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Different perspectives on the care delivery process
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
Last month I was able to conduct five interviews with key stakeholders, generate the patient flow diagram, define the problems, and propose potential interventions. The project is on time for the allotted time frame.
Interviewees include physicians and managers from infectious disease, hospital medicine, psychiatry and care management. They represent the services which admitted IVDU patients have contacts with: inpatient primary team, inpatient ID consult time, BIT (behavior intervention team), and OPAT (Outpatient Parenteral Antibiotic Therapy) program. I asked each interviewee about the specific challenges of care delivery during the inpatient, discharge, and outpatient follow up process.
It is not surprising that most would agree that discharge was the most difficult part. The ID service showed me data that those with IVDU history may have a one-time longer length of stay compared to the average. The social-psychological issues, including medication compliance, insurance coverage, and mental health comorbidities, are the most commonly mentioned factor for delayed discharge.
When asked about a suggestion for a particular area for quality improvement, different services came up with different recommendations. ID suggested looking at availability of community resources and improving patients’ access to them. Psychiatry has been trying to screen all admitted patients for substance use disorders, with an intention of early intervention. Hospital medicine and care management were contemplating the potential means for a repatriation program, i.e., making the transferring acute care facility agree to receive patients back once tertiary care was complete. Given that Dartmouth-Hitchcock Medical Center has a few satellite community hospitals, it would make sense to establish some institutional protocol to optimize patient flow within the system.
My next step would be to pursue one or two areas for improvement from the above options. I will work with the relevant stakeholders to define the problems and come up with a plan. I am excited about moving forward to the next phase.
My research approach has changed slightly during the process. Initially I was narrowly focused on the desired outcomes of decreasing length of stay and readmission rate. Dr. Huntington challenged me to understand the whole process thoroughly as well as to spend time on defining the problems before diving into interventions. I enjoyed my role of being a learner, researcher, and consultant in this project. I gained a very in-depth perspective on how each service operates and coordinates. Also, it is both challenging and fun to coming up with an improvement plan. In my future residency and physician career, I am definitely going to pursue more care improvement initiatives.
Yun Li is an MD/MBA student attending Geisel School of Medicine and Tuck School of Business at Dartmouth. She obtained her Bachelor of Arts degree from Hanover College double-majoring in Economics and Biological Chemistry. Ms. Li participated in research in injury epidemiology and genetics, and has conducted studies on traditional Tibetan medicine, rural health, health NGOs, and digital health. Her career interest is practicing hospital medicine and geriatrics as a clinician/administrator, either in the US or China. Ms. Li is a student member of the Society of Hospital Medicine.
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
Last month I was able to conduct five interviews with key stakeholders, generate the patient flow diagram, define the problems, and propose potential interventions. The project is on time for the allotted time frame.
Interviewees include physicians and managers from infectious disease, hospital medicine, psychiatry and care management. They represent the services which admitted IVDU patients have contacts with: inpatient primary team, inpatient ID consult time, BIT (behavior intervention team), and OPAT (Outpatient Parenteral Antibiotic Therapy) program. I asked each interviewee about the specific challenges of care delivery during the inpatient, discharge, and outpatient follow up process.
It is not surprising that most would agree that discharge was the most difficult part. The ID service showed me data that those with IVDU history may have a one-time longer length of stay compared to the average. The social-psychological issues, including medication compliance, insurance coverage, and mental health comorbidities, are the most commonly mentioned factor for delayed discharge.
When asked about a suggestion for a particular area for quality improvement, different services came up with different recommendations. ID suggested looking at availability of community resources and improving patients’ access to them. Psychiatry has been trying to screen all admitted patients for substance use disorders, with an intention of early intervention. Hospital medicine and care management were contemplating the potential means for a repatriation program, i.e., making the transferring acute care facility agree to receive patients back once tertiary care was complete. Given that Dartmouth-Hitchcock Medical Center has a few satellite community hospitals, it would make sense to establish some institutional protocol to optimize patient flow within the system.
My next step would be to pursue one or two areas for improvement from the above options. I will work with the relevant stakeholders to define the problems and come up with a plan. I am excited about moving forward to the next phase.
