The American Heart Hospital Journal
• provide consultation on all aspects of medical education;
• promote and develop skills that enhance the quality of health sciences education:
• assist in the development of outstanding teachers, curriculum developers, program leaders, and educational scholars;
• provide guidance to medical educators in turning their teaching activity into scholarly presentations and products;
• provide guidance for educational recognition and rewards; and
• assist in the identification and/or development of guidelines to recognize excellence in educational scholarship and scholarly activity.
On a yearly basis, they select participants in the Faculty Teaching Scholars Program, an 18-month course designed “to address the professional development needs of faculty who are committed to a significant career investment in health sciences education.” Graduates have included clinicians from all medical disciplines as well as PhDs from within the College of Medicine.
With the help of CES experts, we have nearly completed an analysis of predictors of fellowship graduate board certification examination performance when weighing the contribution of morning conference attendance, faculty evaluations during clinical rotations, and in-training ECG interpretation test scores. They have collaborated to aid in efficiently tracking and labeling data in accordance with Institutional Review Board certifications and have helped facilitate conversations with psychometricians at the ABIM about how best to proceed with proper statistical analysis. This process has already identified additional areas for future investigation to improve our faculty evaluations of fellow performance to save valuable time while hopefully providing better information. Benefits from this type of collaboration extend beyond the relationship and data-driven educational reform. Co-authors of anticipated manuscripts are able to demonstrate academic productivity that engages them in the peer-review process while satisfying promotion criteria.
The Dawn of the Quality Improvement and Safety Era
“At the very least, quality improvement has little chance of success in health care organizations without the understanding, the participation, and in many cases the leadership of individual doctors.” Donald M Berwick, MD, MPP
Winter 2011
Special Report
Former President and Chief Executive Officer of the Institute for Healthcare Improvement
The 1999 release of the landmark IOM report To Err is Human: Building a Safer Health System arguably launched the current era of quality healthcare and patient safety. In it, authors estimated that as many as 98,000 people die in hospitals each year as the result of preventable medical errors, resulting in total costs between $17 and $29 billion nationwide. These were considered results of faulty systems, processes, and conditions throughout healthcare institutions and facilities. Proposed actions included increasing the national focus on safety, encouraging voluntary reporting of statistics, raising performance standards, and creating a culture of safety at the level of healthcare delivery.
From a cardiovascular standpoint, national organizations have recognized the need to define standards for quality and safety, while creating data registries and templates for medical centers and practices to participate. The ACC has established several specific quality and safety programs: Imaging in Focus, the Practice Innovation and Clinical Excellence (PINNACLE) Network, Hospital to Home, the Door-to-Balloon Alliance, and the Guidelines in Practice programs, while the American Heart Association (AHA) offers their series of Get With the Guidelines toolkits and the newly established journal Circulation: Cardiovascular Quality and Outcomes. These two entities have also joined forces to release statements regarding performance measures and quality metrics, data elements, and definitions to track outcomes and performance measures for common cardiovascular disease states.17
It is
clear that these efforts are necessary, as the cardiology community continues to face challenges to providing safe, evidence-based care. A recent review of the scientific evidence underlying the 53 guidelines issued by the ACC/AHA from 1984 to 2008 found that only 19 % of Class I recommendations are based on evidence from multiple randomized trials or meta-analyses.18
The release
of the ACC Foundation’s Appropriateness Criteria documents (
www.cardiosource.com) has provided a framework for the utilization of diagnostic (transthoracic, transesophageal, and stress echocardiography, radionuclide imaging, CCT, and CMR) and therapeutic (coronary revascularization) modalities, but patients are still exposed to large amounts of radiation during diagnosis19–21
and management.22 Even with the
many diagnostic tools at our disposal, our clinical triage needs improvement. Data from the National Cardiovascular Data Registry (NCDR) reveal the low diagnostic yield of elective coronary angiography when
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