Appendix B: Summaries
of PFQ Grantee Activities (continued)
PFQ Grant Summary: Implementing Pediatric Patient Safety Practices
Lead Organization: Child Health Corporation of America (CHCA), Child Health
Accountability Initiative (CHAI)
Partner Team: Lucile Packard Children's Hospital at Stanford; 14 CHAI member
hospitals, and later expanded to all 42 CHCA hospitals; Vermont Oxford
Neonatal Network; IHI; and others
Title: Implementing Pediatric Patient Safety Practices
Topic Area: Quality improvement in pediatric inpatient care
Principal Investigators: Paul Sharek, MD, MPH, Medical Director, Child Health Accountability
Initiative (CHAI) and Medical Director Quality Management, Lucile
Packard Children's Hospital at Stanford University
AHRQ Project Officer: Denise Burgess (formerly Marge Keyes)
Total Cumulative Award: $1,144,950
Funding Period: 9/2002–9/2006
Project Status: Completed 9/29/2006
1. Project
Description
Goals. The project sought to improve the healthcare of America's children by
integrating evidence-based practices on pain management, medication safety, and
patient safety into selected CHCA member hospitals. The project planned to work
with the 14 CHCA member hospitals participating in CHCA's quality improvement
group, the Children's Health Accountability Initiative, but later expanded the
project to work with all 42 CHCA member hospitals. Finally, the project planned
to develop collaborative relationships with national pediatric organizations to
disseminate its work more widely.
Activities
and Progress. The Child Health Accountability Initiative (CHAI) was the
clinical performance improvement arm of CHCA until 2004 when it expanded from
14 founding members to include all 42 member hospitals and internal CHCA staff.
This collaborative, formed in 1997 continues to work to improve the quality of
hospital care provided to children. The grant funds provided infrastructure
support to enhance and accelerate CHAI's efforts.
Year
1. CHAI devoted the first year to planning activities and infrastructure
building. They developed a process for the collaborative to select quality
improvement projects and a method of reviewing project plans under the three
priority areas—patient safety, pain management, and medication safety. In
addition to its regular national bi-annual meetings, CHAI organized an annual
meeting to review and re-prioritize pending and potential projects. The grant
funds also allowed CHAI to hire research and administrative staff to support
the project, and funded the travel of 1-2 members of each CHAI hospital.
In
the area of patient safety, CHAI established five "focus groups" to create and
test toolkits for implementing patient safety best practices in hospitals. The groups
focused on five best practices selected from AHRQ's Making Health Care
Safer: A Critical Analysis of Patient Safety Practices publication: (1)
central venous catheter-related bloodstream infections, (2) surgical site
infections, (3) medication errors and adverse drug event, (4) use of corollary
orders to reduce potential adverse drug events, and (5) adverse events due to
transportation of critically ill patients between health care facilities. The
groups recruited CHAI hospital sites to help create implementation toolkits,
implement the best practice interventions, and conduct data collection to
examine the effectiveness of interventions. Toolkits included audit sheets,
best practice lists, supporting literature, implementation tips, information on
barriers and ways to overcome them, and presentations on best practice site
implementation.
In
the area of pain management, CHAI established a collaborative to implement best
practices for post-operative pain management in the neonatal ICU (NICU)
population. Eleven of the CHAI hospital sites chose to participate and collect
baseline data, which were analyzed to determine pain assessment compliance,
select areas for improvement, and identify potential best practices. Once best
practices were identified, the participating hospitals would implement them and
collect post-intervention data to examine effectiveness.
In
the area of medication error reduction, CHAI evaluated a previously developed
pediatric-focused "trigger tool" for identifying inpatient adverse drug
events. Before the PFQ project, CHAI had tested the tool in 12 CHAI hospitals
for sensitivity and positive prediction value, redesigned the tool for a
pediatric population, and re-tested the tool. The results showed that the
trigger tool identifies very different adverse drug event rates for different
patient populations (newborn vs. adolescent) and different units in the
hospital (PICU vs. Hematology-Oncology units). Given this finding, under the
PFQ project, CHAI embarked on refining the trigger tool for subgroups and
hospital units and worked to develop site-specific automation of the trigger
tool in hospitals' CPOE systems.