My research approach has changed slightly during the process. Initially I was narrowly focused on the desired outcomes of decreasing length of stay and readmission rate. Dr. Huntington challenged me to understand the whole process thoroughly as well as to spend time on defining the problems before diving into interventions. I enjoyed my role of being a learner, researcher, and consultant in this project. I gained a very in-depth perspective on how each service operates and coordinates. Also, it is both challenging and fun to coming up with an improvement plan. In my future residency and physician career, I am definitely going to pursue more care improvement initiatives.
Yun Li is an MD/MBA student attending Geisel School of Medicine and Tuck School of Business at Dartmouth. She obtained her Bachelor of Arts degree from Hanover College double-majoring in Economics and Biological Chemistry. Ms. Li participated in research in injury epidemiology and genetics, and has conducted studies on traditional Tibetan medicine, rural health, health NGOs, and digital health. Her career interest is practicing hospital medicine and geriatrics as a clinician/administrator, either in the US or China. Ms. Li is a student member of the Society of Hospital Medicine.
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
Last month I was able to conduct five interviews with key stakeholders, generate the patient flow diagram, define the problems, and propose potential interventions. The project is on time for the allotted time frame.
Interviewees include physicians and managers from infectious disease, hospital medicine, psychiatry and care management. They represent the services which admitted IVDU patients have contacts with: inpatient primary team, inpatient ID consult time, BIT (behavior intervention team), and OPAT (Outpatient Parenteral Antibiotic Therapy) program. I asked each interviewee about the specific challenges of care delivery during the inpatient, discharge, and outpatient follow up process.
It is not surprising that most would agree that discharge was the most difficult part. The ID service showed me data that those with IVDU history may have a one-time longer length of stay compared to the average. The social-psychological issues, including medication compliance, insurance coverage, and mental health comorbidities, are the most commonly mentioned factor for delayed discharge.
When asked about a suggestion for a particular area for quality improvement, different services came up with different recommendations. ID suggested looking at availability of community resources and improving patients’ access to them. Psychiatry has been trying to screen all admitted patients for substance use disorders, with an intention of early intervention. Hospital medicine and care management were contemplating the potential means for a repatriation program, i.e., making the transferring acute care facility agree to receive patients back once tertiary care was complete. Given that Dartmouth-Hitchcock Medical Center has a few satellite community hospitals, it would make sense to establish some institutional protocol to optimize patient flow within the system.
My next step would be to pursue one or two areas for improvement from the above options. I will work with the relevant stakeholders to define the problems and come up with a plan. I am excited about moving forward to the next phase.
My research approach has changed slightly during the process. Initially I was narrowly focused on the desired outcomes of decreasing length of stay and readmission rate. Dr. Huntington challenged me to understand the whole process thoroughly as well as to spend time on defining the problems before diving into interventions. I enjoyed my role of being a learner, researcher, and consultant in this project. I gained a very in-depth perspective on how each service operates and coordinates. Also, it is both challenging and fun to coming up with an improvement plan. In my future residency and physician career, I am definitely going to pursue more care improvement initiatives.
Yun Li is an MD/MBA student attending Geisel School of Medicine and Tuck School of Business at Dartmouth. She obtained her Bachelor of Arts degree from Hanover College double-majoring in Economics and Biological Chemistry. Ms. Li participated in research in injury epidemiology and genetics, and has conducted studies on traditional Tibetan medicine, rural health, health NGOs, and digital health. Her career interest is practicing hospital medicine and geriatrics as a clinician/administrator, either in the US or China. Ms. Li is a student member of the Society of Hospital Medicine.
Understanding patient process flow
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
This phase of the QI project aims at a thorough understanding of the process flow of a patient, from being transferred from outside the hospital, receiving tertiary care services at Dartmouth-Hitchcock Medical Center, to being discharged to a rehabilitation facility/skilled nursing facility.
I am conducting interviews with key stakeholders to understand the current processes and needs for improvement. The key stakeholders include but are not limited to infectious disease, hospital medicine, nursing, case management, and psychiatry services.
