METRIC (available modules)

available modules

Diabetes

Coronary Artery Disease

Asthma

COPD

Geriatrics

Depression

Hypertension

METRIC

"Measuring, Evaluating, and Translating Research Into Care"

http://www.aafp.org/metric

6 steps

1. Answer some general survey questions about your practice.
2. Review 10 patient charts using evidence-based practice performance measures.
3. Create an Action Plan of practice-based interventions based on the performance measures you need to improve.
4. Implement your Action Plan over a 3-month period.
5. Return to this METRIC module after 3 months to reevaluate your patient charts.
6. Evaluate whether and how the interventions chosen helped you improve care of your patients with diabetes.

1) first you do a really short survey

2) 10 chart reviews: Here is the Chart Review Process (their core measures)

Laboratory
Has the A1C been measured in the past 12 months? *		Yes No
Enter the patient's most recent A1C value:		(%)
Has the patient received a urine microalbumin protein screen in the past 12 months? *		Yes No Unknown Not Applicable (gross proteinuria)
Has a lipid profile been performed in the past 12 months? *		Yes No
Enter the patient's most recent total cholesterol value:		(mg/dL)
Enter the patient's most recent LDL cholesterol value:		(mg/dL)
Enter the patient's most recent HDL cholesterol value:		(mg/dL)
Enter the patient's most recent triglyceride value:		(mg/dL)
Has the patient's blood pressure been measured in the past 12 months? *		Yes No
Enter the patient's most recent systolic blood pressure value.		(mm Hg)
Enter the patient's most recent diastolic blood pressure value.		(mm Hg)
Preventive care
Has the patient had a dilated retinal exam or equivalent assessment by an ophthalmologist or optometrist in the past 12 months? *		Yes No Not Applicable (blindness) Unknown
Has the patient had a complete foot exam (by visual inspection, monofilament and pulse exam) within the past 12 months? *		Yes No Not Applicable (bilateral amputee)
Has the patient received a flu vaccine in the past 12 months? *		Yes No Not Applicable (egg alergy, Hx of drug interaction, contraindication) Unknown
Does the chart reflect a recommendation for aspirin therapy (dose >=75mg)? *		Yes No Not Applicable (patient is <>
Is the patient a smoker? *		Yes No Not Assessed
Does the chart reflect that the patient has been counseled to stop smoking? *		Yes No Not Applicable (nonsmoker)

3) then you get a report back (too big to display)

4) next it gives you some suggestions you can pick from (too many to display)

there is a pretty long list and it includes simple things like you watching a video to more involved things like including a care flowsheet, doing group visits, etc.

you can choose 1 or more of these suggestions.

5) Three months later... you reevaluate your charts (10 chart audits)

6) you get a report to compare and see how it worked

Frontline Diabetes

Is a course for 3rd year FP residents. It's 1 1/2 days of sessions and it's really good. I think it's usually in Texas, Arizona, or Nevada.

It's probably a good idea to register during the 2nd half of your second year.

http://diabetes.afmrd.org/diabetes/index.html

Mayo Young Investigator Research Symposium (mayo link)

Call for abstracts, deadline: December 15, 2009

Symposium date: March 28-29, 2010

http://mayoweb.mayo.edu/fellows/documents/SavetheDateandCallforAbstracts-final.pdf

Consultants who will help you...

Sara let me know that the following consultants are interested in helping us/spronsoring us with FPIN projects:

Tara Kaufman
Margaret Gill
Steve Merry
Marc Matthews
John Bachman

funding sources list

MAFP (Minnesota Academy of Family Physicians) Foundation
http://www.mafp.org/foundationgrant.asp

Mayo small grants program & a lot of others (mayo link)
http://mayoweb.mayo.edu/ctsa/opportunities.html

American cancer society
www.cancer.org/research

Women's Health Symposium Call for Abstracts

The date is 1/6/2010 (all afternoon). Abstracts due 10/30/2009

http://mayoweb.mayo.edu/office-womens-health/research.html

How to do posters (mayo link)

http://mayoweb.mayo.edu/id-posters/

Journal of Primary Care & Community Health

A possible publication opportunity:

http://www.sagepublications.com/promos/1096092JA.htm

Notes from OB ultrasound meeting 8/26/2009

Assets available at the Sim Center
- 3-4 ultrasound machines
- Dr. Brost
- MFM fellows?

