Internal Medicine Resident Experiences With a 5-Month Ambulatory Panel Management Curriculum

Implementation of a Quality Metrics Competition to Improve Panel Management Among Internal Medicine Residents

Background Panel management is essential for residents to learn, yet challenging to teach. To our knowledge, prior literature has not described curricula utilizing a financially incentivized competition to improve resident primary care metrics. Objective We developed a panel management curriculum, including a financially incentivized quality competition, to improve resident performance on quality metrics. Methods We developed a cancer screening and diabetes metric quality competition for internal medicine residents at Vanderbilt University Medical Center for their primary care clinics for the 2020-2021 (pilot) and 2021-2022 academic years. Residents received several educational tools, including a 1-hour introduction to the health maintenance dashboard within the electronic medical record (EMR) and instructions on how to access the quality dashboard outside the EMR, and were encouraged to discuss panel management with preceptors. Chief residents distributed measures to trainees 3 times annually, so residents were aware of their competition ranking. Residents' composite metrics at year end were compared to baseline to determine top performers. The top 15 performers received $100 gift cards as incentives. We also assessed the curriculum's impact on the residents' metrics in aggregate. Results At curriculum completion, residents (n=100) demonstrated an average improvement of 1.9% from baseline composite metrics for the percent of patients receiving screening. In aggregate, residents improved in every measure except HbA1c testing. Breast cancer screening had the largest improvement from 69.5% (1518 of 2183) to 75.6% (1646 of 2178) of all patients receiving recommended screening. Conclusions The curriculum resulted in more patients receiving recommended cancer and diabetes screenings.

Resident Perceptions of Continuity Clinic Patient Metrics Differ From EHR Data: Pilot Use of Population Health Dashboards

BACKGROUND AND OBJECTIVES

Population health management (PHM) dashboards using electronic health record (EHR) data can teach trainees about the population they serve while also delivering data on their clinical practice. Yet, few studies have demonstrated their use. In this pilot study, we assessed baseline resident perceptions of population health metrics for continuity clinic panels by comparing resident estimates with EHR-reported values delivered by individualized PHM dashboards.

METHODS

A descriptive, comparative study was conducted at a primary continuity clinic site for pediatric residents in January 2018. Residents were surveyed about population health metrics for their patient panels, including demographics, utilization, and medical diagnoses. We compared resident estimates to corresponding EHR-reported values using 2-tailed paired t tests.

RESULTS

A total of 42 out of 55 eligible residents (76%) completed the survey. Compared with EHR-reported values, residents estimated higher percentages of emergency department utilization (22.1% vs 10.3%, P < .01) and morbidity, including medical complexity (15.6% vs 5.9%, P < .01), overweight (38.1% vs 11.7%, P < .01), obesity (20.5% vs 15.8%, P = .02), and asthma (34.6% vs 21.4%, P < .01).

CONCLUSIONS

In this pilot study of PHM dashboards, resident perceptions of continuity clinic population health metrics did not align with EHR data. Estimates were higher for measures of utilization and morbidity. PHM dashboards may help trainees better understand their patient populations and serve as a consistent source of objective practice data. However, further research and investment is needed to evaluate dashboard implementation and impact on trainee and patient outcomes.

A Mixed-Methods Program Evaluation of a Self-directed Learning Panel Management Curriculum in an Internal Medicine Residency Clinic

BACKGROUND

Panel management (PM) curricula in internal medicine (IM) residency programs often assign performance measures which may not address the varied interests or needs of resident-learners.

AIM

To evaluate a self-directed learning (SDL)-based PM curriculum.

SETTING

University-based primary care practice in Burlington, Vermont.

PARTICIPANTS

Thirty-five internal medicine residents participated.

PROGRAM DESCRIPTION

Residents completed a PM curriculum that integrated SDL, electronic health record (EHR)-driven performance feedback, mentorship, and autonomy to set learning and patient care goals.

PROGRAM EVALUATION

Pre/post-curricular surveys assessed EHR tool acceptability, weekly curricular surveys and post-curricular focus groups assessed resident perceptions and goals, and an interrupted time series analysis of care gap closure rates was used to compare the pre-intervention and intervention periods. Majority of residents (28-32 or 80-91%) completed the surveys and focus groups. Residents found the EHR tools acceptable and valued protected time, mentorship, and autonomy to set goals. A total of 13,313 patient visits were analyzed. There were no significant differences between rates between the pre-intervention period and the first intervention period (p=0.44).

DISCUSSION

A longitudinal PM curriculum that incorporated SDL and goal setting with EHR-driven performance feedback was well-received by residents, however did not significantly impact the rate of care gap closure.