I have developed an interview guide to facilitate the interviews. Based on a framework similar to SWOT analysis, the key questions include: (1) what makes this patient population particularly difficult to receive appropriate care/support? (2) What makes them difficult to be discharged when tertiary service is completed? (3) What can help them stay longer in the community and delay/prevent readmission?
I am working on retrieving clinical data from medical records and an infectious disease service database, and am going to analyze current patient status. Key metrics will include but not limited to length of stay, 30‐day readmission rate, patient satisfaction rating, infectious disease provider follow-up rate, and hospitalization cost.
A challenge I foresee I will encounter is deciding on a focused area for the improvement project. The constraints may be coming from clinical data availability or the willingness for the stakeholder to participate. For this purpose, I am going to ask each stakeholder about their priorities, and what they view as the most urgent or important aspects to improve. I also hope to identify stakeholders who might already have been thinking or working on improving care for this patient population.
I will address the data availability issue by following up closely with the infectious disease service. After I develop a general sense of the data, I will work with the interdisciplinary team to decide on a focused area for improvement.
One unexpected thing I learned during the last month was project planning. Initially, I was struggling with putting the details of the project together. I recalled later that at business school we often use timelines to facilitate project planning. I carved out two hours of my time. On a piece of paper, I wrote down one-by-one the tasks I need to accomplish for each phase of the study. I also set up an internal deadline for communications and deliverables with my advisor. Now I can track my progress much better and am confident that the project will move towards its landmarks.
Yun Li is an MD/MBA student attending Geisel School of Medicine and Tuck School of Business at Dartmouth. She obtained her Bachelor of Arts degree from Hanover College double-majoring in Economics and Biological Chemistry. Ms. Li participated in research in injury epidemiology and genetics, and has conducted studies on traditional Tibetan medicine, rural health, health NGOs, and digital health. Her career interest is practicing hospital medicine and geriatrics as a clinician/administrator, either in the US or China. Ms. Li is a student member of the Society of Hospital Medicine.
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
This phase of the QI project aims at a thorough understanding of the process flow of a patient, from being transferred from outside the hospital, receiving tertiary care services at Dartmouth-Hitchcock Medical Center, to being discharged to a rehabilitation facility/skilled nursing facility.
I am conducting interviews with key stakeholders to understand the current processes and needs for improvement. The key stakeholders include but are not limited to infectious disease, hospital medicine, nursing, case management, and psychiatry services.
I have developed an interview guide to facilitate the interviews. Based on a framework similar to SWOT analysis, the key questions include: (1) what makes this patient population particularly difficult to receive appropriate care/support? (2) What makes them difficult to be discharged when tertiary service is completed? (3) What can help them stay longer in the community and delay/prevent readmission?
I am working on retrieving clinical data from medical records and an infectious disease service database, and am going to analyze current patient status. Key metrics will include but not limited to length of stay, 30‐day readmission rate, patient satisfaction rating, infectious disease provider follow-up rate, and hospitalization cost.
A challenge I foresee I will encounter is deciding on a focused area for the improvement project. The constraints may be coming from clinical data availability or the willingness for the stakeholder to participate. For this purpose, I am going to ask each stakeholder about their priorities, and what they view as the most urgent or important aspects to improve. I also hope to identify stakeholders who might already have been thinking or working on improving care for this patient population.
I will address the data availability issue by following up closely with the infectious disease service. After I develop a general sense of the data, I will work with the interdisciplinary team to decide on a focused area for improvement.
One unexpected thing I learned during the last month was project planning. Initially, I was struggling with putting the details of the project together. I recalled later that at business school we often use timelines to facilitate project planning. I carved out two hours of my time. On a piece of paper, I wrote down one-by-one the tasks I need to accomplish for each phase of the study. I also set up an internal deadline for communications and deliverables with my advisor. Now I can track my progress much better and am confident that the project will move towards its landmarks.
