Dr. Vidyarthi is associate professor, Duke-National University of Singapore Graduate School of Medicine and consultant, SingHealth Pvt Ltd., Singapore. Formerly, she was associate professor of medicine and director of quality and safety programs, Office of Graduate Medical Education, University of California, San Francisco, School of Medicine, San Francisco, California. Dr. Green is professor, Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. Dr. Rosenbluth is associate professor, Division of Hospital Medicine, Department of Pediatrics, and director of quality and safety programs, Office of Graduate Medical Education, University of California, San Francisco, School of Medicine, San Francisco, California. Dr. Baron is professor, Division of General Internal Medicine, Department of Medicine, and associate dean of graduate medical education, University of California, San Francisco, School of Medicine, San Francisco, California.
Acad Med. 2014 Mar;89(3):460-8. doi: 10.1097/ACM.0000000000000159.
Teaching hospitals strive to engage physicians in quality improvement (QI), and graduate medical education (GME) programs must promote trainee competence in systems-based practice (SBP). The authors developed a QI incentive program that engages residents and fellows, providing them with financial incentives to improve quality while simultaneously gaining SBP experience. In this study, they describe and evaluate success in meeting goals set during the program's first six years.
During fiscal years (FYs) 2007-2012, QI project goals for all or specific training programs were set collaboratively with residents and fellows at the University of California, San Francisco (UCSF). Data were collected from administrative databases, via chart abstraction, or through independently designed techniques.
Approximately 5,275 residents and fellows were eligible and participated in the program. A total of 55 projects were completed. Among the 18 all-program projects, goals were achieved for 11 (61%) in three domains: patient satisfaction, quality/safety, and operation/utilization. Among the 37 program-specific projects, goals were achieved for 28 (76%) in four categories: patient-level interventions, enhanced communication, workflow improvements, and effective documentation. Residents and fellows earned an average of $800 in bonuses/FY for achieving these goals.
Thousands of residents and fellows across disciplines participated in real-life, real-time QI during the program's first six years. Participation provided an experience that may promote SBP competence and resulted in improved quality of care across the UCSF Medical Center. Similar programs may assist teaching hospitals and GME programs in meeting current and future QI and training mandates.
教学医院努力使医生参与质量改进（QI），而研究生医学教育（GME）计划必须促进学员在基于系统的实践（SBP）方面的能力。作者开发了一项 QI 激励计划，该计划使住院医师和研究员参与其中，为他们提供经济激励，以提高质量，同时获得 SBP 经验。在这项研究中，他们描述并评估了在计划实施的头六年中实现目标的成功。
在 2007 年至 2012 年财政年度（FYs）期间，与加利福尼亚大学旧金山分校（UCSF）的住院医师和研究员共同制定了所有或特定培训计划的 QI 项目目标。数据来自行政数据库，通过图表摘要或通过独立设计的技术收集。
大约有 5275 名住院医师和研究员符合条件并参加了该计划。共完成了 55 个项目。在所有计划的 18 个项目中，有 11 个（61%）在三个领域达到了目标：患者满意度、质量/安全和运营/利用。在 37 个特定计划的项目中，有 28 个（76%）在四个类别中达到了目标：患者层面的干预措施、增强沟通、工作流程改进和有效的文件记录。住院医师和研究员因实现这些目标而平均每 FY 获得 800 美元的奖金。
在计划实施的头六年中，数千名跨学科的住院医师和研究员参与了现实生活中的实时 QI。参与提供了促进 SBP 能力的经验，并导致 UCSF 医疗中心的护理质量得到改善。类似的计划可能会帮助教学医院和 GME 计划满足当前和未来的 QI 和培训要求。
