Abstract Introduction Clinical departments at academic medical centers strive to deliver clinical care, provide education and training, support faculty development, and promote scholarship. These departments have experienced increasing demands to improve the quality, safety, and value of care delivery. However, many academic departments lack a sufficient number of clinical faculty members with expertise in improvement science to lead initiatives, teach, and generate scholarship. In this article, we describe the structure, activities, and early outcomes of a program within an academic department of medicine to promote scholarly improvement work. Methods The Department of Medicine at the University of Vermont Medical Center launched a Quality Program with three primary goals: (a) improve care delivery, (b) provide education and training, and (c) promote scholarship in improvement science. The program serves as a resource center for students, trainees and faculty, offering education and training, analytic support, consultation in design and methodology, and project management. It strives to integrate education, research, and care delivery to learn, apply evidence and improve health care. Results Over the first 3 years of full implementation, the Quality Program supported an average of 123 projects annually, including prospective clinical quality improvement initiatives, retrospective assessment of clinical programs and practices, and curriculum development and evaluation. The projects have yielded a total of 127 scholarly products, defined as peer‐reviewed publications and abstracts, posters, and oral presentations at local, regional, and national conferences. Conclusions The Quality Program may serve as a practical model for promoting care delivery improvement, training, and scholarship in improvement science while advancing the goals of a learning health system at the level of an academic clinical department. Dedicated resources within such departments offer the potential to enhance care delivery while promoting academic success for faculty and trainees in improvement science.

INTRODUCTION:Despite the growing importance of quality improvement (QI) training in medical education, there is a lack of faculty with expertise in QI at many academic medical centers. In this report, we describe the design, implementation, and evaluation of a QI training program for faculty in hospital medicine at an academic medical center aimed at increasing faculty capacity in QI.METHODS:With input from an initial focus group of hospital medicine faculty, we developed a 12-session, active-learning curriculum incorporating core concepts in QI applied to a real-life QI problem. We used a survey instrument to assess changes in self-reported confidence, the Quality Improvement Knowledge Application Tool-Revised to assess changes in applied knowledge, and a second focus group to obtain qualitative feedback regarding the curriculum.RESULTS:Self-reported confidence in numerous QI skills increased after completion of the curriculum; however, concurrent improvement in applied knowledge was not observed. Qualitatively, participants not only described improved understanding of QI methodology and greater confidence contributing to QI initiatives but also a sense they were not prepared to lead a QI project independently.DISCUSSION:An active-learning faculty training program is feasible with limited resources and was associated with increased faculty confidence in QI skills.

Hospital visitor restriction policies prompted by Coronavirus Disease 2019 (COVID-19) may lead to a less comfortable or informed inpatient experience for oncology patients admitted for non-COVID-19 conditions. We surveyed oncology inpatients before (n = 47) and after (n = 65) implementation of a no-visitor policy using a validated questionnaire to measure patient experience. Results revealed no significant difference in the percentage of patients reporting "no problems" (P < .05) in all questions. Patient experience was not adversely impacted by visitor restrictions enacted in response to COVID-19 on an oncology service, as measured by a questionnaire capturing common concerns among inpatients.

Approximately 1.7% of the US population has chronic hepatitis C virus (HCV) infection, but among adults born between 1945 and 1965 prevalence increases to 3.25%, and this birth cohort accounts for almost 75% of the total burden of HCV.1 2 The availability of effective direct-acting antiviral (DAA) therapy for HCV makes screening, linkage to care and treatment a national priority. The Centers for Disease Control and Prevention (CDC) and US Preventative Services Task Force (USPSTF) have recommended one-time HCV screening for persons born between 1945 and 1965,2 3 yet only 14%–17% of this cohort has been screened for HCV.4 5 To improve adherence to HCV screening recommendations for patients hospitalised at our medical centre, the Division of Infectious Diseases (ID) at the University of Vermont Medical Center (UVMMC) undertook a quality improvement (QI) initiative to screen patients born between 1945 and 1965 who were seen by the ID Consultation Service. UVMMC is a 562-bed academic medical centre affiliated with the Robert Larner MD College of Medicine at the University of Vermont (UVM) and serves over 1 million patients in Vermont and New York State. Recognising that the baseline prevalence rate of HCV is 1.45% of adults in Vermont and 1.49% in New York,1 we hypothesised that screening hospitalised patients seen by the ID Consultation Service would increase screening rates, identify undiagnosed HCV infections and link patients to care. We developed a protocol to identify patients born between 1945 and 1965 seen by the ID Consultation Service, perform HCV screening and link patients to outpatient care. All patients receiving a consult were being treated for conditions unrelated to HCV (eg, osteomyelitis, endocarditis, urinary tract infections). ID physicians …