Start: Baseline assessment
- October workshop?
- One station is available to us from Dr. Billings (I discussed this with him)
- Each resident in a group of 4 residents would get approximately 40 minutes at that station.

How: Stages of learning (ultrasound)
Scanning with lights on --> lights off --> gel packs obscure --> in fake torso & uterus

Learning sessions
- lunchtime
- food provided (by program?)
- time/dates (M-W over a 6 - 8 week period)
- how long needed (per resident: two 1-hour sessions? four? more?)
- block activities before lunch
- focus on 2nd and 3rd years?
- focus on residents on FMOB & OB?
- 10 motivated residents to participate as learners...

Learning objectives
- General anatomy and orientation
- CRL
- AFI
- BPP
- Adnexae
- Placenta
- Gender

*From The Society of Teachers of Family Medicine Group on Hospital and Procedural Training
http://sites.google.com/site/fmacademics/home/files/OB20090826RESED.pdf?attredirects=0
Basic prenatal ultrasound
• Amniotic Fluid Index
• fetal presentation
• placental location
Other procedures
• Ultrasound guidance for central vascular access,

Advanced prenatal ultrasound
• Dating
• Anatomic survey

Assessing Learning
- Can they find it?
- How long did it take to find it?
- How accurate are the measurements?

OB ultrasound study

The first meeting of this group will be tomorrow. We'll be discussing a few things...

1) Review the purpose of the study.

2) Study outline. some sort of plan that we can put together for IRB approval (it should be exempt)

3) How do you define competency in OB ultrasound? specifically, how does AAFP define this?

4) Baseline assessment:
at the upcoming workshop or at another time?
what will be assessed? AFI, femur length, pelvic U/S, etc...

5) Short term agenda/Long term agenda
what exactly will happen at the FM workshop in October (Dr. Billings's plan?)
participants/scheduling
what do we need to do to get ready for baseline assessment
what do we need to do to get ready for initial training/assessment
poster presentation
end point

6) Articles...
http://sites.google.com/site/fmacademics/home/files/OB20090826ACMED.pdf?attredirects=0

http://sites.google.com/site/fmacademics/home/files/OB20090826JAMA.pdf?attredirects=0

http://sites.google.com/site/fmacademics/home/files/OB20090826RESED.pdf?attredirects=0

Dr Garrison's QI Inpatient update

(linked files are at: http://docs.google.com/Doc?docid=0AemBxPGH210uZGZqNWs2cmdfMzRmNndqczRwNQ&hl=en &

http://docs.google.com/fileview?id=0B-mBxPGH210uYzlhNDAxMGEtMzg2OS00MzhhLWI2MzgtMzRkNTRiYWY0ZWFj&hl=en

Enclosed is a very rough draft of a proposal for our project. Please take a look at it. We need to do the following:
1) Write a brief background & significance section (see enclosed article for ideas and bibliography)
Eventually we need to do a literature search
2) Fill in the holes in the data we collect (i.e. think about definitions for CAD & where to find the information - see table in proposal)

3) Budget - for now nothing, but we may wish to obtain some funding from our dept's small grants program later

Feel free to make changes to the document.

<>

Good news! I talked with Dr. Thatcher (research cmtee chair). We will be able to use the data abstractors for our project! I'm going to try and meet with them next week - I'll let you know a time and place to see if any of you can join me.

Sample size looks like 103 cases and 206 controls (assumed 2:1 ratio) - very doable with our numbers for 1yr on the service.

I think we definitely should submit this to the IRB so we can attempt to publish our findings later.
I would encourage all of you to go thru the IRB certification/training process if you haven't already. The old process took about 20min, I assume this new one is roughly the same. You need to do that before you can be listed as a co-investigator.

http://mayoweb.mayo.edu/research-education/PHRPWelcome.html

Electronic resources committee?

I was wondering if there was a need (or interest) in putting together an "electronic resources committee". One thing they could address is the resources that are available on the web for us, reviewing them periodically for areas that need updating or improvement. I think there are some links on FM home page, some links on the "Useful links - Click here" page, and there is also a page full of old FM grand rounds topics and resources.