Yun Li is an MD/MBA student attending Geisel School of Medicine and Tuck School of Business at Dartmouth. She obtained her Bachelor of Arts degree from Hanover College double-majoring in Economics and Biological Chemistry. Ms. Li participated in research in injury epidemiology and genetics, and has conducted studies on traditional Tibetan medicine, rural health, health NGOs, and digital health. Her career interest is practicing hospital medicine and geriatrics as a clinician/administrator, either in the US or China. Ms. Li is a student member of the Society of Hospital Medicine.
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
This phase of the QI project aims at a thorough understanding of the process flow of a patient, from being transferred from outside the hospital, receiving tertiary care services at Dartmouth-Hitchcock Medical Center, to being discharged to a rehabilitation facility/skilled nursing facility.
I am conducting interviews with key stakeholders to understand the current processes and needs for improvement. The key stakeholders include but are not limited to infectious disease, hospital medicine, nursing, case management, and psychiatry services.
I have developed an interview guide to facilitate the interviews. Based on a framework similar to SWOT analysis, the key questions include: (1) what makes this patient population particularly difficult to receive appropriate care/support? (2) What makes them difficult to be discharged when tertiary service is completed? (3) What can help them stay longer in the community and delay/prevent readmission?
I am working on retrieving clinical data from medical records and an infectious disease service database, and am going to analyze current patient status. Key metrics will include but not limited to length of stay, 30‐day readmission rate, patient satisfaction rating, infectious disease provider follow-up rate, and hospitalization cost.
A challenge I foresee I will encounter is deciding on a focused area for the improvement project. The constraints may be coming from clinical data availability or the willingness for the stakeholder to participate. For this purpose, I am going to ask each stakeholder about their priorities, and what they view as the most urgent or important aspects to improve. I also hope to identify stakeholders who might already have been thinking or working on improving care for this patient population.
I will address the data availability issue by following up closely with the infectious disease service. After I develop a general sense of the data, I will work with the interdisciplinary team to decide on a focused area for improvement.
One unexpected thing I learned during the last month was project planning. Initially, I was struggling with putting the details of the project together. I recalled later that at business school we often use timelines to facilitate project planning. I carved out two hours of my time. On a piece of paper, I wrote down one-by-one the tasks I need to accomplish for each phase of the study. I also set up an internal deadline for communications and deliverables with my advisor. Now I can track my progress much better and am confident that the project will move towards its landmarks.
Yun Li is an MD/MBA student attending Geisel School of Medicine and Tuck School of Business at Dartmouth. She obtained her Bachelor of Arts degree from Hanover College double-majoring in Economics and Biological Chemistry. Ms. Li participated in research in injury epidemiology and genetics, and has conducted studies on traditional Tibetan medicine, rural health, health NGOs, and digital health. Her career interest is practicing hospital medicine and geriatrics as a clinician/administrator, either in the US or China. Ms. Li is a student member of the Society of Hospital Medicine.
Thinking about the basic science of quality improvement
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
I reviewed recent literature about my research topic, which is clinical pathways for hospitalized injection drug users due to injection-related infection sequelae and came up with my research proposal. As part of a scholarly pursuit, I believe having a theoretical background of quality improvement to be important. Before further diving into the research topic, I also generated a small reading list of the “basic science” of quality improvement, which covers topics of general operational science and those in health care applications.
What makes standardization in health care difficult? In my operations class at Tuck School of Business, we watched a video showing former Soviet Union ophthalmologists performing “assembly line” cataract surgery. It includes multiple surgeons sitting around multiple rotating tables, each surgeon performing exactly one step of the cataract surgery. I recall all my classmates were amused by the video, because it appeared both impractical (as one surgeon was almost chasing the table) as well as slightly de-humanizing. In the health care setting, standardization can be difficult. The service is intrinsically complex, it is difficult to define processes and to measure outcomes, and standardization can create tension secondary to physician autonomy and organizational culture.
In service delivery, the person (the patient in health care organizations) is part of the production process. Patients by nature are not standard inputs. They assume different pre-existing conditions and have different preferences for clinical and non-clinical services/processes. The medical service itself, consisting of both clinical and operational processes, sometimes can be difficult to qualify and measure. A hospital can control patient flow by managing appointment and beds allocation. Clinical pathways can be defined for different diseases. However, patients can encounter undiscovered diseases or complications during the treatment, making the clinical service different and unpredictable.
