Michael Ho, MD, PhD, Professor of Medicine, DOM Vice Chair for Quality
From left to right: Tara Ward, Henry Kramer, Laura Macke, Lorna Allen, Tim Yen, Sarah Mann. Cohort 2 at the CTP meeting in April 2022.
The objective of the Leaders in Informatics, Quality and Systems (LInQS) Fellowship Program is to develop CUSOM Department of Medicine fellows and junior faculty into future leaders with successful academic careers in the areas of quality improvement (QI), clinical system design, complex learning healthcare systems, clinical informatics, and/or patient safety. The LInQS Fellowship is a 2-year program in which we provide didactics, longitudinal mentorship and hands-on training from faculty mentors with diverse expertise to support trainees and junior faculty.
The didactic portion of the program will include participation in the Quality Safety Academy and the Institute for Healthcare Quality, Safety & Efficiency (IHQSE) Foundations in Healthcare Leadership Workshop, in addition to the LInQS faculty-led lecture series. Participants will attend regular work-in-progress meetings and be able to tailor their experience to meet their career goals. Divisions will support the participants through protecting a percentage of their time to dedicate to the program (see below).
Examples of deliverables for participants at the end of the 2-year program (Must complete at least 3):
|Cohort 4 (2022-2024)|
|Sarah Tietz, MD (Assistant Professor, Medicine - Geriatrics)|
|Hillary Landau, MD, MBA (Instructor, Medicine - Hospital Medicine)|
|Megan Spradlin, MPAS, PA-C (Instructor, Medicine - Medical Oncology & Hospital Medicine)|
|Michael Root, MD, MBA (Fellow, Medicine - Pulmonary Sciences & Critical Care Medicine)|
|Kristy Gama, MSN, ANP-BC (Senior Instructor, Medicine - Cardiology)|
Nancy Fang, MD, MS (Assistant Professor, Obstetrics & Gynecology - Family Planning)
Anjeli Kalra, MD (Assistant Professor, Medicine - Allergy & Clinical Immunology)
|Whitney Vuchetich, DNP (Instructor, Medicine - Internal Medicine)|
|Cohort 3 (2021-2023)|
Annie Chen, MD (Assistant Professor, Medicine-Renal Medicine & Hypertension)
Dr. Chen is interested in increasing Epogen prescribing rates for patients with chronic kidney disease (CKD) stage IV and V patients. She is currently collecting data on Epogen use and hopes to standardize prescribing among providers to align with national recommendations. Overall, she hopes to improve anemia management and increase the percentage of patients with hemoglobin levels within normal ranges.
Brendan Mulhern, MD (Pediatric Hospital Medicine Fellow)Dr. Mulhern is interested in creating a standardized workflow to administer COVID-19 vaccines for eligible pediatric inpatients at Children’s Hospital Colorado. He is currently collecting baseline data and working with inpatient teams to understand their current processes. He is also working with the flu vaccine team to optimize co-administration for patients age 12-18 years.
Julie Knoeckel, MD (Assistant Professor, Medicine-Hospital Medicine)
Dr. Knoeckel is interested in improving medication reconciliation rates on admission for patients at Denver Health. She has already collected a large baseline data set and is currently analyzing reconciliation rates. Historically, the hospital medicine service has a complete reconciliation rate around 50% and she aims to increase that rate to 70%.
Robert Metter, MD (Assistant Professor, Medicine-Hospital Medicine)
Dr. Metter is working with the Virtual Health Center at UCH to develop an algorithm that will predict clinical deterioration in admitted patients by comparing baseline outpatient vitals to admission vitals. Current models flag several false positive alerts that must be reviewed by nursing before alerting providers. He is hoping to build a model that will provide more accurate alerts and identify deterioration earlier.
Neha Agarwal, MD (Pulmonary Sciences & Critical Care Fellow)
Dr. Agarwal in interested in improving the process for referrals in the inpatient setting for outpatient procedures after discharge from UCH. She has partnered with Interventional Radiology and hopes to understand their role in performing procedures requested by Pulmonologists.
|Cohort 2 (2020-2022)|
Laura Macke, MD (Assistant Professor, Medicine-Internal Medicine)Dr. Macke is interested in developing a point-of-care clinical decision support (CDS) tool for primary care physicians in the treatment of Diabetes Mellitus Type 2 (DM2). CDS tools have shown to increase adherence to treatment guidelines and 66% of surveyed providers said they would use an EHR-based care pathway, with DM2 as the most requested pathway. SGLT2i medications have well documented benefits for DM2 patients, but less than 30% of UCH patients are on appropriate SGLT2i therapy. Dr. Macke’s CDS tool went live in February 2021 and they are capturing usage data and educating providers to improve pathway usage. Additionally, she is building a best practice alert to notify providers when patients’ A1c is > 8%, directing providers to the pathway for prescribing recommendations.