Year
2. In the area of patient safety, the group working on central venous
catheter-related bloodstream infections completed its time series data
collection. Three of the seven participating hospital sites had substantially
improved central line associated infection rates, and none of the remaining
sites had worsening infection rates. CHAI statistician began an in-depth analysis
of the data for further conclusions. The focus group working on use of
corollary orders to reduce potential adverse drug events, which had four
participating CHAI hospital sites, and the group working on adverse events due
to transportation of critically ill patients between health care facilities,
which had seven participating CHAI hospital sites, collected baseline data from
participating hospital sites and implemented best practices.
Also
in the area of patient safety, the project began a collaborative to improve
communication during transfers from the emergency department to inpatient
med-surg units through the use of a standardized checklist at the time of
transfer.
In
the area of post-operative pain management for the NICU population, each of the
eleven participating hospital sites selected best practices, incorporated the
interventions, and began collecting post-intervention data.
In the area of
medication errors, further work on the trigger tool involved a joint venture
between CHAI, Vermont Oxford Neonatal Network (VON), and the AHRQ funded
"Center for Neonatal Patient Safety". This group created, pilot tested,
refined, and analyzed a NICU based trigger tool to identify adverse events in
this high-risk population. VON maintains the largest database of NICU patient
information in the world, including 75% of all newborns with birthweight of
1500 grams and under in the U.S. and the partnership connected CHAI to VON's expertise and database.
Year 3. From
the end of 2004 to early 2005, CHAI significantly expanded the project from the
14 CHAI hospitals to include all 42 CHCA hospitals. This massive expansion was
undertaken in part because it became apparent to non-participating sites that
the CHAI interventions were so effective that they should not be limited to the
14 hospitals. CHAI learned from its experience with the five focus groups that
their QI approach needed more rigor and more accountability. This coincided
with member hospital CEOs coming to realize that QI was not just something for
the quality department; rather that "quality was the business they were in."
For
these reasons, CHAI decided to shift its strategy to incorporate the Institute
for Healthcare Improvement (IHI) "breakthrough" improvement model, which includes
the rapid cycle "plan-do-studyact" approach to QI, as it expanded to include
all 42 CHCA hospitals. CHAI's quality improvement efforts with all CHCA
hospitals centered on two rapid cycle breakthrough projects: (1) reducing
catheter-associated bloodstream infections in children by 50 percent, in which
29) hospitals participated and (2) reducing adverse drug events related to
narcotics in children by 50 percent, in which 20 sites participated. Of the 42
CHCA hospitals, 33 participated in at least one of these two projects, with 18
sites participating in both. Participating hospitals attended a series of
learning sessions, reported data monthly and received intensive coaching on
change implementation in conference calls between sessions.
Efforts
to improve communication during transfer from ED to inpatient units were
completed in February 2005. The 11 hospitals that implemented best practices
related to NICU post-operative pain management also finished their work and
submitted site-specific data for analysis. Based on the findings and lessons
learned from this project, CHCA plans to embark on a NICU based project for all
CHCA member hospitals.
In
the third year, CHAI completed its pilot test of the NICU trigger tool, using
42 charts from 4 pilot site volunteer hospitals. The project revised the
trigger tool based on the analysis of the pilot data and expanded it to 15
participating hospital sites including 6 CHCA hospitals and 9 VON hospitals
(several are in both groups). Each hospital contributed 50 charts for the full
NICU trigger tool trial to identify adverse events. The review found 505 unique
adverse events; of which 58 percent were determined to be preventable. The most
frequent adverse events were nosocomial infections, catheter infiltrations,
intracranial bleeds, and accidental extubations. These findings helped NICUs
better target their patient safety efforts. The project intends to refine the
trigger tool based on results and analysis of the full trigger trial.