Lastly standardization can encounter resistance from physicians and other health care providers. “Patients are not cars” is a phrase commonly used when discussing standardization. A health care organization needs to have not only tools, but also the cultural and managerial foundations to carry out changes. I am looking forward to using this project opportunity to further explore the local application of quality improvement.
Yun Li is an MD/MBA student attending Geisel School of Medicine and Tuck School of Business at Dartmouth. She obtained her Bachelor of Arts degree from Hanover College double-majoring in Economics and Biological Chemistry. Ms. Li participated in research in injury epidemiology and genetics, and has conducted studies on traditional Tibetan medicine, rural health, health NGOs, and digital health. Her career interest is practicing hospital medicine and geriatrics as a clinician/administrator, either in the US or China. Ms. Li is a student member of the Society of Hospital Medicine.
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
I reviewed recent literature about my research topic, which is clinical pathways for hospitalized injection drug users due to injection-related infection sequelae and came up with my research proposal. As part of a scholarly pursuit, I believe having a theoretical background of quality improvement to be important. Before further diving into the research topic, I also generated a small reading list of the “basic science” of quality improvement, which covers topics of general operational science and those in health care applications.
What makes standardization in health care difficult? In my operations class at Tuck School of Business, we watched a video showing former Soviet Union ophthalmologists performing “assembly line” cataract surgery. It includes multiple surgeons sitting around multiple rotating tables, each surgeon performing exactly one step of the cataract surgery. I recall all my classmates were amused by the video, because it appeared both impractical (as one surgeon was almost chasing the table) as well as slightly de-humanizing. In the health care setting, standardization can be difficult. The service is intrinsically complex, it is difficult to define processes and to measure outcomes, and standardization can create tension secondary to physician autonomy and organizational culture.
In service delivery, the person (the patient in health care organizations) is part of the production process. Patients by nature are not standard inputs. They assume different pre-existing conditions and have different preferences for clinical and non-clinical services/processes. The medical service itself, consisting of both clinical and operational processes, sometimes can be difficult to qualify and measure. A hospital can control patient flow by managing appointment and beds allocation. Clinical pathways can be defined for different diseases. However, patients can encounter undiscovered diseases or complications during the treatment, making the clinical service different and unpredictable.
Lastly standardization can encounter resistance from physicians and other health care providers. “Patients are not cars” is a phrase commonly used when discussing standardization. A health care organization needs to have not only tools, but also the cultural and managerial foundations to carry out changes. I am looking forward to using this project opportunity to further explore the local application of quality improvement.
Yun Li is an MD/MBA student attending Geisel School of Medicine and Tuck School of Business at Dartmouth. She obtained her Bachelor of Arts degree from Hanover College double-majoring in Economics and Biological Chemistry. Ms. Li participated in research in injury epidemiology and genetics, and has conducted studies on traditional Tibetan medicine, rural health, health NGOs, and digital health. Her career interest is practicing hospital medicine and geriatrics as a clinician/administrator, either in the US or China. Ms. Li is a student member of the Society of Hospital Medicine.
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
I reviewed recent literature about my research topic, which is clinical pathways for hospitalized injection drug users due to injection-related infection sequelae and came up with my research proposal. As part of a scholarly pursuit, I believe having a theoretical background of quality improvement to be important. Before further diving into the research topic, I also generated a small reading list of the “basic science” of quality improvement, which covers topics of general operational science and those in health care applications.
What makes standardization in health care difficult? In my operations class at Tuck School of Business, we watched a video showing former Soviet Union ophthalmologists performing “assembly line” cataract surgery. It includes multiple surgeons sitting around multiple rotating tables, each surgeon performing exactly one step of the cataract surgery. I recall all my classmates were amused by the video, because it appeared both impractical (as one surgeon was almost chasing the table) as well as slightly de-humanizing. In the health care setting, standardization can be difficult. The service is intrinsically complex, it is difficult to define processes and to measure outcomes, and standardization can create tension secondary to physician autonomy and organizational culture.