There's a few network folders with resources, digital recordings of lectures, podcasts, etc...

There's also some issues with shorthand dictionaries. I'm doing a study that involves shorthand, but it doesn't fully address FM shorthand issues -- and it doesn't take into account any concerns that other people might have about shorthand.

On top of that, you have me putting stuff out there on a blog. So that brings up the issue of what belongs on email and what should be distributed in other ways.

A committee could meet every few months and could start to get a handle on these issues. I don't know if any such committee already exists, if not I'd like to explore it. Any other residents interested in this?

Data Miners

The link is the form for a data abstraction request.
http://docs.google.com/Doc?docid=0AemBxPGH210uZGZqNWs2cmdfMzFoY2NnNG43Mw&hl=en

This is what the data abstractors say (they are looking for work/to keep busy):

We can pull clinical information from electronic records back through 1996

Can pull from programs including GPAS, MICS, Documents Browser, Synthesis, and limited billing information through MICS

We have some contacts that can pull patient lists together with certain criteria –
(i.e. Family Medicine patients that are over 18 and have a diagnosis of diabetes from 2000-2004)

Have done a study involving all three Mayo Clinic sites

Have pulled information to find distance patient traveled from home to a Family Medicine site for their visit

We can enter data from surveys that are completed or create a survey and send out from information given to us

Information we pull:
Demographics (current info only) – age, race, sex, marital status
Laboratory information in MICS
Diagnosis
Visit counts
CVI/PFH – current information only
Any information found in a clinical note through Documents Browser
We have a Charlson index and specific disease list
Can calculate BMI’s
Vitals

We typically work in Excel spreadsheets but we also have limited ability to work with Access as well.

We have done studies with as few as 50 patients and as many as 4000. The timeframe to do each study depends on numerous things such as data to be pulled, complexity of spreadsheet, and other projects we are working on.

QI Inpatient Team

Amy was going to get back to us on the technical goals of the inpatient bounce-back study.

QI team B

Ryan was going to look into refining their proposal, but currently it's something like:
Would directly going to lab, Xray, etc shorten patient's clinic time?

QI team A

Current issues:
We need to visit with Dr. Matthews and see if his study interferes with ours or ours interferes with his.
- he is doing a study on preassessment of patient knowledge of diabetes.

Need some standardized script or format for the precare visits (part of the research methods)

Should we assess the impact of the handouts the nurses give the patients?

Should we use care team A & B together and just compare it to historical data or should we compare A to B?

We need to complete Dr. Garrison's tasks for next meeting.

Do we need to meet up for a brief discussion?

Quality Improvement Meeting 8/13/2009 Recap

Issues discussed:

Dr. Garrison did a talk on coding/billing.

We talked about the QI projects.

Broke into teams for about 30 minutes. Afterward, discussed all as a group.

Assignment:

Dr. Garrison would like the following issues accomplished for the next meeting 9/10/2009:

Each group should discuss independently before the next meeting and having something on paper regarding the following issues:

1) Aim of study

hypothesis

objectives

2) Background and Significance

justification for project, why is it important

planned supporting research (literature review)

3) Methods

what is going to be measured

duration of information gathering

4) Budget

how much will it cost?

Institutional Review Board (IRB)

Each group should consider putting together a proposal for IRB

*It's not that big a deal

*Everyone should complete online IRB training at http://irbe.mayo.edu/ (you only have to do this once in residency anyways)

*Each team should then complete one (1) IRB application for the group project.

Groups (bold = attended, bold red italics = leading):

Team A

Sawyer, Morgan, Garcia, McManus, Lynch, Robertson

Team B

Ludwig, Truitt, Schoofs, McClone, Meier, Lovold, Rybar, Oberhelman

Inpatient team

Couch, Michaud, Mansukhani, Caro

Podcasts

Here's another one that Andrew did last year that was pretty cool.

Is there anyone interested in (or already) recording lectures and short didactics for publication on the department website.

The title of podChief goes to the first person who volunteers. Also, let me know if you're already doing it and I just didn't know...

Vasectomies

Since I get a stomach ache when I think about vasectomies, is there anyone willing to take up the job of coordinating vasectomies (and any other family med procedures) you can think of? Andrew did it last year.