Year
4. The group working to reduce bloodstream infections completed
intermediate data collection and implemented multiple best practices at the 29
participating hospital sites. The project entered into a "sustaining phase,"
which emphasized the spread of project lessons to new units at participating
sites and to CHCA members unable to previously participate. For example, CHCA
teamed with National Association of Children's Hospitals and Related
Institutions (NACHRI) and National Initiative for Children's Healthcare Quality
(NICHQ) to sponsor a series of web casts aligned with IHI's 100,000 Lives
Campaign that will be open to any hospital, not just CHCA hospitals during
which the ADE and CABSI project and data were discussed.
In
the area of medication errors, CHAI refined and improved the NICU trigger tool
based on results from the full trial, guidance and feedback from content
experts and IHI recommendations. Based on the success of the NICU trigger tool,
CHCA has begun to develop and test a pediatric ICU trigger tool and recruited
22 hospitals to participate. Efforts to reduce adverse drug events (ADE)
related to narcotics, involving 20 CHCA hospitals, included implementation of
best practices, coaching of hospitals by project staff, and feedback reporting
to hospitals, and data analysis. Future efforts will focus on sustaining these
improvements.
2. Partnership
Structure/Function
The Child Health
Corporation of America, a collection of 42 free-standing children's hospitals
in the U.S. and Canada, was initially formed
in 1997 as a purchasing collaborative. In 2001, a subset of the member
hospitals began working together in the area of quality improvement and
established the Child Health Accountability Initiative (CHAI) under the
umbrella of CHCA. CHCA partnered with Dr Paul Sharek the medical director of
CHAI and the medical director of quality improvement at Lucile Packard Children's
Hospital at Stanford University (a CHAI hospital) to serve as the PFQ project's
principal investigator.
The
project's four levels of partnership included: one between CHCA's staff and
the PI, Dr. Sharek; a second among the 14 hospitals in CHAI; a third between
CHCA and all its hospital members; and a fourth between CHCA and other
pediatric care associations for dissemination purposes. The grant funds
provided infrastructure support—hiring a project manager, data analyst,
statistician, and 2 quality improvement experts—that allowed these existing
partnerships to work better collaboratively and provide more rigor to the
quality improvement work already begun. The grant also helped pay for each of
the 14 hospitals to send representatives to CHCA's semi-annual national
meetings and the annual CHAI meeting, which were components of the larger
semi-annual CHCA meetings, to discuss the project selection and progress.
Though Dr. Sharek guided the process of project selection, the selection of
projects occurred democratically with input from all 14 CHAI members based
primarily on the availability of evidence-based interventions and the
individual and collective priorities of the 14 member hospitals.
In
2004, the performance improvement department of CHCA ("CHAI") expanded to
include the entire 42 members in CHCA. The first 2 major pediatric patient
safety projects overseen by the CHCA performance improvement department after
this expansion were "Decreasing catheter associated blood stream infections"
and "Decreasing adverse drug events related to narcotics in pediatric
patients". These two large collaborative projects utilized the Institute for
Healthcare Improvement (IHI) model for collaborative quality improvement,
which included the following implementation strategies: pediatric content
expert-development of a "bundle" of evidence based best practices to be
implemented, monthly group conference calls with all the participating sites,
monthly progress reports to the sites' senior leaders that included
site-specific feedback and prescriptive recommendations. It also established an
active project-focused list-serve, and made it possible to submit data to CHCA
staff through an extranet Web site.