In service delivery, the person (the patient in health care organizations) is part of the production process. Patients by nature are not standard inputs. They assume different pre-existing conditions and have different preferences for clinical and non-clinical services/processes. The medical service itself, consisting of both clinical and operational processes, sometimes can be difficult to qualify and measure. A hospital can control patient flow by managing appointment and beds allocation. Clinical pathways can be defined for different diseases. However, patients can encounter undiscovered diseases or complications during the treatment, making the clinical service different and unpredictable.
Lastly standardization can encounter resistance from physicians and other health care providers. “Patients are not cars” is a phrase commonly used when discussing standardization. A health care organization needs to have not only tools, but also the cultural and managerial foundations to carry out changes. I am looking forward to using this project opportunity to further explore the local application of quality improvement.
Yun Li is an MD/MBA student attending Geisel School of Medicine and Tuck School of Business at Dartmouth. She obtained her Bachelor of Arts degree from Hanover College double-majoring in Economics and Biological Chemistry. Ms. Li participated in research in injury epidemiology and genetics, and has conducted studies on traditional Tibetan medicine, rural health, health NGOs, and digital health. Her career interest is practicing hospital medicine and geriatrics as a clinician/administrator, either in the US or China. Ms. Li is a student member of the Society of Hospital Medicine.
Identifying clinical pathways for injection drug–related infectious sequelae
Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
It is not surprising that my medical school – home to a group of passionate thought leaders in health service and policy research, including the Dartmouth Atlas and Accountable Care Organization – required all first-year medical students to take a course called “health care delivery science.”
The course offered me the first glimpse into quality improvement. However, because of a lack of clinical context, much of the course remained theoretical until my clinical years. During the hospital medicine rotation, I took care of a 40-year old patient who was newly diagnosed with metastatic pancreatic cancer. It was challenging to deliver devastatingly bad news. The patient and family, however, were most confused and frustrated by the roles of different specialists and care providers, the purpose and scheduling of procedures, and diet arrangement. I wondered how I could make their experience better.
After several meetings with my mentor, Professor Jonathan Huntington, a hospitalist, MD-PhD researcher, and director of Care Coordination Center at Dartmouth-Hitchcock Medical Center (DHMC), we identified a research area that has rising interest, importance, and relevance to the rural New Hampshire population. It is about identifying a clinical pathway for injection drug–related infectious sequelae.
Because of the unique bio-socio-psycho needs of injection drug users, hospitalizations due to injection-related infection sequelae often contribute to increased length of stay, readmission rates, and expenses out of state and federal health care funding. Prolonged stays also result in the waste of tertiary care resources for nontertiary needs, underutilization of regional care resources such as community and critical access hospitals, and increased care burden, as most patients travel long distances to obtain care.
We will pilot and implement a clinical pathway in the medicine units and measure length of stay, readmission rate, patient satisfaction rating, infectious disease provider follow-up rate, and hospitalization cost. I appreciate the grant support from SHM, and am looking forward to working with Dr. Huntington and other providers at DHMC, as well as developing myself professionally.
Yun Li is an MD/MBA student attending Geisel School of Medicine and Tuck School of Business at Dartmouth, Hanover, N.H. She obtained her Bachelor of Arts degree from Hanover College double-majoring in Economics and Biological Chemistry. Ms. Li participated in research in injury epidemiology and genetics, and has conducted studies on traditional Tibetan medicine, rural health, health NGOs, and digital health. Her career interest is practicing hospital medicine and geriatrics as a clinician/administrator, either in the United States or China. Ms. Li is a student member of the Society of Hospital Medicine.
Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
It is not surprising that my medical school – home to a group of passionate thought leaders in health service and policy research, including the Dartmouth Atlas and Accountable Care Organization – required all first-year medical students to take a course called “health care delivery science.”
