Jeffrey Glasheen - Academia.edu (original) (raw)

Papers by Jeffrey Glasheen

Archives of Internal Medicine, 2006

Bloomfield et al argue in favor of long hours in medical training and recall a mentor whose caref... more Bloomfield et al argue in favor of long hours in medical training and recall a mentor whose careful supervision ensured quality of care. We believe that the suggestion that resident supervision can entirely prevent problems related to overwork is overly optimistic. There is evidence ...

John Wiley & Sons, Inc. eBooks, Jul 30, 2012

Journal of Hospital Medicine, Jul 1, 2008

T his update reviews key clinical articles for hospitalists published over the past year. Selecti... more T his update reviews key clinical articles for hospitalists published over the past year. Selection criteria include high methodological quality, pertinence to hospital medicine, and likelihood that a change in practice is warranted. Table 1 summarizes practice changes.

Journal of Hospital Medicine, Mar 1, 2015

In this issue of the Journal of Hospital Medicine, the results of 2 inpatient handoff studies fur... more In this issue of the Journal of Hospital Medicine, the results of 2 inpatient handoff studies further shape our evolving understanding of in-hospital care transitions. Schouten and colleagues, 1 report no difference in adverse outcomes when admissions were handed off to the primary team using face-to-face compared to non-face-to-face interactions. Meanwhile, Hanson and colleagues 2 report that a written handoff tool is used infrequently by covering interns. Schouten et al.'s study attempted to isolate the impact of the verbal portion of the handoff between admitting and accepting team by evaluating whether early adverse outcomes differed between patients whose teams performed a face-to-face handoffs compared to those who did not. Their study was a retrospective chart review, and no additional process changes, training, or instruction regarding handoffs were implemented or measured. Handoffs occurred primarily between advanced practice providers, hospitalists, and a small number of resident physicians, so generalizability of this study to other institutions may be limited. No difference in adverse events was noted between admissions with face-to-face compared to those without face-to-face handoffs (2.6% vs 3.2%). Unfortunately, this study was likely underpowered to detect significant changes in adverse events, with a sample size of 805 total patients with a 3% baseline rate of adverse events (by our estimate, over 5000 patients would be needed in each group-10,000 overall-to detect a 30% relative difference in event rates). Further, this study did not examine other outcomes that could be impacted by the handoff process such as provider efficiency or patient experience. Face-to-face handoffs, the gold standard for handoffs between providers, was 1 of the sign-out approaches examined in a study by Graham and colleagues. 3 This study, in contrast to the Schouten et al. study, prospectively evaluated adverse events before and after implementation of face-to-face handoffs, with structured written sign-out from the primary

Archives of internal medicine, Jan 26, 2009

Southern Medical Journal, 2005

International journal of clinical medicine, 2016

Objective: A pharmacist and physician collaborative practice intervention to improve the initial ... more Objective: A pharmacist and physician collaborative practice intervention to improve the initial dosing of vancomycin was implemented with the goal of decreasing the number of subtherapeutic first troughs and increasing the number of therapeutic troughs. Methods: Using the best available evidence, a nomogram was created to determine the initial vancomycin dose. The nomogram utilized actual bodyweight and glomerular filtration rate (eGFR) estimated with the MDRD4 equation. The dose was based on the 2009 ASHP/IDSA/SIDP guidelines, which recommended 15-20 mg/kg every 8-12 hours. Providers ordered "vancomycin IV dosed per pharmacy". Results: The pre-(n = 75) and post-intervention (n = 108) cohorts had similar age, gender distribution, weight, and eGFR. The median total daily vancomycin dose was similar in pre-and post-intervention groups (2000 mg), although the median first trough was higher following the intervention (13.0 vs. 14.8 mcg/ml, p = 0.03). Following the intervention, the proportion of first troughs under 10 mcg/ml decreased (32% to 13%, p = 0.003), while the proportion of troughs in the 10-20 mcg/ml therapeutic range increased (50.7% vs. 69.4%, p = 0.01). There was no difference in the proportion of troughs over 20 mcg/ml (17.3% vs. 17.6%, p = 0.96). Conclusions: A multidisciplinary intervention utilizing a nomogram-based pharmacy collaborative practice model significantly improves the proportion of therapeutic initial vancomycin troughs and decreases the number of subtherapeutic troughs by half.

