• Readmission= A patient discharged from Family Medicine service and admitted as urgent or emergent to any other service in Shands UF Health system within 30 days of the discharge (excludes observation patients on both discharges and readmits)
• Readmission rate= Readmissions/ Discharges
• Current Weekly Average = Average readmission rate for 10-week period (9/21/2015-11/29/2015), 1 year from pre-intervention period. Average weekly rate for pre-intervention period (9/22/2014- 11/30/2014) was 23%
• 1st Lower Limit= Current Weekly Average – 1 standard deviations; 1st Upper Limit= Current Weekly Average + 1 standard deviations
• 2nd Lower Limit= Current Weekly Average – 2 standard deviations; 2nd Upper Limit= Current Weekly Average + 2 standard deviations
• 3rd Upper Limit= Current Weekly Average + 3 standard deviations
Hospital Readmission Quality Improvement Projects
The inpatient team has taken several initiatives to address hospital readmissions and improve patient care.
• Weekly Quality Rounds Discussion
• COMPARE2 (see details of study in research section)
• Home Visits for High Risk Patients
• Risk Stratification: LACE Tool
• Follow Up Appointments
Clinic Quality Improvement Initiatives
As part of the department goal to improve patient care and continually improve our processes, all clinic sites are working within their own practice to implement process and or workflow changes to meet goals of various quality measures. Medical directors are taking the lead and engaging staff in quality improvements efforts tailored to their unique patient populations. Clinic sites also review monthly reports to monitor changes. Below are the items that clinics are focusing on:
• Chronic Conditions Management
> Asthma/ COPD
> Heart Failure
• Emergency Department Utilization
• Pneumococcal Vaccines
• Advanced Directives
Resident-Led Quality Improvement Project
The residents at the Main St. clinic form teams that develop and initiate quality improvement efforts in the clinic.
• Preventative Screenings
Millar J, Psychas P, Valle D. Identifying Malaria risk factors in a hyper-endemic setting using Baynesian model selection. University of Florida Emerging Pathogens Research Day. Gainesville, FL. February 18, 2016.
Agana D. UF Primary Care physicians’ satisfaction. University of Florida College of Medicine Celebration of Research Day. Gainesville, FL. February 13, 2016.
Agana D. Characteristics of Emergency Department utilizers of UF Family Medicine in 2015. 2016 University of Florida Public Health and Health Professions Research Day, Gainesville, FL. April 13, 2016.
Carek P. Lessons learned in the first two years of the I3 POP Collaborative Cohort.” North American Primary Care Research Group Annual Meeting. Cancun, Mexico. October 2015.
Carek P, Dietrich E, Feller D, Malaty J, Lombardi J, Blanc P, Samraj G. Addressing hospital readmissions: Impact of weekly review. University of Florida Health Quality and Patient Safety Week. Gainesville, FL. March 17, 2016.
Clugston J. Concussion prevention in football. Concussion Across the Spectrum of Injury Conference: New York University, School of Medicine, Department of Neurology. New York, NY. February 26, 2016.
Clugston J. Update on concussion prevention in football. Safety in Adolescent and High School Sports Conference, University of Florida Orthopedics and Sports Medicine Institute. Gainesville, FL. February 20, 2016.
Porter M. The ‘July effect’: A look at medical admissions. North American Primary Care Research Group. Cancun, Mexico. October 24-28, 2015.
Porter M. A qualitative study to explore tobacco use and cessation in a homeless population. North American Primary Care Research Group. Cancun, Mexico. October 24-28, 2015.
Dickmann S, Blanc P, Dieuvil M, Kramer D, Malaty J. Mildly elevated transaminases and evaluation for Hepatitis B and C in a Family Medicine center. The 49th Annual Spring Conference for the Society of Teachers of Family Medicine. Minneapolis, MN. April 30 - May 4, 2016.
George J, Malaty J. Type 2 Diabetes quality improvement project: utilizing EMR to improve quality of care. The 49th Annual Spring Conference for the Society of Teachers of Family Medicine. Minneapolis, MN. April 30 - May 4, 2016.
Malaty J, Taylor D, George J, Kramer D. Team-based chronic kidney disease quality improvement project. The 49th Annual Spring Conference for the Society of Teachers of Family Medicine. Minneapolis, MN. April 30 - May 4, 2016.
Carek P, Lombardi J, Malaty J, Porter M, Samraj G. Impact of weekly multidisciplinary readmissions rounds on readmission rate. The 49th Annual Spring Conference for the Society of Teachers of Family Medicine. Minneapolis, MN. April 30 - May 4, 2016.
Porter M, Agana D, Carek P, Hatch R, Rubin D. Family Medicine clerkship directors’ views and actions on medical students’ impressions of Family Medicine: A CERA study. The 49th Annual Spring Conference for the Society of Teachers of Family Medicine. Minneapolis, MN. April 30 - May 4, 2016.
Hatch R, Agana D, Carek P, Porter M, Rubin D. Job satisfaction among academic family physicians. The 49th Annual Spring Conference for the Society of Teachers of Family Medicine. Minneapolis, MN. April 30 - May 4, 2016.
Porter M, Carek P, Blanc P, Listhaus A. B120 referral rate in a Family Medicine Residency clinic: How does it compare? The 49th Annual Spring Conference for the Society of Teachers of Family Medicine. Minneapolis, MN. April 30 - May 4, 2016.
Dieuvil M, Carek P, Judge E, Listhaus A, Samraj G. Does insurance status influence HPV vaccination rates at university based primary care clinics? The 49th Annual Spring Conference for the Society of Teachers of Family Medicine. Minneapolis, MN. April 30 - May 4, 2016.
