Slide 1

Hospitalists, scholarly activity, quality improvement, and researchHospitalists Best Practices Conference February 19, 2010J Rush Pierce Jr, MD, MPH

AgendaAre hospitalists interested in research?What kind of research do (can) hospitalists do?What is the IRB and how should hospitalists relate to it?Questions for discussion

Predictors of selecting academic medicine as a careerCompletion of graduate degree or fellowship trainingParticipation in research and publication while in medical school or fellowshipDesire to teach or conduct researchInfluence of a mentor

J Gen Intern Med 2006; 21:12221229.

Themes related to remaining an academic physicianEarly exposure to researchMentoringPersonal and social factorsCareer support as junior faculty

Medical Education 2009: 43: 335341

Types of research by hospitaliststhe hospitalist model itselfclinical approach to hospitalized patientsimplementation of best practicescare transitions improving patient safetyJ Gen Intern Med 2008; 23(8):126972

Strategies for success SHARP model (Univ Michigan)Protected timeMentorshipEpidemiologic and statistical supportCollaborative opportunities with subspecialistsRecruitment of fellowship trained hospitalists

Journal of Hospital Medicine 2008;3:308313

Collaborative in-patient medical service (CIMS) - Hopkins

Journal of Hospital Medicine 2008;3:314318.

UNM Hospitalist research interest

UNM hospitalist research experience

UNM Hospitalist research confidence

Perceived UNM institutional support

What would help at UNM?

Case ReportsResources (ACP Website)What types of patients?Rare conditions, unusual presentation of common illness, esp instructive, unusual complication, unusual aspect of managementRelative role of facultyWhere to present and where to publish

Case Reports - tipsKeep list of potential ptsIdentify early who will take leadDo brief literature review firstDraft an abstract earlyGet the patient's permissionGet the patient's phone numberBug the resident/student often!Be aware of meeting deadlines for abstracts

Case reports - meetingsMEETING

NM Chapter of ACP SHMSGIMWAFMR/WSCIABSTRACT DEADLINE

mid-Augustearly Januaryearly Februarylate summer

Case reports where to publishGeneral journals (South Med J, Amer J Med Science) Specialty journals (J Amer Geriatrics Soc, etc)Case report specific journalsJ Medical Case Reports http://jmedicalcasereports.com/J Case Reports in Medicine http://www.hindawi.com/journals/crm/

Case reports topics for discussionGuidelines for order of authorshipRole of IRBMeetings and travelSection expectation

Curriculum Development Type of projects:New curriculumNew techniqueNew programResourcesWhere to present/publishUsually coupled with survey of satisfaction, perceived confidence, and/or objective measures of knowledge transfer

Curriculum Development - tipsKeep a list of ideasKeep records!Decide on objective measurements before hand; think about a surveyGet library to help with lit reviewOften involve several faculty divide up roles

Surveys - tipsDemographicsTwo basic types of questions: is there a difference, is there an association?Look for surveys previously doneGet help earlyDesign strategies to improve participationPlan on submitting to IRB

IRBWhat is IRB and what is its role?When do I need to submit to IRB?What is HIPPA waiver and when do I need it?Do I need to be trained?

http://hsc.unm.edu/som/research/HRRC/HRRCHomePage.shtml

IRB submissionExempt vs. expedited vs. full reviewGetting ready: Research protocol on the wikiGetting the correct formsSubmitting the formsYour role as PI

Quality ImprovementThe nature of QIMeasure quality, design an intervention, remeasure quality, refine the interventionQI in medicineWhat is scientific research and when is QI research?

QI projects in the hospital getting startedRead lit beforehand (how to measure, what interventions have been done, problems)Decide how you will get baseline measurementsWrite down planned metrics and interventionsDiscuss with managementGet necessary partners on boardRole of IRB

QI projects: resourcesSHM http://www.hospitalmedicine.org/AHRQ http://www.ahrq.gov/ACEBP http://www.acestar.uthscsa.edu/Research.htm

UNMHSC CTSC for statistical supporthttp://hsc.unm.edu/research/ctsc/PSU.shtml

QI Projects - tipsAssume that you will publishKeep good records!Read the SQUIRE GuidelinesWork in a group and assign rolesTalk to the IRB; anticipate time for approval

IRB Practical TipsLook at website to determine if your proposal is exempt. Key issues: No interventions, just chart reviewDe-identified dataTalk (in person) with a HRRC support person about your proposalListen to the HRRC support personWrite protocolFill out formsDont argue, you will loseMake all suggested changes

27Discussion questionsQI and Role of IRB; PI trainingCase reports: (guidelines for order of authorship, role of IRB, meetings and travel, Section expectation)Statistical and epidemiologic helpDept support for research activities (travel to meetings, infrastructure, seed grants)How to provide mentoring