Archives of Internal Medicine, 2011

... Correspondence: Dr Borne, Internal Medicine, Univer-sity of Colorado Hospital, 12401 E 17th A... more ... Correspondence: Dr Borne, Internal Medicine, Univer-sity of Colorado Hospital, 12401 E 17th Ave, Mail Stop F782, Aurora, CO 80045 (ryan.borne@ucdenver.edu). Financial Disclosure: None reported. ... 2003;138(3):161-167. 3. Coleman EA, Smith JD, Raha D, Min SJ. ...

Journal of Hospital Medicine

BackgroundFew hospitals have built surveillance for diagnostic errors into usual care or used com... more BackgroundFew hospitals have built surveillance for diagnostic errors into usual care or used comparative quantitative and qualitative data to understand their diagnostic processes and implement interventions designed to reduce these errors.ObjectivesTo build surveillance for diagnostic errors into usual care, benchmark diagnostic performance across sites, pilot test interventions, and evaluate the program's impact on diagnostic error rates.Methods and AnalysisAchieving diagnostic excellence through prevention and teamwork (ADEPT) is a multicenter, real‐world quality and safety program utilizing interrupted time‐series techniques to evaluate outcomes. Study subjects will be a randomly sampled population of medical patients hospitalized at 16 US hospitals who died, were transferred to intensive care, or had a rapid response during the hospitalization. Surveillance for diagnostic errors will occur on 10 events per month per site using a previously established two‐person adjudicati...

Journal of General Internal Medicine, Sep 28, 2011

Journal of General Internal Medicine, 2007

BACKGROUND: Increasing complexity of medical care, coupled with limits on resident work hours, ha... more BACKGROUND: Increasing complexity of medical care, coupled with limits on resident work hours, has prompted consideration of extending Internal Medicine training. It is unclear whether further hour reductions and extension of training beyond the current duration of 3 years would be accepted by trainees. OBJECTIVE: We aimed to determine if further workhour reductions and extension of training would be accepted by trainees and whether resident burnout affects their opinions. DESIGN: A postal survey was sent to all 143 Internal Medicine residents at the University of Colorado School of Medicine in May 2004. MEASUREMENTS: The survey contained questions related to opinions on work-hour limits using a 5-point Likert scale ranging from strongly agree to strongly disagree. Burnout was measured using the Maslach Burnout Inventory, organized into three subscales: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment, with burnout defined as high EE or DP. RESULTS: Seventy-four percent (106/143) of residents returned the survey. The vast majority (84%) of residents disagreed or strongly disagreed with extending training to 4 or 5 years. Burnout residents were less averse to extending training (strongly agree or agree, 18.9% vs 4.3%, P = .04). The majority of residents (68.9%) disagreed or strongly disagreed with establishing a 60-hour/week limit. Residents who met the criteria for burnout were more likely to agree that a 60-hour limit would be better than an 80-hour limit (strongly agree or agree, 22% vs 8%, P=.02). CONCLUSIONS: In this program, most Internal Medicine residents are strongly opposed to extending their training to 4 or 5 years and would prefer the current 80 hours/week cap. A longer, less intense pace of Internal Medicine training seems to be less attractive in the eyes of current trainees.

PubMed, Jul 1, 2005

Background: Medication interactions account for a significant proportion of overanticoagulation i... more Background: Medication interactions account for a significant proportion of overanticoagulation in warfarin users. However, little is known about the incidence or degree of interaction with commonly used oral antibiotics. Objective: To investigate the incidence and degree of overanticoagulation associated with commonly used oral antibiotics. Design: Retrospective cohort study of patients using warfarin who initiated an antibiotic (azithromycin, levofloxacin, or trimethoprim/sulfamethoxazole (TMP/SMX)) or terazosin for clinical indications between January 1998 and December 2002. The incidence of international normalized ratio (INR) elevation and the degree of change and bleeding events after institution of either medication type was recorded. Subjects: Patients at a university-affiliated Veteran's Affairs Medical Center. Results: The mean change in INR was -0.15 for terazosin, 0.51 for azithromycin, 0.85 for levofloxacin, and 1.76 for TMP/SMX. These mean INR changes in the antibiotic groups were all statistically different from the terazosin group. The incidence of supratherapeutic INR was 5% for terazosin, 31% for azithromycin, 33% for levofloxacin, and 69% for TMP/SMX. The incidence of absolute INR >4.0 was 0% for terazosin, 16% for azithromycin, 19% for levofloxacin, and 44% for TMP/SMX. Conclusions: Among acutely ill outpatients, oral antibiotics (azithromycin, levofloxacin, and TMP/SMX) increase the incidence and degree of overanticoagulation.