Laura Peters, DNP, FNP-C (Assistant Professor, Medicine-Cardiology)
Laura is interested in increasing advanced care planning and documentation of medical durable power of attorney (MDPOA) for patients with chronic illnesses. Colorado is an “all-interested-parties” state, meaning any interested party can participate in end-of-life decision-making for a person that does not have their wishes outlined in an MDPOA. Only 5% of patients in the Cardiology Division have an MDPOA or advanced care planning (ACP) documentation on file. Laura plans to create a smart phrase for after visit summaries, nursing reminders for ACP discussions, notifications to patients within MyHealthConnection and she is working with UCH to employ a nurse ACP navigator for the heart transplant and COPD clinics. Laura continues her work with funding awarded by the Clinical Effectiveness and Patient Safety Small Grants Program.
Timothy Yen, MD (Gastroenterology & Hepatology Fellow)
Dr. Yen is interested in improving quality of care after endoscopy for patients admitted with upper gastrointestinal bleeding. Upper GI bleeding is a common reason for admissions and re-admissions, and post-procedural care significantly impacts patient outcomes. The goal of Dr. Yen’s project is to improve minimal standard endoscopy report compliance (e.g., standard-of-care post-procedure documentation and care), improve proton-pump inhibitor (PPI) compliance and improve repeat esophagogastroduodenoscopy (EGD) procedure coordination. Dr. Yen implemented new note templates that saved providers time and added standardization for discharge and post-care procedures. Since beginning in 2019, Dr. Yen has been able to improve inpatient PPI compliance from 54% to 74%, improve discharge PPI compliance from 35% to 54% and scheduling of repeat EGD’s from 68% to 87%.
Tara Ward, MSN, RN, AGACNP-BC (Instructor, Medicine-Hospital Medicine)
Tara Ward is interested in improving transitions of care for ambulatory patients after discharge. Lack of standardization during hospital discharges can lead to adverse outcomes and readmissions, so ensuring appropriate follow-up care is key. In support of the hospital transformation program, Tara hopes to improve follow-up appointment scheduling within 14 days of discharge for Medicaid patients treated in the hospital medicine service. Tara has developed a new protocol for discharge practices and has implemented daily care coordinator huddles to improve communication and ensure follow-up appointment scheduling.
Henry Kramer, MD (Assistant Professor, Medicine-Hospital Medicine)
Dr. Kramer is interested in improving anticoagulation safety for patients with venous thromboembolism (VTE). The continuum of care for VTE is resource intensive, expensive and dangerous. There's no standardized process for VTE treatment or discharge which leads to missed referrals, poor outcomes and poor provider and patient satisfaction. Dr. Kramer has partnered with the anticoagulation safety program for improving readmissions and experience (ASPIRE-VTE) through Society of Hospital Medicine to implement a FAST bundle. The FAST bundle will help to standardize care guidelines and standardize the transitions of care process. He has developed a care pathway for the Division of Hospital Medicine that will guide patients through a series of steps including pharmacist consult, standardized discharge checklists, follow-up care coordination, nursing education and care management outreach.
Lorna Allen, FNP-C, MSN (Instructor, Medicine-Infectious Disease)
Lorna Allen is interested in reducing vancomycin prescribing errors during the patient discharge process. UCHealth currently discharges about 1,000 per year on outpatient parenteral antimicrobial therapy (OPAT) and there is no standardized approach currently in use, which can lead to missed or incorrect dosing, toxicities and readmissions. Lorna has developed an OPAT-specific note template that will automatically be pulled into the after visit summary and discharge medication list through the use of smart links. She is also developing a best practice alert to remind providers to add IV antibiotics to the discharge medication list when an OPAT episode is created.
Sarah Mann, MD (Assistant Professor, Medicine-Infectious Disease)
Dr. Mann is interested in improving retention and linkage to care for HIV patients. HIV patients are in a high-risk population and lower retention rates correlate with worsened outcomes and increased transmission of HIV. UCH does not have a formal inpatient linkage to care program, so Dr. Mann is establishing a protocol for HIV patient discharge follow-up including Epic patient list tracking, outreach from retention specialist and new discharge workflows.
