Melissa Stevens, MD (Hospital Medicine) Watch video
Topic: "Use of High Risk Medications in the Elderly in the Emergency Department Setting: A Quality Improvement Initiative"
With support from a Department of Medicine FAME (Fostering the Academic Mission at Emory) grant in 2012, Dr. Stevens implemented a multicomponent quality improvement program to facilitate safer prescribing at ED discharge through education, ‘geriatricized’ medication order sets (inspired by the Beers criteria – named for geriatrician Mark Beers), and provider audit and feedback with peer benchmarking. When funding became available through the VA’s Geriatric Research Education and Clinical Centers (GRECCs) to promote clinical demonstration projects aimed at optimizing care for older Veterans, Dr. Stevens teamed up with Emory geriatrician and GRECC investigator, Camille Vaughan (another 2006 alumna), to expand the program, now called EQUIPPED (Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department).
EQUIPPED has been continuously funded by VA since 2012 and is now being implemented in 8 VA EDs (including VA GRECCs affiliated with UAB, Vanderbilt, Duke, and Icahn School of Medicine at Mount Sinai). Results from Atlanta were published in the Journal of the American Geriatrics Society in May 2015 demonstrating a 50% relative reduction in inappropriate prescriptions for older adults discharged from the ED. EQUIPPED was awarded a 2014 John A. Hartford Foundation pilot grant to expand outside the VA and the team, led by Drs. Vaughan and Stevens, has a proposal currently under review with AHRQ.
Read the 2017 EQUiPPED article and the 2015 article on preliminary results from the first VA sites.
Robin Klein, MD (General Medicine)
Topic: Scholarship in Primary Care - new curriculum that focuses on promoting scholastic endeavors by the primary care residents
"The curriculum has been very successful. Residents have given dozens of presentations at meetings, earned awards and been part of many publications. What I take away from this experience is that scholarship and research can be interesting and useful to a variety of residents with different career goals. To achieve this it is vital to think broadly about scholarship to include clinical research, quality work, practice application, outcomes research, and medical education scholarship. Our curriculum is now funded by a federal training grant. New layers are added to the curriculum with each class of residents. Currently, I am looking at the impact of the curriculum on trainees and graduates."
Lesley Miller, MD (General Medicine)
Topic: Cutting losses: Investigating reasons for sub-optimal Liver Clinic follow-up and testing strategies to improve continuity of care
"We learned that appointment keeping was not related to their concerns about their disease, or logistical factors, but was related to clinic factors such as interval between appointments and lack of reminder phone calls. We implemented changes in the Liver Clinic based on these results, i.e., reminder phone calls and efforts to minimize intervals between appointments. The FAME project has also laid the groundwork for additional extramural grant applications/funding for other Grady Liver Clinic projects."
Vandana Niyyar, MD (Nephrology)
Topic: Does early intervention by a multi-disciplinary vascular access team improve arteriovenous fistula prevalence rate in a dialysis population?
"With the encouraging results from the FAME grant, we improved the quality of care for our hemodialysis patients. Not only do the patients in our protocol have a better access for chronic hemodialysis, but this has encouraged us to consider the expansion of this project to other hemodialysis units at Emory. A subsequent project in collaboration with the CDC focuses on decreasing the incidence of bloodstream infections in chronic hemodialysis patients by instituting preventive measures and participation in a national BSI prevention program, augmented by a social and behavioral change process to enlist staff members in infection prevention."