Hospital Medicine Clinics, 2016

The American Journal of Medicine, Jul 1, 2007

Pharmacotherapy, Aug 1, 2003

To evaluate the effect of levofloxacin coadministration on the international normalized ratio (IN... more To evaluate the effect of levofloxacin coadministration on the international normalized ratio (INR) in patients receiving warfarin therapy. Prospective analysis. Outpatient clinic at a Veterans Affairs medical center. Eighteen adult patients receiving warfarin. On the basis of clinical diagnosis and judgment, levofloxacin was prescribed to the 18 patients for treatment of various types of infection. The INR was measured before and at 2-8-day intervals after the coadministration of levofloxacin therapy, and once after completing therapy. Warfarin dosages were adjusted when necessary. Warfarin dosages were changed in seven patients as a result of the first nontherapeutic INR values obtained after start of levofloxacin therapy. Owing to a concern regarding noncompliance and the adverse effect of bleeding, warfarin dosage was adjusted in one patient even though his first INR value was in the high end of the therapeutic range (2.98, therapeutic range 2-3). One patient withdrew from the study after the first INR measurement after levofloxacin coadministration. Because of a concern about the possible bleeding complication, warfarin dosage was also adjusted in this patient after obtaining his first INR value. Therefore, only the INR values obtained before and the first INR values obtained after levofloxacin administration were compared to evaluate the effect of levofloxacin on INR determination of warfarin therapy. The INR values obtained before levofloxacin administration did not differ significantly from the first INR values obtained after levofloxacin coadministration (mean +/- SD 2.61 +/- 0.44 vs 2.74 +/- 0.83, 95% confidence interval -0.449-0.196, p=0.419). The INR values measured before and after concomitant levofloxacin therapy were not significantly different. However, the ability to detect a significant difference may be affected by the small number of patients studied. Further studies with a larger sample are required to better determine the effect of levofloxacin coadministration on INR monitoring during warfarin therapy

Journal of Hospital Medicine, Jun 30, 2015

Journal of Graduate Medical Education

Background The growth of hospital medicine has resulted in a parallel growth of hospital medicine... more Background The growth of hospital medicine has resulted in a parallel growth of hospital medicine training within internal medicine residency programs (IMRPs), but the experience and outcomes of these training offerings have not yet been described. Objective To describe the first dedicated hospitalist track and the program evaluation data. Methods The University of Colorado Hospitalist Training Track (HTT) is a 3-year track within the IMRP with robust inpatient clinical training, specialized didactics, experiential improvement work, and career mentorship. We collected data on graduates' current practices and board certification pass rates. To further evaluate the track, we electronically sent a cross-sectional survey to 124 graduates from 2005 to 2019 to identify current practice settings, graduate roles, and assessment of the training track. Results Among 124 graduates, 97 (78.2%) practice hospital medicine, and the board certification pass rate was slightly higher than the ove...

American Journal of Medical Quality, 2021

Training in leadership and health system transformation is increasingly important in undergraduat... more Training in leadership and health system transformation is increasingly important in undergraduate medical education in order to develop a pipeline of engaged physicians dedicated to transforming health care. Despite this growing need, it is unclear whether current leadership training methods have long-term impact on students' career trajectory. The authors analyzed career outcomes from 6 years of the Health Innovations Scholars Program (HISP) to better understand how the program affected the 46 graduates' future involvement in health system transformation and leadership. Eighty-eight percent of the graduates remained involved in quality improvement, 70% held leadership positions, 31% participated in health innovation, and 15% participated in patient safety initiatives. Project involvement of the graduates represented both primary and secondary catalysts for health system change, leading to 28 unique catalyst events. HISP is a model for directing trainees' career trajectory toward engagement in health system leadership and redesign.

American Journal of Medical Quality, 2021

Despite decades of effort to drive quality improvement, many health care organizations still stru... more Despite decades of effort to drive quality improvement, many health care organizations still struggle to optimize their performance on quality metrics. The advent of publicly reported quality rankings and ratings allows for greater visibility of overall organizational performance, but has not provided a roadmap for sustained improvement in these assessments. Most quality training programs have focused on developing knowledge and skills in pursuit of individual and project-level improvements. To date, no training program has been associated with improvements in overall organization-level, publicly reported measures. In 2012, the Institute for Health care Quality, Safety, and Efficiency was launched, which is an integrated set of quality and safety training programs, with a focus on leadership development and support of performance improvement through data analytics and intensive coaching. This effort has trained nearly 2000 individuals and has been associated with significant improvement in organization-level quality rankings and ratings, offering a framework for organizations seeking systematic, long-term improvement.