Judge E, Carek P, Dieuvil M, Listhaus A, Samraj, G. Racial differences in HPV vaccination rates at an Academic Family Medicine clinic. The 49th Annual Spring Conference for the Society of Teachers of Family Medicine. Minneapolis, MN. April 30 - May 4, 2016.
Potts S, Carek P, Danoff R, Lausen H, Munzing T. Requirements, milestones, NAS, and other accreditation issues: A workshop with the ACGME review committee for Family Medicine. The 49th Annual Spring Conference for the Society of Teachers of Family Medicine. Minneapolis, MN. April 30 - May 4, 2016.
Baker R, Honeyford K, Levene LS, Mainous AG 3rd, Jones DR, Bankart MJ, Stokes T. Population characteristics, mechanisms of primary care and premature mortality in England: a cross-sectional study. BMJ Open. 2016; 6(2): e009981.
Beers PJ, Adgerson CN, Millan SB. Porcine tri-layer wound matrix for the treatment of stage IV pressure ulcers. JAAD Case Reports. 2016; 2(2): 122-124. doi:10.1016/j.jdcr.2016.01.001.
Carney PA, Conry CM, Mitchell KB, Ericson A. Dickinson WP, Martin JC, Carek PJ, Douglass AB Eiff MP. The Importance of and the complexities associated with measuring continuity of care during resident training: possible solutions do exist. Fam Med. 2016; 48(4): 286-93.
Carris NW, Ghuschyan V, Libby AM, Smith SM. Health-related quality of life in persons with apparent treatment-resistant hypertension on at least four antihypertensives. J Hum Hypertens. 2016; 30: 191-6.
Gong Y, Wang Z, Beitelshees AL, McDonough CW, Langaee TY, Hall K, Schmidt SO, Curry RW, Gums JG, Bailey KR, Boerwinkle E, Chapman AB, Turner ST, Cooper-DeHoff RM, Johnson JA. Pharmacogenomic genome-wide meta-analysis of blood pressure response to β-blockers in hypertensive African Americans. Hypertension. 2016; 67(3): 556-63. doi: 10.1161/HYPERTENSIONAHA.115.06345. Epub 2016 Jan 4.
Harle CA, Listhaus A, Covarrubias C, Schmidt SOF, Mackey S, Carek PJ, Fillingim RB, Hurley RW. Overcoming barriers to implementing patient-reported outcomes in an electronic health record: A Case Report. JAMIA. 2016; 23(1): 74-79.
Mainous AG 3rd, Tanner RJ, Baker R. Prediabetes diagnosis and treatment in primary care. J Am Board Fam Med. 2016; 29(2): 283-5. doi: 10.3122/jabfm.2016.02.150252.
Mainous AG 3rd, Tanner RJ, Anton SD, Jo A. Grip strength as a marker of hypertension and diabetes in healthy weight adults. Am J Prev Med. 2015; 49(6): 850-8.
Mainous AG 3rd, Tanner RJ, Anton SD, Jo A. Low grip strength and prediabetes in normal-weight adults. J Am Board Fam Med. 2016; 29(2): 280-2.
Mainous AG 3rd, Tanner RJ, Mainous RW, Talbert J. Health considerations in regulation and taxation of electronic cigarettes. J Am Board Fam Med. 2015; 28(6): 802-6.
Malaty J. Take a breath and consider the other’s perspective. Fam Med. 2016; 48(3): 226-7.
Mims LD, Everard K, Hall K, Hatch RL, Malaty J, Rubin D, Agana DF, Carek PJ. Family medicine clerkship directors’ influence on the residency program selection process. Fam Med. 2016; 48(2): 108-13.
Moseley R. Healthcare Ethics Committee. Miami, FL: CITI Program, University of Miami; 2016.
Nguyen K, Jacobs K. Urethral prolapse. Consultant for Pediatricians. 2016; 15(3): 138-140.
Porter M, Mims L, Garven C, Gavin J, Carek P, Diaz V. International health experiences in Family Medicine residency training. Fam Med. 2016; 48(2): 114-2-.
Sacino AN, Shuster JJ, Nowicki KW, Carek PJ, Wegman MP, Listhaus A, Gibney JM, Chang LK. Novel application of a reverse triage protocol providing increased access to care in an outpatient, primary care clinic setting. Fam Med. 2016; 48(2): 136-9.
Smith SM, Carris NW, Dietrich ED, Gums JG, Uribe L, Coffey C, Gums TH, Carter BL. Physician-pharmacist collaboration versus usual care in treatment-resistant hypertension. J Am Soc Hypertens. 2016; 10(4): 307-17.
Shniderman A, Solberg LB. Cosmetic psychopharmacology for prisoners: Reducing crime and recidivism through cognitive intervention. Neuroethics. 2015; 8(3): 315-326.
The grip strength and diabetes publications listed above in the Publication section have received a lot of press, notability with Fox News TV and the Wall Street Journal. Links to articles are listed below.
Fox News TV - Detroit
Fox News TV - Los Angeles
Wall Street Journal
The prediabetes studies have also generated more than 100 news articles including US News and World Report, MSN, AARP, Medline Plus, and many TV stations. Links to articles are listed below.
US News and World Report
Dr. Ray Moseley participated in a televised discussion on the show Viewpoint titled “Navigating Ethics: Computers and Patient Privacy.” The conversation, which featured a discussion about the ethical implications of electronic health records on patient care and privacy, aired March 6, 2016 on WPBT2, a local PBS-affiliate network in the Miami area. Link to the video is listed below.