Background Medications for opioid use disorder (MOUD) significantly reduce morbidity and mortality from opioid use disorder (OUD). To prescribe MOUD, physicians must obtain a DEA waiver through requirements outlined in the Drug Addiction Treatment Act of 2000 (DATA 2000). We developed an Addiction Medicine curriculum that features DATA 2000 waiver training at the Robert Larner, MD College of Medicine (LCOM). Methods All third-year medical students completed a virtual DATA 2000 waiver training at the commencement of clinical clerkships. We conducted a curriculum needs assessment followed by pre- and post-training surveys to evaluate MOUD pharmacology knowledge and best prescribing practices. Results Of LCOM students surveyed, 77.6% reported interest in being waivered to prescribed MOUD for OUD treatment. Third-year medical students demonstrated increases in both MOUD Pharmacology Knowledge from 64.2% to 84.8% (chi-squared = 40.8; p < .001) and MOUD Best Prescribing Practices from 55.9% to 75.2% (chi-squared = 29.9; p < .001). Discussion Surveys showed the majority of students felt waiver training was relevant to their future practice. An online DATA 2000 waiver training format effectively improved student knowledge of MOUD. Conclusion: This curriculum exposed medical students to DATA 2000 waiver training, MOUD pharmacology and best practices, and increased the number of future physicians eligible to treat OUD using MOUD.

Background: Young adults, transitioning from pediatric to adult endocrinology clinics, are at risk for adverse events. As these patients assume responsibility for their care, ensuring an effective process for health care transition (HCT) and integration into an adult clinic is imperative. Yet, there is a scarcity of data on implementing HCT best practice guidelines into adult endocrinology care using QI methodology. Objective: To improve the quality of HCTs for young adult patients (18-26 years of age) diagnosed with a variety of endocrinologic conditions by implementing Got Transition’s Six Core Elements of Health Care Transition 2.0 and utilizing the Integrating Young Adults into Adult Health Care toolkit. Methods: A team of pediatric and adult endocrinology clinicians, QI experts, and patient and family advisors (PFAs) was established to guide implementation of the Six Core Elements. Got Transition measurement tools (Current Assessment of Health Care Transition Activities-CAHCTA; Health Care Transition Process Measurement Tool-HCTPMT) were used to establish baseline scores and track progress on a quarterly basis. The team developed a “Welcome Packet” to orient and integrate young adults into adult endocrinology care. QI tools were used to identify current clinical processes and opportunities for system changes through Plan-Do-Study-Act (PDSA) cycles. Results: From October 2019 to July 2020, baseline scores improved on both the CAHCTA by 84.6% (Baseline: 13; Q1: 15; Q2: 23; Q3: 24) and the HCTPMT by 1,250.0% (Baseline: 2; Q1: 16; Q2: 25; Q3: 27). PFAs provided feedback about the Welcome Packet. PDSA Cycle 1 included a “pre-visit” during new patient visits to orient patients to adult endocrinology care using the Welcome Packet. PDSA Cycle 2 focused on piloting the Endocrine Society Patient Self-assessment. Conclusion: The implementation of HCT best practice guidelines using rigorous QI methodology can significantly improve young adults’ integration into adult health care. Disclosure M. P. Gilbert: Consultant; Self; Novo Nordisk. S. G. DeVoe: None. A. G. Kennedy: None. M. Ogelby: None. A. Consigli: None. P. Zimakas: None. A. B. Repp: None. K. J. Robinson: None.

Purpose: The objective of this study was to examine barriers to accessing and utilizing routine preventive health-care checkups for Vermont young adults. Methods: A population-based analysis was conducted using aggregated data from the 2011-2014 Behavioral Risk Factor Surveillance System (BRFSS) surveys of Vermont young adults aged 18-25 years (N = 1,329). Predictors analyzed as barriers were classified county of residence, health-care coverage, and annual household income level, as well as covariates, with the outcome of the length of time since the last routine checkup. Results: A total of 81.1% of Vermont young adults reported having a routine checkup in the past 2 years. Health-care coverage was a predictor of undergoing routine checkups within the past 2 years, with 85.2% of insured respondents undergoing checkups compared with 56.3% of uninsured respondents (p < .001). Additionally, 81.9% of respondents from Vermont counties classified as mostly rural reported undergoing a checkup within the past 2 years (p < .05). A total of 80.8% of respondents from the middle level (p < .05) and 89.0% of respondents from the highest level (p < .001) of annual household incomes reported undergoing a checkup in the past 2 years. Finally, age (p < .001) and sex (p < .01) were shown to indicate receipt of routine preventive checkups more often. Conclusions: For Vermont young adults, health-care coverage, classified county of residence, and household income level were shown to be indicators of undergoing routine preventive health care more often. Further investigation is needed to examine how these barriers may impede preventive screenings, thereby contributing to the ongoing development of health-care guidelines and policies for young adults in rural settings. (c) 2018 Society for Adolescent Health and Medicine. All rights reserved.

Literature on international experiences highlights their significant impact on the development of cross-cultural knowledge and awareness. Using practical examples derived from literature on multiculturalism, the multifaceted dimensions of international experiences are critically reviewed as an essential process for counselors dedicated to utilizing such experiences to enhance their cross-cultural awareness. The authors explore the dimensions of interpersonal and intrapersonal processes, as well as the expanded sense of identity that derives from international experiences. Using materials from the literature and findings from research, the authors expand dialogue on the efficacy of international experiences in contributing to cross-cultural competence.