agreement for patients receiving opioid medications in a primary care setting.

Fifteen years of aligning faculty development with primary care clinician-educator roles and academic advancement at the Medical College of Wisconsin.

Starting in 1991, the Medical College of Wisconsin's (MCW) primary care-focused faculty development programs have continuously evolved in order to sustain tight alignment among faculty members' needs, institutional priorities, and academic reward structures. Informed by literature on the essential competencies associated with academic success and using educational methods demonstrated to achieve targeted objectives, MCW's initial 1.5-day per month comprehensive faculty development programs prepared faculty as clinician-researchers, leaders, and educators.

An Assessment of the Impact of Multimedia, Technology-Based Learning Tools on the Cardiac Auscultation Skills of Third-Year Medical Students.

Background: Previous studies have shown that medical students and post-graduate trainees need to improve their proficiency in cardiac auscultation. Technologic advances have created new learner-centered opportunities to enhance proficiency in this important physical examination skill.

Objectives: We sought to determine if technology-based, self-directed learning tools improved the cardiac auscultation skills of third-year medical students.