Table 1. Major Partner Organizations and Roles in the Project
|
Organization |
Role in Project |
Lead Organization (grant recipient) |
Child Health Corporation of
American (CHCA), Child Health
Accountability Initiative (CHAI), the
collaborative clinical performance
improvement arm of CHCA (from
1997-2004; performance
improvement department expanded
to include all 42 members in 2004).
|
Overall leadership and selection/implementation of
projects
|
Key
Collaborators |
Lucile Packard Children's Hospital,
Stanford University
14 CHAI hospitals
Vermont Oxford Neonatal Network
(VON) and the Center for Neonatal
Patient Safety (an AHRQ funded
center)
Consultants: Institute for Healthcare
Improvement (IHI) and David
Classen, MD
National Association of Children's
Hospitals and Related Institutions
(NACHRI) and National Initiative
for Children's Healthcare Quality
(NICHQ)
|
The project PI, Dr. Paul Sharek oversaw project
implementation, decision-making regarding publication
focus, and development of relationships with other
collaborators. He also prepared all grant related reports,
attended AHRQ sponsored grant conferences, and
presented the project and outcomes at numerous venues.
CHAI hospitals participated in various focus group QI
projects
VON helped create a new neonatal trigger tool for the
project to identify adverse events (AEs) in the Neonatal
Intensive Care Unit (NICU). Additionally, the VON
partnership has extended to include a focus on NICU
based quality improvement in years 2006 onward for
CHCA
Consultants provided expert opinion for the project's
development and implementation, and provide space on
the IHI Web site
to disseminate toolkits and findings
NACHRI and NICHQ helped with broader
dissemination of project results, via multiple national
conference presentations by CHCA
|
Target Organizations |
Initially 14 CHAI participating
hospitals and organizations; later
expanded to all 42 CHCA hospitals
|
Participated in various QI projects by providing data
and implementing best practices
|
3. Project Evaluation and Outcomes/Results
Pain management
- Results from the 9
sites participating in the pain management project (of the original 11)
included: (1) Numeric pain assessment performed by MDs or NNPs may be more
effective than those assessments solely used/documented by RNs; (2) a numeric
pain scale should be used on day 1 and day 2 post-op; (3) a central method for
documentation is most effective; and (4) hospitals should adopt a standardized
tool for pain assessment and use it consistently.
Medication safety
- The CHCA Adverse
Drug Event pediatric trigger tool identified 22 times more adverse drug events
than traditional reporting mechanisms (i.e. incident reports). The project
plans to place the final trigger tool on the IHI Web site for general use.
- Data analysis of
the 18 CHCA hospitals that participated in the 18 month collaborative project
to reduce adverse drug events (ADE) related to narcotics showed a
collaborative-wide decrease from 39.1 to 17.1 ADEs per 1000 narcotic doses, a
49 percent reduction for the entire collaborative. Savings from this
collaborative, in which 662 ADEs were prevented, was between $1.7 and $3.1
million depending on the whether these ADEs were "not preventable ($1.7
million) or "preventable" ($3.1 million) using the cost data provided by Bates
et all in the medical literature (JAMA 1997).
Patient safety
- Twelve CHAI sites
that implemented measures to improve communication during transfers the ER and
inpatient units improved pediatric patient safety as manifested by decreased
duplicate or missed medications, duplicate or missed lab tests, and incorrect
or absent infection control information to minimize iatrogenic inpatient
infections.
- Final data
analysis showed improvements in infection rates for 18 of 29 participant sites
(57% reduction in these 18 sites), and a collaborative wide reduction for all
29 participating hospitals from 6.9 to 4.8 per 1000 line days, a 31 percent
reduction, and those in this collaborative achieved over 88% compliance to the
IHI and CHCA-built "best practice" maintenance bundle. Eleven hospital sites
decreased catheter-associated bloodstream infection (CABSI) rates more than 50
percent. Overall, 112 CABSIs were avoided, resulting in a net savings of
$960,549 based on the actual costs established by the CHCA database.
4. Major Products
- Neonatal ICU
trigger tool, and toolkit, available on the CHCA Web site as well as soon to be
available on the Vermont Oxford Network and Institute for Healthcare
Improvement (IHI) Web sites.