I'm sure we could get you a title (i.e. desired infertility chief) if you do it.

details:
We are in the process of making more vasectomy procedures available to residents. Dr. Harman (now ????) performs the majority of vasectomies at the Northwest clinic. Likewise, Dr. Robelia does the majority of them at the Northeast clinic. Dr. Merry does them at the Baldwin Clinic (?). They are excellent educators and are interested in letting us assist them. Also, the two of them have very different styles with which they perform the procedure.

Monday of each week, an eMail will be sent out with available vasectomy opportunities for that week. They will be assigned on a first-come, first-served basis. Please take into account that these are "extra curricular," and will not be scheduled instead of required activities (rotation, Kasson, FMPC, etc.). That means that you’ll have to do them post-call, on a day off, or wherever you can fit one in.

Also remember that there are vasectomy opportunities with Drs. Bernard, Billings, and Adamson that occur throughout residency.

Clinical Reviews

Hopefully all the 3rd years know at this point that this is covered for them. Definitely a good experience for all who can attend.

October 26-29 or November 9-11.

You just need to register, see Tammy's emails for details.

Family Medicine Forum - Call for Abstracts

The forum is on Monday, October 26th, 2009

The deadline for abstracts is Friday, September 18, 2009

Here's the link to the announcement/submission form:

http://docs.google.com/Doc?docid=0AemBxPGH210uZGZqNWs2cmdfMzBjYzU4czlkbg&hl=en

epocrates discount for residents/students

I know there was lukewarm interest in Epocrates previously, but I use it all the time. I found a really significant discount for all of the residents (and students).

The Minnesota Medical Association (which we all belong to) has already negotiated a 50% discount for us. I know it works because I just signed up. The code is at:

http://www.mmaonline.net/ProductsandServices/PracticeManagement/Software/tabid/1455/Default.aspx

If you have an Iphone it really looks like it's got some pretty cool features. There's a demo at: http://www.youtube.com/watch?v=vwwujfwLHOk

FPIN topics (as of 8/7/2009): get them while they're hot

click on the images to enlarge/read them...

Help Desk Answers Topics





Clinical Inquiries Topics

Workshop/Didactic Suggestions

Maggie Moore suggested an ultrasound/injection workshop with Dr. Barnes.

Dr. Bernard suggested we get a vascular specialist to talk to us about DVT/PE treatment.

Now (8/16/2009) there's a survey and I'll keep harping on you (residents) until everyone has done it.

Journal Club 2.2

Ladies and Gentlemen,
In the interest of improving staff and resident attendance to our department's Journal Club, we've changed the date to the second Tuesday of each month. If it would encourage your attendance either I will or will not wear a tutu to the next meeting in honor of this change. Let me know where you stand on that because I'm going to need some lead time to order mine from the metabolic syndrome dance studio supply store.

1) Please let me know if you are interested in being a facilitator (either staff or resident). If so, please give the dates for which you'd be willing to facilitate.
2) Suggestions for topics or articles.
3) Requests for restaurants.

In any event, here are the upcoming dates.
Tuesday, September 8
Tuesday, October 13
Tuesday, November 10
Tuesday, December 8
Tuesday, January 12
Tuesday, February 9 (***THE BIG 2-2-2***)
Tuesday, March 9
Tuesday, April 13
Tuesday, May 11
Tuesday, June 8

Take care,
Mark

About Journal Club
Journal club is a monthly meeting the second Tuesday of every month. It intends to focus on the evidence that supports the care we provide. Usually we'll be reviewing a single journal article.
To prepare, we ask that you read the article. Some example worksheets such as at http://www.mclibrary.duke.edu/subject/ebm?tab=appraising&extra=worksheets or http://www.cebm.net/index.aspx?o=1913 may help guide your critical appraisal of the article.
Most of all it's supposed to be relevant and interesting.
And remember, the fourth step to overcoming Journal Club is to make a searching and fearless moral inventory of ourselves.

Research Update

The FPIN slides have the current available FPIN topics.

http://docs.google.com/present/edit?id=0AemBxPGH210uZGZqNWs2cmdfMTVoYjdyajNkZg&hl=en