Ryan Flood, DO (Assistant Professor, Medicine-Nephrology)
Dr. Flood is interested in increasing the percentage of patients with chronic kidney disease (CKD) receiving appropriate pharmacotherapy. 15% of adults in the US have CKD and most (9 in 10) are unaware. The use of angiotensin converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) have been shown to reduce progression of CKD in both diabetic and non-diabetic patients. Dr. Flood will create a best practice alert to remind providers to add CKD to the patient’s problem list and provide prescribing recommendations for ACE-I and ARB medications.
|Cohort 1 (2019-2021)|
Shoshana Tell, MD (Pediatric Endocrine Fellow)
Dr. Tell wanted to improve lipid management in Type 1 diabetes (T1D) in pediatric patients through decreasing low-density lipoprotein (LDL) values using stain therapies. High LDL values are a significant predictor of cardiovascular events and mortality in patients with T1D. Statin therapies have been shown to reduce cardiovascular mortality and morbidities by 25% in diabetes, though only 57% of adults and 14% of children are on appropriate statin therapies. Dr. Tell developed a new lipid management algorithm, which included therapy recommendations based on lab values, diet/lifestyle coaching timepoints and Epic tools (e.g., RD referral order templates, Epic note templates and Best Practice Advisory for statin orderset) to make lipid management easier for providers and patients. The percentage of patients with elevated LDL on statin therapy went from 14% to 50% in one year. For this work, Dr. Tell was named the American Academy of Pediatrics / Pediatric Endocrine Society Leona Cuttler QI Award winner for 2021. This award is given to a medical student, resident, fellow or junior faculty who has developed an exemplary QI project judged on originality, application of QI methodology and relevance to current Pediatric Endocrinology practice. Dr. Tell has accepted a position at the Joseph Sanzari Children’s Hospital in Hackensack, NJ. There, she will continue her work in Pediatric Endocrinology and improving lipid management for pediatric patients with Type 1 Diabetes.
Blake Jones, MD (Gastroenterology & Hepatology Fellow)
Dr. Jones was interested in improving the adenoma detection rate through screening colonoscopies for his Division. Adenoma detection is an important metric for cancer pre-screening and prevention. Providing feedback, such as a colonoscopy report card, to providers has been shown to improve detection rates, but capturing these data are difficult as there are multiple sources and data are entered as free text in Epic pathology and Provation endoscopy procedure notes. The goal of this project was to turn unstructured EHR data (e.g. Health Data Compass) into structured data reports using natural language processing (e.g., Regular Expression) to prospectively capture ADR’s for providers. With the data obtained, he is prospectively building a database for providers to view their own performance metrics and compare those to other providers. He also used an Epic Reporting Workbench and Smartlists to track ADR’s with real-time reporting. Dr. Jones continues his work to build the ADR provider dashboard in his new role as an Assistant Professor of Medicine in the Division of Gastroenterology and Hepatology at the University of Colorado School of Medicine.
Jennifer Taylor, MD (Pulmonary Sciences & Critical Care Fellow)
Dr. Taylor was interested in addressing chronic pulmonary obstructive disease (COPD) care in ambulatory clinics at the University of Colorado Center for Lungs and Breathing. Despite how commonly COPD occurs, the documentation of COPD severity, key for prescribing appropriate, guideline-based therapy, is highly variable. The goal of this project was to increase spirometry testing (e.g. >80% of patients) to appropriately diagnose and treat COPD. Interventions included provider education, Epic tools (e.g., integration of symptom documentation into patient charts) and inclusion of an mMRC dyspnea score using COPD assessment tools. While the COVID-19 pandemic significantly impacted the progress of Dr. Taylor’s work, she was able to collect spirometry testing data, which will be used in the future to improve testing rates. After fellowship completion, Dr. Taylor accepted a position in private practice.
Aaron Emmons, MD (Cardiology Fellow)
Dr. Emmons was interested in increasing SGLT2i prescriptions among patients discharged to home with a diagnosis of heart failure (HFrEF) or type 2 diabetes mellitus (DM2). SGLT2i are a novel class of medications that were developed to treat diabetes, but have benefit in multiple cardiovascular conditions including heart failure. Despite multiple, large randomized trials showing benefit in HFrEF, uptake has been low. While the COVID-19 pandemic significantly impacted the progress of Dr. Emmon’s work, he was able to develop an SGLT2i Epic order set for patients discharged with HFrEF. After fellowship completion, Dr. Emmons accepted a position in private practice.
LInQS Fellowship Program Faculty