- Taylor B., et
al., Assessing Postoperative Pain in Neonates: A Multicenter Observational
Study, Pediatrics (in press).
- Sharek PJ.,
Horbar JD, Mason W, et al. Adverse Events in the Neonatal Intensive Care Unit:
Development, Testing, and Findings of an NICU-Focused Trigger Tool to Identify
Harm in North American NICUs." Pediatrics October 2006;118(4):1332-40.
- Presentations by
Dr. Sharek and other project representatives at several national conferences:
panel on Patient Safety across Settings and Populations: Children's Care at
AHRQ's 2005 Annual Patient Safety and Health IT Conference, June 2005; VON
Performance Improvement 2005 conference, September 2005, Nashville, TN;
"Improving Safety in Children's Hospitals through Collaboration," National
Institute for Children's Healthcare Quality Forum, March 2006, Orlando FL; European
Forum on Quality Improvement in Health Care: April 27, 2006; all CHCA
semi-annual meetings.
- Two new toolkits
available on CHCA Web site: (1) Catheter Associated Blood Steam Infections in
Pediatrics and (2) Adverse Drug Events in Narcotics.
5. Potential for Sustainability/Expansion after PFQ
Grant Ends
The evolution of the project's target organizations,
from the 14 CHCA member hospitals participating in CHAI to all 42 CHCA members
hospitals represents a significant expansion in the number of children's
hospitals actively participating in quality improvement activities. This was
made possible in part by the AHRQ grant funds that supported the creation of
additional infrastructure, data analysis and research support at CHCA, lending
more rigor to CHAI work, which in turn led to more CHCA site participation,
more publishable work, and increased likelihood of sustainability of activities
in sites and dissemination outside of CHCA.
Quality improvement work will be continued at CHCA
with other support once AHRQ funding ends. CHCA will provide financial support
for future quality improvement collaboratives, including those just beginning
in September 2006 (Decreasing Surgical Site Infection Rates, and Decreasing
wait times in the Emergency Department). CHCA regards this work as contributing
to its overall mission and will dedicate funds from the revenues generated
through its group purchasing activities. Additionally, at times, there will be
a fee for each site to participate in future collaboratives. This fee, of
$23,000 for one or both collaboratives, has not decreased the participation of
members in the collaboratives; over 30 members are participating.
CHCA has built into its organization a mechanism for
what they call "spread" that relies on its Web site to provide learning
opportunities, resources, tools, etc., from all CHCA performance improvement
projects. In addition, CHCA and VON are discussing a CHCA NICU performance
improvement project that will leverage the best practice recommendations set forth
by the recently completed NICU post-operative pain management project.
Return to Appendix B Contents
PFQ Grant Summary: Training for Improved Provider Response to Bioterrorism
Lead Organization: Connecticut Department of Health (DPH)
Partner Team: Connecticut DPH; Yale New Haven Health System (YNHHS), Center for
Emergency Preparedness and Disaster Response
Title: Training for Improved Provider Response to Bioterrorism
Topic Area: Bioterrorism Continuing Medical Education for physicians
Principal Investigators: Louise Dembry, MD (Yale-New Haven Health System) and Michael
Hoffman, Ph.D (Connecticut DPH-retired) and Lloyd Mueller, Ph.D
(Connecticut DPH)
AHRQ Project Officer: Sally Phillips
Total Cumulative Award: $299,999
Funding Period: 10/2002–9/2005
Project Status: Completed September 2005
1. Project
Description
Goals. The aim of this project was to identify and/or develop a web-based
bioterrorism training program for front-line physicians, and evaluate its
effectiveness. The Connecticut Department of Public Health (DPH), the primary
grant institution, receives funding from CDC and HRSA to provide bioterrorism
education and training for the state's public health and health care delivery
systems. This work, however, does not address the educational content and
methods of delivery most appropriate for and effective with different health
care professionals, a gap this project was designed to fill. The project
proposed a two-phase approach—a planning phase that would select or develop
bioterrorism teaching tools/programs, and a second phase to test and evaluate
their effectiveness.