Archives of Internal Medicine, 2006

Bloomfield et al argue in favor of long hours in medical training and recall a mentor whose caref... more Bloomfield et al argue in favor of long hours in medical training and recall a mentor whose careful supervision ensured quality of care. We believe that the suggestion that resident supervision can entirely prevent problems related to overwork is overly optimistic. There is evidence ...

John Wiley & Sons, Inc. eBooks, Jul 30, 2012

Journal of Hospital Medicine, Jul 1, 2008

T his update reviews key clinical articles for hospitalists published over the past year. Selecti... more T his update reviews key clinical articles for hospitalists published over the past year. Selection criteria include high methodological quality, pertinence to hospital medicine, and likelihood that a change in practice is warranted. Table 1 summarizes practice changes.

Journal of Hospital Medicine, Mar 1, 2015

In this issue of the Journal of Hospital Medicine, the results of 2 inpatient handoff studies fur... more In this issue of the Journal of Hospital Medicine, the results of 2 inpatient handoff studies further shape our evolving understanding of in-hospital care transitions. Schouten and colleagues, 1 report no difference in adverse outcomes when admissions were handed off to the primary team using face-to-face compared to non-face-to-face interactions. Meanwhile, Hanson and colleagues 2 report that a written handoff tool is used infrequently by covering interns. Schouten et al.'s study attempted to isolate the impact of the verbal portion of the handoff between admitting and accepting team by evaluating whether early adverse outcomes differed between patients whose teams performed a face-to-face handoffs compared to those who did not. Their study was a retrospective chart review, and no additional process changes, training, or instruction regarding handoffs were implemented or measured. Handoffs occurred primarily between advanced practice providers, hospitalists, and a small number of resident physicians, so generalizability of this study to other institutions may be limited. No difference in adverse events was noted between admissions with face-to-face compared to those without face-to-face handoffs (2.6% vs 3.2%). Unfortunately, this study was likely underpowered to detect significant changes in adverse events, with a sample size of 805 total patients with a 3% baseline rate of adverse events (by our estimate, over 5000 patients would be needed in each group-10,000 overall-to detect a 30% relative difference in event rates). Further, this study did not examine other outcomes that could be impacted by the handoff process such as provider efficiency or patient experience. Face-to-face handoffs, the gold standard for handoffs between providers, was 1 of the sign-out approaches examined in a study by Graham and colleagues. 3 This study, in contrast to the Schouten et al. study, prospectively evaluated adverse events before and after implementation of face-to-face handoffs, with structured written sign-out from the primary

Archives of internal medicine, Jan 26, 2009

Southern Medical Journal, 2005

International journal of clinical medicine, 2016

Objective: A pharmacist and physician collaborative practice intervention to improve the initial ... more Objective: A pharmacist and physician collaborative practice intervention to improve the initial dosing of vancomycin was implemented with the goal of decreasing the number of subtherapeutic first troughs and increasing the number of therapeutic troughs. Methods: Using the best available evidence, a nomogram was created to determine the initial vancomycin dose. The nomogram utilized actual bodyweight and glomerular filtration rate (eGFR) estimated with the MDRD4 equation. The dose was based on the 2009 ASHP/IDSA/SIDP guidelines, which recommended 15-20 mg/kg every 8-12 hours. Providers ordered "vancomycin IV dosed per pharmacy". Results: The pre-(n = 75) and post-intervention (n = 108) cohorts had similar age, gender distribution, weight, and eGFR. The median total daily vancomycin dose was similar in pre-and post-intervention groups (2000 mg), although the median first trough was higher following the intervention (13.0 vs. 14.8 mcg/ml, p = 0.03). Following the intervention, the proportion of first troughs under 10 mcg/ml decreased (32% to 13%, p = 0.003), while the proportion of troughs in the 10-20 mcg/ml therapeutic range increased (50.7% vs. 69.4%, p = 0.01). There was no difference in the proportion of troughs over 20 mcg/ml (17.3% vs. 17.6%, p = 0.96). Conclusions: A multidisciplinary intervention utilizing a nomogram-based pharmacy collaborative practice model significantly improves the proportion of therapeutic initial vancomycin troughs and decreases the number of subtherapeutic troughs by half.

