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107. PATHWAYS INITIATIVE TO IMPROVE TRANSITION CARE IN A MED-PEDS RESIDENCY PROGRAM
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receiving weekly feedback by 30%, improving the average Likert score by 1, and improving each quality measure by 30%. INTERVENTIONS: We used the model for improvement, with resident-designed monthly PDSA cycles, led by the chief residents. PDSA cycle 1 focused on reminders. Biweekly emails were sent to all residents on setting expectations and asking for feedback, and one email was sent to faculty and fellows about the importance of weekly feedback. PDSA cycle 2 focused on education and incentives. Cards were provided to each resident with tips for receiving high quality feedback and a link to log the feedback, for which points were awarded towards the resident’s “House Staff Cup” team. MEASURES: Data are collected via weekly online surveys, which are disseminated through a QR code at grand rounds to provide protected time for survey response. RESULTS: We have shown improvement in every outcome measure, though not yet to our goal. The frequency of weekly feedback has improved from 55% to 65% after two PDSA cycles. The average Likert score has improved from 2.9 to 3.23. The five quality measures have improved by an average of 28% from baseline. CONCLUSIONS AND NEXT STEPS: Our largest gains after two PDSA cycles have been in the quality measures, which were likely impacted by improved awareness of what constitutes high quality feedback. The frequency of feedback has improved, but not to our 30% goal. Additional cycles will be designed with input from residents with a goal of overcoming barriers such as time constraints and faculty culture. We hope to see improvements in the evaluation and feedback components on our ACGME survey this year.
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107. PATHWAYS INITIATIVE TO IMPROVE TRANSITION CARE IN A MED-PEDS RESIDENCY PROGRAM Robert Sanchez, MD, Erin Hickey, MD, University of Chicago, Chicago, IL, Jessica Gold, MD, Children’s Hospital of Philadelphia, Philadelphia, PA, George Weyer, MD, Nabil Abou Baker, MD, Rita Rossi-Foulkes, MD, University of Chicago, Chicago, IL BACKGROUND: Approximately 750,000 adolescents with special health care needs graduate to adulthood annually, often with their health suffering. Less than half receive the services needed for a successful transition. In Illinois the Division of Specialized Care for Children Family Survey revealed that only 18.2% of youth ages 14-21 received transition services. A recent review demonstrated that almost two thirds of HCT evaluation studies had statistically significant positive outcomes. Another study demonstrated that providing HCT services resulted in a 28%
ACADEMIC PEDIATRICS reduction in per member per month total cost driven by reductions in hospitalization and ED visits. AIM STATEMENT: 1. Increase HCT services for youth and young adults with special health care needs (YASHCN) in a Med-Peds residency practice (10% per year). 2. Increase HCT consultations for YASHCN (10% per year). 3. Improve HCT knowledge, attitudes and practices among Med-Peds residents. (improve annually). 4. Provide Med-Peds residents with a longitudinal QI project aligned with ACGME requirements. INTERVENTIONS: PATHways is a residency-based HCT consultative service founded to improve health for YASHCN and provide HCT education to residents. PATHways’ QI initiatives are modeled after Gottransition’s Six Core Elements. A HCT policy was disseminated. EMR tools were developed to assess HCT skills and create portable health summaries. A registry of over 200 YASHCN aged 14-26 in the practice was created. Formal HCT education was provided to residents through HCT consultations. MEASURES: 1. Baseline and annual follow up HCT knowledge, attitude, and practices survey of residents 2. Baseline and annual follow up audits of patients in the HCT registry addressing key elements (readiness assessment, HCT planning, creation of portable health summaries) 3. Tracking of consultations: Requesting services, diagnoses, HCT services provided. RESULTS: 33 consultations were provided over 18 months and were received from 9 different services with Pediatrics comprising 70%. Autonomy planning and completion of portable healthcare summaries comprised the majority of consults (80%). Consultations also aided in guardianship (43%), insurance and income support planning (67%), and identifying adult providers (20%). Residents surveys demonstrated increased HCT knowledge. Residents correctly identified the ages to introduce HCT, begin HCT planning, and prepare for transfer (scores increased by 8%, 21%, and 8%, respectively). They were able to identify specific tools for HCT including the clinic’s policy and registry. After one year, 42% of residents stated that they addressed HCT readiness often in their practice, increased from 18%, and no residents reported not ever addressing HCT, improved from 38%. Residents reported providing more frequent guidance on education, insurance planning, registering for adult services, guardianship assessment, and identifying adult providers. Residents reported feeling more empowered and engaged in caring for YASCHN. Baseline and follow up chart audits demonstrated that readiness assessment improved from 10 to 50%, transition planning improved from 20 to 60% and creation of portable health summaries improved from 5 to 45%. CONCLUSIONS AND NEXT STEPS: The PATHways initiative is a feasible way to improve HCT for YASHCN and resident HCT knowledge, attitudes and practices. Next Steps: 1. Utilize the EMR’s new feature, Slicer Dicer for transition registry management and chart audits. 2. Mailers and EMR messages will be sent to all patients in the transition registry directing them to schedule a HCT appointment. 3. Continue to raise awareness about the PATHways consultation services. 108. HEPATITIS B VACCINATION IN DUKE UNIVERSITY AND DUKE REGIONAL HOSPITAL NEWBORN NURSERIES Govind Krishnan, MD, Matthew R. McCulloch, MD, Sarah Germana, MD, Sophie Shaikh, MD, Jane Trinh, MD, Eve Hammett, CNM, Carleen McKenna, RN, Jazmine Staton, MS, Duke University Hospital, Durham, NC BACKGROUND: Vertical transmission continues to be a mode of Hepatitis B virus (HBV) infection despite implementation of
ABSTRACTS
receiving weekly feedback by 30%, improving the average Likert score by 1, and improving each quality measure by 30%. INTERVENTIONS: We used the model for improvement, with resident-designed monthly PDSA cycles, led by the chief residents. PDSA cycle 1 focused on reminders. Biweekly emails were sent to all residents on setting expectations and asking for feedback, and one email was sent to faculty and fellows about the importance of weekly feedback. PDSA cycle 2 focused on education and incentives. Cards were provided to each resident with tips for receiving high quality feedback and a link to log the feedback, for which points were awarded towards the resident’s “House Staff Cup” team. MEASURES: Data are collected via weekly online surveys, which are disseminated through a QR code at grand rounds to provide protected time for survey response. RESULTS: We have shown improvement in every outcome measure, though not yet to our goal. The frequency of weekly feedback has improved from 55% to 65% after two PDSA cycles. The average Likert score has improved from 2.9 to 3.23. The five quality measures have improved by an average of 28% from baseline. CONCLUSIONS AND NEXT STEPS: Our largest gains after two PDSA cycles have been in the quality measures, which were likely impacted by improved awareness of what constitutes high quality feedback. The frequency of feedback has improved, but not to our 30% goal. Additional cycles will be designed with input from residents with a goal of overcoming barriers such as time constraints and faculty culture. We hope to see improvements in the evaluation and feedback components on our ACGME survey this year.