Activities
and Progress. During the first planning year, project staff conducted
literature reviews on effective educational methods and tools for physicians,
as well as emergency preparedness and bioterrorism training programs.
Information from these reviews led project staff to create a 30-minute Power
Point presentation on basic principles of emergency management called
"Emergency Management 101." Staff also created a tool for comparing courses in
emergency/disaster preparedness based on three sets of criteria developed by
the (1) American College of Emergency Physicians, (2) Centers for Disease
Control and Prevention, and (3) OSHA/U.S. Army Biological Defense
Command/National Fire Protection Administration. The tool was used to examine
training programs that had competency standards developed by researchers at Columbia University and St. Louis University.
To
inform the selection of an emergency/disaster preparedness training program,
the project created and conducted a pilot survey of clinicians on information
needs and preferred learning modalities for continuing medical education
(CME). Project staff distributed the survey to 2,075 physicians at three Yale
New Haven Health System hospitals (Yale-New Haven Hospital, Bridgeport Hospital, and Greenwich Hospital). A total of 811 surveys were returned. Analysis
of the survey results showed that physicians were more interested in their
roles in emergency or bioterrorism events, and how they should respond, rather
than the clinical aspects of disease detection, which was the focus of training
modules developed by Columbia University and St. Louis University. This
mismatch led the project team to develop a new training course to better meet
physicians' needs.
During
the second year, project staff created the training program, "Bioterrorism
Preparedness for Clinicians - EM 201," a 50-minute web-based program on basic
principles of emergency management that emphasized (1) bioterrorism-related
syndrome identification, (2) immediate precautions to protect health care
workers and prevent person-to-person transmission, and (3) the reportable
disease process in Connecticut and chain of communication for suspicious
syndromes/events. Web-based sources of additional information on specific
diseases also were provided. The grantee obtained approval from the Bridgeport
Hospital Department of Medical Education for one CME credit for the training
program. The project pilot-tested the new training course with a small group of
physicians at Yale-New Haven Hospital/Yale University School of Medicine.
During
the third year (Phase II), physicians who responded to the original survey and
said they would be willing to test the new training course were asked to
participate. Actually getting physicians to take the course proved more
difficult than expected, partly because physicians are very busy and free CME
credits were not sufficient inducement. In addition, volunteers were not
guaranteed that they could take the course right away, as some would be
randomly assigned to a control group. Project staff secured enough
participation by allowing those in the control group to take the course after
the study period, and by offering a prize drawing. Study participants took a
pre-test of competency related to bioterrorism, participated in the web-based
training, and were tested on their knowledge immediately after taking the
course, as well as four to six months later, to measure longer-term knowledge
retention. Control group physicians were given the pre-test, and a test four to
six months later.
Statistical
analysis of the intervention and control group test results showed that
physicians taking the bioterrorism preparedness course experienced a
significant increase in knowledge as seen in the differences between pre-test
and immediate post-test mean examination scores (60.6 to 77.2), while control
group scores did not change (56.2 to 56.60). Unfortunately, longer term
follow-up scores among the physicians taking the course showed a marked
decrease to a mean of 64.4, close to their baseline measure of knowledge. This
could be due to lack of opportunity to actually use the knowledge gained during
the course.
Although
the original proposal planned to adapt the course for other types of health
professionals, such as nurses and physician assistants, and to test the course
among health professionals in the northern part of the state, the need to
develop a new training course and problems enrolling physicians in the first
study produced delays and caused funds to run out before the project could
expand to additional test groups/sites.