Archives of Internal Medicine, 2011

... Correspondence: Dr Borne, Internal Medicine, Univer-sity of Colorado Hospital, 12401 E 17th A... more ... Correspondence: Dr Borne, Internal Medicine, Univer-sity of Colorado Hospital, 12401 E 17th Ave, Mail Stop F782, Aurora, CO 80045 (ryan.borne@ucdenver.edu). Financial Disclosure: None reported. ... 2003;138(3):161-167. 3. Coleman EA, Smith JD, Raha D, Min SJ. ...

Journal of Hospital Medicine

BackgroundFew hospitals have built surveillance for diagnostic errors into usual care or used com... more BackgroundFew hospitals have built surveillance for diagnostic errors into usual care or used comparative quantitative and qualitative data to understand their diagnostic processes and implement interventions designed to reduce these errors.ObjectivesTo build surveillance for diagnostic errors into usual care, benchmark diagnostic performance across sites, pilot test interventions, and evaluate the program's impact on diagnostic error rates.Methods and AnalysisAchieving diagnostic excellence through prevention and teamwork (ADEPT) is a multicenter, real‐world quality and safety program utilizing interrupted time‐series techniques to evaluate outcomes. Study subjects will be a randomly sampled population of medical patients hospitalized at 16 US hospitals who died, were transferred to intensive care, or had a rapid response during the hospitalization. Surveillance for diagnostic errors will occur on 10 events per month per site using a previously established two‐person adjudicati...

Journal of General Internal Medicine, Sep 28, 2011

Journal of General Internal Medicine, 2007

BACKGROUND: Increasing complexity of medical care, coupled with limits on resident work hours, ha... more BACKGROUND: Increasing complexity of medical care, coupled with limits on resident work hours, has prompted consideration of extending Internal Medicine training. It is unclear whether further hour reductions and extension of training beyond the current duration of 3 years would be accepted by trainees. OBJECTIVE: We aimed to determine if further workhour reductions and extension of training would be accepted by trainees and whether resident burnout affects their opinions. DESIGN: A postal survey was sent to all 143 Internal Medicine residents at the University of Colorado School of Medicine in May 2004. MEASUREMENTS: The survey contained questions related to opinions on work-hour limits using a 5-point Likert scale ranging from strongly agree to strongly disagree. Burnout was measured using the Maslach Burnout Inventory, organized into three subscales: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment, with burnout defined as high EE or DP. RESULTS: Seventy-four percent (106/143) of residents returned the survey. The vast majority (84%) of residents disagreed or strongly disagreed with extending training to 4 or 5 years. Burnout residents were less averse to extending training (strongly agree or agree, 18.9% vs 4.3%, P = .04). The majority of residents (68.9%) disagreed or strongly disagreed with establishing a 60-hour/week limit. Residents who met the criteria for burnout were more likely to agree that a 60-hour limit would be better than an 80-hour limit (strongly agree or agree, 22% vs 8%, P=.02). CONCLUSIONS: In this program, most Internal Medicine residents are strongly opposed to extending their training to 4 or 5 years and would prefer the current 80 hours/week cap. A longer, less intense pace of Internal Medicine training seems to be less attractive in the eyes of current trainees.

PubMed, Jul 1, 2005

Background: Medication interactions account for a significant proportion of overanticoagulation i... more Background: Medication interactions account for a significant proportion of overanticoagulation in warfarin users. However, little is known about the incidence or degree of interaction with commonly used oral antibiotics. Objective: To investigate the incidence and degree of overanticoagulation associated with commonly used oral antibiotics. Design: Retrospective cohort study of patients using warfarin who initiated an antibiotic (azithromycin, levofloxacin, or trimethoprim/sulfamethoxazole (TMP/SMX)) or terazosin for clinical indications between January 1998 and December 2002. The incidence of international normalized ratio (INR) elevation and the degree of change and bleeding events after institution of either medication type was recorded. Subjects: Patients at a university-affiliated Veteran's Affairs Medical Center. Results: The mean change in INR was -0.15 for terazosin, 0.51 for azithromycin, 0.85 for levofloxacin, and 1.76 for TMP/SMX. These mean INR changes in the antibiotic groups were all statistically different from the terazosin group. The incidence of supratherapeutic INR was 5% for terazosin, 31% for azithromycin, 33% for levofloxacin, and 69% for TMP/SMX. The incidence of absolute INR >4.0 was 0% for terazosin, 16% for azithromycin, 19% for levofloxacin, and 44% for TMP/SMX. Conclusions: Among acutely ill outpatients, oral antibiotics (azithromycin, levofloxacin, and TMP/SMX) increase the incidence and degree of overanticoagulation.