The course offered me the first glimpse into quality improvement. However, because of a lack of clinical context, much of the course remained theoretical until my clinical years. During the hospital medicine rotation, I took care of a 40-year old patient who was newly diagnosed with metastatic pancreatic cancer. It was challenging to deliver devastatingly bad news. The patient and family, however, were most confused and frustrated by the roles of different specialists and care providers, the purpose and scheduling of procedures, and diet arrangement. I wondered how I could make their experience better.
After several meetings with my mentor, Professor Jonathan Huntington, a hospitalist, MD-PhD researcher, and director of Care Coordination Center at Dartmouth-Hitchcock Medical Center (DHMC), we identified a research area that has rising interest, importance, and relevance to the rural New Hampshire population. It is about identifying a clinical pathway for injection drug–related infectious sequelae.
Because of the unique bio-socio-psycho needs of injection drug users, hospitalizations due to injection-related infection sequelae often contribute to increased length of stay, readmission rates, and expenses out of state and federal health care funding. Prolonged stays also result in the waste of tertiary care resources for nontertiary needs, underutilization of regional care resources such as community and critical access hospitals, and increased care burden, as most patients travel long distances to obtain care.
We will pilot and implement a clinical pathway in the medicine units and measure length of stay, readmission rate, patient satisfaction rating, infectious disease provider follow-up rate, and hospitalization cost. I appreciate the grant support from SHM, and am looking forward to working with Dr. Huntington and other providers at DHMC, as well as developing myself professionally.
Yun Li is an MD/MBA student attending Geisel School of Medicine and Tuck School of Business at Dartmouth, Hanover, N.H. She obtained her Bachelor of Arts degree from Hanover College double-majoring in Economics and Biological Chemistry. Ms. Li participated in research in injury epidemiology and genetics, and has conducted studies on traditional Tibetan medicine, rural health, health NGOs, and digital health. Her career interest is practicing hospital medicine and geriatrics as a clinician/administrator, either in the United States or China. Ms. Li is a student member of the Society of Hospital Medicine.
Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
It is not surprising that my medical school – home to a group of passionate thought leaders in health service and policy research, including the Dartmouth Atlas and Accountable Care Organization – required all first-year medical students to take a course called “health care delivery science.”
The course offered me the first glimpse into quality improvement. However, because of a lack of clinical context, much of the course remained theoretical until my clinical years. During the hospital medicine rotation, I took care of a 40-year old patient who was newly diagnosed with metastatic pancreatic cancer. It was challenging to deliver devastatingly bad news. The patient and family, however, were most confused and frustrated by the roles of different specialists and care providers, the purpose and scheduling of procedures, and diet arrangement. I wondered how I could make their experience better.
After several meetings with my mentor, Professor Jonathan Huntington, a hospitalist, MD-PhD researcher, and director of Care Coordination Center at Dartmouth-Hitchcock Medical Center (DHMC), we identified a research area that has rising interest, importance, and relevance to the rural New Hampshire population. It is about identifying a clinical pathway for injection drug–related infectious sequelae.
Because of the unique bio-socio-psycho needs of injection drug users, hospitalizations due to injection-related infection sequelae often contribute to increased length of stay, readmission rates, and expenses out of state and federal health care funding. Prolonged stays also result in the waste of tertiary care resources for nontertiary needs, underutilization of regional care resources such as community and critical access hospitals, and increased care burden, as most patients travel long distances to obtain care.
We will pilot and implement a clinical pathway in the medicine units and measure length of stay, readmission rate, patient satisfaction rating, infectious disease provider follow-up rate, and hospitalization cost. I appreciate the grant support from SHM, and am looking forward to working with Dr. Huntington and other providers at DHMC, as well as developing myself professionally.
Yun Li is an MD/MBA student attending Geisel School of Medicine and Tuck School of Business at Dartmouth, Hanover, N.H. She obtained her Bachelor of Arts degree from Hanover College double-majoring in Economics and Biological Chemistry. Ms. Li participated in research in injury epidemiology and genetics, and has conducted studies on traditional Tibetan medicine, rural health, health NGOs, and digital health. Her career interest is practicing hospital medicine and geriatrics as a clinician/administrator, either in the United States or China. Ms. Li is a student member of the Society of Hospital Medicine.