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107. PATHWAYS INITIATIVE TO IMPROVE TRANSITION CARE IN A MED-PEDS RESIDENCY PROGRAM Robert Sanchez, MD, Erin Hickey, MD, University of Chicago, Chicago, IL, Jessica Gold, MD, Children’s Hospital of Philadelphia, Philadelphia, PA, George Weyer, MD, Nabil Abou Baker, MD, Rita Rossi-Foulkes, MD, University of Chicago, Chicago, IL BACKGROUND: Approximately 750,000 adolescents with special health care needs graduate to adulthood annually, often with their health suffering. Less than half receive the services needed for a successful transition. In Illinois the Division of Specialized Care for Children Family Survey revealed that only 18.2% of youth ages 14-21 received transition services. A recent review demonstrated that almost two thirds of HCT evaluation studies had statistically significant positive outcomes. Another study demonstrated that providing HCT services resulted in a 28%
ACADEMIC PEDIATRICS reduction in per member per month total cost driven by reductions in hospitalization and ED visits. AIM STATEMENT: 1. Increase HCT services for youth and young adults with special health care needs (YASHCN) in a Med-Peds residency practice (10% per year). 2. Increase HCT consultations for YASHCN (10% per year). 3. Improve HCT knowledge, attitudes and practices among Med-Peds residents. (improve annually). 4. Provide Med-Peds residents with a longitudinal QI project aligned with ACGME requirements. INTERVENTIONS: PATHways is a residency-based HCT consultative service founded to improve health for YASHCN and provide HCT education to residents. PATHways’ QI initiatives are modeled after Gottransition’s Six Core Elements. A HCT policy was disseminated. EMR tools were developed to assess HCT skills and create portable health summaries. A registry of over 200 YASHCN aged 14-26 in the practice was created. Formal HCT education was provided to residents through HCT consultations. MEASURES: 1. Baseline and annual follow up HCT knowledge, attitude, and practices survey of residents 2. Baseline and annual follow up audits of patients in the HCT registry addressing key elements (readiness assessment, HCT planning, creation of portable health summaries) 3. Tracking of consultations: Requesting services, diagnoses, HCT services provided. RESULTS: 33 consultations were provided over 18 months and were received from 9 different services with Pediatrics comprising 70%. Autonomy planning and completion of portable healthcare summaries comprised the majority of consults (80%). Consultations also aided in guardianship (43%), insurance and income support planning (67%), and identifying adult providers (20%). Residents surveys demonstrated increased HCT knowledge. Residents correctly identified the ages to introduce HCT, begin HCT planning, and prepare for transfer (scores increased by 8%, 21%, and 8%, respectively). They were able to identify specific tools for HCT including the clinic’s policy and registry. After one year, 42% of residents stated that they addressed HCT readiness often in their practice, increased from 18%, and no residents reported not ever addressing HCT, improved from 38%. Residents reported providing more frequent guidance on education, insurance planning, registering for adult services, guardianship assessment, and identifying adult providers. Residents reported feeling more empowered and engaged in caring for YASCHN. Baseline and follow up chart audits demonstrated that readiness assessment improved from 10 to 50%, transition planning improved from 20 to 60% and creation of portable health summaries improved from 5 to 45%. CONCLUSIONS AND NEXT STEPS: The PATHways initiative is a feasible way to improve HCT for YASHCN and resident HCT knowledge, attitudes and practices. Next Steps: 1. Utilize the EMR’s new feature, Slicer Dicer for transition registry management and chart audits. 2. Mailers and EMR messages will be sent to all patients in the transition registry directing them to schedule a HCT appointment. 3. Continue to raise awareness about the PATHways consultation services. 108. HEPATITIS B VACCINATION IN DUKE UNIVERSITY AND DUKE REGIONAL HOSPITAL NEWBORN NURSERIES Govind Krishnan, MD, Matthew R. McCulloch, MD, Sarah Germana, MD, Sophie Shaikh, MD, Jane Trinh, MD, Eve Hammett, CNM, Carleen McKenna, RN, Jazmine Staton, MS, Duke University Hospital, Durham, NC BACKGROUND: Vertical transmission continues to be a mode of Hepatitis B virus (HBV) infection despite implementation of