Hospital Medicine Clinics, 2016

The American Journal of Medicine, Jul 1, 2007

Pharmacotherapy, Aug 1, 2003

To evaluate the effect of levofloxacin coadministration on the international normalized ratio (IN... more To evaluate the effect of levofloxacin coadministration on the international normalized ratio (INR) in patients receiving warfarin therapy. Prospective analysis. Outpatient clinic at a Veterans Affairs medical center. Eighteen adult patients receiving warfarin. On the basis of clinical diagnosis and judgment, levofloxacin was prescribed to the 18 patients for treatment of various types of infection. The INR was measured before and at 2-8-day intervals after the coadministration of levofloxacin therapy, and once after completing therapy. Warfarin dosages were adjusted when necessary. Warfarin dosages were changed in seven patients as a result of the first nontherapeutic INR values obtained after start of levofloxacin therapy. Owing to a concern regarding noncompliance and the adverse effect of bleeding, warfarin dosage was adjusted in one patient even though his first INR value was in the high end of the therapeutic range (2.98, therapeutic range 2-3). One patient withdrew from the study after the first INR measurement after levofloxacin coadministration. Because of a concern about the possible bleeding complication, warfarin dosage was also adjusted in this patient after obtaining his first INR value. Therefore, only the INR values obtained before and the first INR values obtained after levofloxacin administration were compared to evaluate the effect of levofloxacin on INR determination of warfarin therapy. The INR values obtained before levofloxacin administration did not differ significantly from the first INR values obtained after levofloxacin coadministration (mean +/- SD 2.61 +/- 0.44 vs 2.74 +/- 0.83, 95% confidence interval -0.449-0.196, p=0.419). The INR values measured before and after concomitant levofloxacin therapy were not significantly different. However, the ability to detect a significant difference may be affected by the small number of patients studied. Further studies with a larger sample are required to better determine the effect of levofloxacin coadministration on INR monitoring during warfarin therapy

Journal of Hospital Medicine, Jun 30, 2015

Journal of Graduate Medical Education

Background The growth of hospital medicine has resulted in a parallel growth of hospital medicine... more Background The growth of hospital medicine has resulted in a parallel growth of hospital medicine training within internal medicine residency programs (IMRPs), but the experience and outcomes of these training offerings have not yet been described. Objective To describe the first dedicated hospitalist track and the program evaluation data. Methods The University of Colorado Hospitalist Training Track (HTT) is a 3-year track within the IMRP with robust inpatient clinical training, specialized didactics, experiential improvement work, and career mentorship. We collected data on graduates' current practices and board certification pass rates. To further evaluate the track, we electronically sent a cross-sectional survey to 124 graduates from 2005 to 2019 to identify current practice settings, graduate roles, and assessment of the training track. Results Among 124 graduates, 97 (78.2%) practice hospital medicine, and the board certification pass rate was slightly higher than the ove...

American Journal of Medical Quality, 2021

Training in leadership and health system transformation is increasingly important in undergraduat... more Training in leadership and health system transformation is increasingly important in undergraduate medical education in order to develop a pipeline of engaged physicians dedicated to transforming health care. Despite this growing need, it is unclear whether current leadership training methods have long-term impact on students' career trajectory. The authors analyzed career outcomes from 6 years of the Health Innovations Scholars Program (HISP) to better understand how the program affected the 46 graduates' future involvement in health system transformation and leadership. Eighty-eight percent of the graduates remained involved in quality improvement, 70% held leadership positions, 31% participated in health innovation, and 15% participated in patient safety initiatives. Project involvement of the graduates represented both primary and secondary catalysts for health system change, leading to 28 unique catalyst events. HISP is a model for directing trainees' career trajectory toward engagement in health system leadership and redesign.

American Journal of Medical Quality, 2021

Despite decades of effort to drive quality improvement, many health care organizations still stru... more Despite decades of effort to drive quality improvement, many health care organizations still struggle to optimize their performance on quality metrics. The advent of publicly reported quality rankings and ratings allows for greater visibility of overall organizational performance, but has not provided a roadmap for sustained improvement in these assessments. Most quality training programs have focused on developing knowledge and skills in pursuit of individual and project-level improvements. To date, no training program has been associated with improvements in overall organization-level, publicly reported measures. In 2012, the Institute for Health care Quality, Safety, and Efficiency was launched, which is an integrated set of quality and safety training programs, with a focus on leadership development and support of performance improvement through data analytics and intensive coaching. This effort has trained nearly 2000 individuals and has been associated with significant improvement in organization-level quality rankings and ratings, offering a framework for organizations seeking systematic, long-term improvement.