Journey to Quality Care

Advocacy for CME – Meeting State Requirements: In 2018, the Florida legislature passed the Controlled Substances Bill (HB 21), which required certain registered practitioners to complete a specified board-approved continuing education course to obtain authorization to prescribe controlled substances by January 2019 and as part of their biennial license renewal. This bill defined authorized CE providers as “statewide physician associations,” a definition that excluded hospitals/health systems, universities, and other provider types. Unwilling to accept that Baptist Health South Florida (BHSF) would not be permitted to provide a state-approved version of this required course to its own physician learners, I headed to Tampa for the Florida Board of Medicine’s (FBOM) June 2018 meeting, where I made an appeal for approval of BHSF’s course. Read more. 

Addressing Clinician Burnout: We have held several “Leading Healthy Work Systems” workshops. This multi-session, small group activity, which takes place over the course of three months, is designed to give learners the necessary skills to recognize the physical, social, technological, and cultural attributes in their work environment that impact productivity and occupational well-being. It also aims to provide physician leaders with tools and strategies to understand and proactively the systems in which they work. Read more.

Addressing Human Trafficking: Our conference/webinar, “Human Trafficking: Training Healthcare for Policy and Prevention,” was designed to train healthcare professionals to identify, treat, and advocate for victims of human trafficking. Children who are sexually abused and neglected are at significant risk for becoming trafficking victims. There are tens of thousands of victims and survivors in the United States and more than half will see a healthcare professional, some while in captivity. Our intention was to raise awareness in the healthcare community by shifting the focus from trafficking as a criminal activity to trafficking as a psychosocial issue, and to highlight the social determinants of health. Several speakers with legal, legislative, and law enforcement expertise provided a framework of the commercial sex trade. A survivor gave her personal narrative. Psychiatrists, child psychiatrists, obstetricians, and gynecologists and the Dean of the medical school emphasized the need for such training. They provided key identifying signs and symptoms, risk factors, treatment engagement and advocacy efforts. Read more. 

Raising Awareness of Physical Inactivity: We developed the ACSM American Fitness Index^® (Fitness Index) in partnership with the Anthem Foundation to raise awareness of high levels of physical inactivity nationwide. The Fitness Index ranks America’s 100 largest cities on a composite of health behaviors, health outcomes, community infrastructure, and local policies that support a physically active lifestyle. With the help of the Fitness Index, local officials, community groups, health organizations, and individual citizens can assess factors contributing to their city’s fitness, health, and quality of life. The rankings and scores serve as an annual evaluation tool for measuring progress at the community level. We share the rankings, scores, and indicators at our annual meeting, through a summary report, and in an online city comparison tool. Learn more.

Overcoming Barriers to Caring for Transgender Patients: We identified barriers to caring for transgender patients living with HIV that included both unclear institutional policies and clinicians' discomfort. Our institutional systems were not flexible enough to fully accommodate patients whose gender identity differs from their assigned sex at birth. Furthermore, some clinicians were unsure how to interact with these patients and their families in a compassionate and appropriate way. To overcome these barriers, we invited a speaker from a regional transgender equality group to our HIV lecture series to directly address specific issues, including communications, housing, and restroom facility protocol. We also invited a national expert to help us educate our clinical staff on what it means to be transgender, how young people realize that they are transgender, what medical treatments are available, and how to interact with transgender patients and families. Learn more.

Immunization for Immunocompromised Patients: We developed a partnership with several pediatric specialists who care for patients with conditions that compromise their immune systems (e.g., transplant, lupus, HIV). Because of their immunocompromised condition they cannot follow the immunization standard guidelines recommended by the Centers for Disease Control and Prevention and American Academy of Pediatrics. However, these patients are at higher risk of serious consequences if they are not fully immunized. The baseline assessment found immunization rates for several vaccines to be very low (around 20%). We designed and implemented a quality improvement/performance improvement (QI/PI) protocol that included all-staff education and systems changes to identify the immunization status of patients as they arrived for appointments. The project included several PDSA cycles (Plan Do Study Act) in order to reach the goal of 80% immunization rate. The final immunization rate was approximately 88%. Learn more.

Addressing Opioid Abuse in Ohio: We participate in the Governor’s Cabinet Opiate Action Team (GCOAT), which was established to address the continuing epidemic of misuse, abuse, and overdose from prescription opioids. The GCOAT consists of five working groups: (1) Treatment; (2) Professional Education; (3) Public Education; (4) Enforcement; (5) Recovery Supports. Additionally, as a follow-up to state initiatives and resolutions adopted by the House of Delegates, the policymaking body of the OSMA, we provide educational activities focused on the prescribing of opioids. Our SmartRx online educational activity keeps prescribers up to date as Ohio continues to address the prescription drug abuse epidemic. To supplement our SmartRx activity, we provide additional resources for physicians and other prescribers to inform them about appropriate prescribing and clinical treatment. Our BeSmart online resources help raise awareness about Ohio’s prescription opioid misuse and addiction problem, providing links to prescribers and distributing preventative information to patients as well as information about addiction and recovery. Learn more.

Offering MOC: We saw offering Maintenance of Certification points as a great opportunity to give something to our physicians without burdening them with extra work. It’s important for us to engage our physicians with relevant education, and they were very excited to take advantage of the opportunity to receive CME and MOC at the same time. We were able to offer MOC for a wide variety of topics including pediatric trauma, digestive health, emergency and critical care ultrasounds, and longitudinal progression of complex trauma and addiction. Plus, offering MOC was relatively easy for us, as an organization, too. We were already providing CME activities, so all we had to do was ensure the education meets the boards’ requirements, register the activities in the Program and Activity Reporting System (PARS) for MOC, and ask the learner for his or her birthday (month and day) and learner ID. Then, following the activity, we reported the learner data in PARS. Learn more.

Collaborating to Address Postpartum Hemorrhage: In the US, hemorrhage is a leading cause of maternal death, yet many of these deaths are preventable. The need for real-life training is especially great in rural areas, where the maternal death rate is up to 64 percent higher than in urban areas. To address that need, we formed a collaboration with Heartland Health Alliance, Bryan College of Health Sciences, Bryan Medical Center, and Benjamin Byers, DO, Center for Maternal & Fetal Care, to present an interdisciplinary OB Simulation for Postpartum Hemorrhage onsite at 12 rural communities across Nebraska. The activity utilized assigned prework reading on the American College of Obstetricians and Gynecologists (ACOG) clinical guidelines, didactic lecture, hands on simulation with a fully functioning OB mannequin, and a physician roundtable debrief. Read more. 

Improving Access to Data: Studies have shown that by analyzing complex data sets, clinicians can identify patterns that can improve patient care, yet institutional surveys showed a lack of clinician knowledge regarding access to quality data. In response, our team collaborated with the Center for Quality to develop educational sessions that increase clinicians’ engagement with big data. Topics such as “UCM Data: What's Available & How Can I Get It?” and “Avoiding Simple Solutions for Complex Healthcare Problems” are chosen based on needs identified by QI professionals in their interactions with clinicians. Evaluation results have shown participants are now more likely to use evidence-based data in their clinical decision making, and several QI projects have originated from these sessions. Average attendance has more than doubled since the project’s inception, and we hope to continue to expand its reach to encourage clinician interaction with big data. Learn more.