2. Partnership
Structure/Function
Project
staff from the two lead organizations, the Connecticut DPH and the Yale New
Haven Health System, held meetings on at least a monthly basis during critical
periods to coordinate tasks involved in planning, implementing, and evaluating
project activities. Those attending the meetings included the Co-Principal
Investigators (Louise Dembry, MD from YNHHS and Lloyd Mueller, Ph.D, CT DPH);
the Director of Office of Emergency Preparedness at YNHHS (Christopher Cannon),
the project's clinical Education and Research Coordinator (David Burich), and
the project's consultant (Kari Hartwig, Ph.D., Yale University).
Additional experts
were consulted to provide advice on clinical and public health epidemiology and
surveillance, the development and evaluation of competency assessment tools and
educational modules, and statistical analysis of survey results. Experts were
drawn from Yale University School of Medicine, Department of Epidemiology and
Public Health; Columbia University; and St. Louis University.
Table 1. Major Partner Organizations and Roles in the Project
|
Organization |
Role in Project |
Lead Organization (grant recipient) |
Connecticut
Department of Public
Health (DPH)
|
Grant recipient/fiduciary; assisted in coordinating project
activities and outcomes for bioterrorism education and
training activities funded through HRSA and CDC grants,
and with public health community; DPH also provided
technical assistance on study research design and analysis,
and on coordination with other emergency preparedness
education and training
|
Key
Collaborators |
Yale New Haven
Health System
(YNHHS), Center for
Emergency
Preparedness and
Disaster Response
Columbia University,
Mailman School of
Public Health and St.
Louis University,
School of Public
Health
|
Project Investigator is Associate Medical Director of this
Center at YNHHS, which carried out the work of the
project: evaluated existing competency assessment tools for
physicians, surveyed physicians on learning needs and
preferences, developed training tools and modules, and
surveyed course participants and controls
Shared competency evaluation tools and educational
modules, as well as interactive tools for training,
communication, and improvement of surveillance and threat
assessment. Modules and tools were intended to be used to
deliver training through distance learning modalities, but
later this mode was determined not to match physician needs
|
Target Organizations |
Practicing physicians
from various work
settings
|
More than 2000 YNHHS physicians for needs assessment;
41 hospital-based clinicians in 3 Yale-New Haven hospitals,
and physicians in community settings in the Southern Tier of
Connecticut for course testing; also 51 control group
physicians from the same settings/area
Planned to expand study group to additional types of health
professionals and to the northern tier of the state, but delays
prevented this
|
3. Project Evaluation and Outcomes/Results
This project was designed to evaluate the effect of a
training program on physician knowledge of bioterrorism preparedness and
response. Like most training programs, it had an initial, significantly large
impact on increasing participants' knowledge, but long-term knowledge retention
was poor. Based on analyses of responses that were answered correctly or
incorrectly by most test-takers, and an evaluation of the course content by
those in the intervention group, modifications were made to the course content.
The project team planned to make further course content changes based on
evaluations by those in the control group (i.e., those allowed to take the
course after the study period). The course also was posted on the Web site of
the YNHHS Office of Emergency Preparedness after changes were made to remove
the Connecticut-specific information and substitute more generic information
about public health agencies. The training now can be accessed by physicians in
any state; "meta-tags" were added to permit common Internet search engines to
locate the courses.
4. Major Products
- Survey instrument
on learning modalities for CME and topics related to bioterrorism.
- "Emergency
Management 101"—30-minute Power Point presentation on basic principles of
emergency management.
- "Bioterrorism
Preparedness—Emergency Management 201 training module, available on the Yale New Haven Center for Emergency Preparedness and Disaster Responses Web site
5. Potential for Sustainability/Expansion after PFQ
Grant Ends
The course developed for this project is now available
on the Yale New Haven Center for Emergency Preparedness and Disaster Responses
Web site http://ynhhs.emergencyeducation.org/. Project staff report that since
its official launch in January 2006, after the end of the project, about 300
physicians have taken the course, which is eligible for CME credit. There is a
state mandate for documentation of CME (approximately 30 hours/year) but it
does not yet include a requirement that any of the CME be related to emergency
preparedness.
Return to Appendix B Contents
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