Department of Family and Preventive Medicine

The University of South Carolina Department of Family and Preventive Medicine has a longitudinal curriculum focused on training residents, medical students, and other health professional trainees in practice transformation, quality improvement (QI) and advanced models of primary care.  The curriculum includes both didactic and experiential activities to provide hands-on experience in conducting practice-based improvement. 

Beginning in 2003, the department launched a multi-year strategic plan that included a clinical redesign of integrated faculty and resident practice using principles outlined in the Future of Family Medicine report.  Through participation in an Institute for Healthcare Improvement (IHI) Collaborative for Access and Efficiency in Primary Care Practice, the department’s Family Medicine Center (FMC) formed four clinical teams of staff, residents, and faculty who focused on improving both individual and team access for patients as well as establishing higher rates of continuity, which had been lagging in its residency program. 

In addition, engagement in the Association of American Medical Colleges (AAMC) Academic Chronic Care Collaborative helped faculty to better understand the principles of the chronic care model, patient activation, care management, team-based care, and use of the model for improvement to enhance care for patients with diabetes.  Subsequently, a partnership with Blue Cross Blue Shield of South Carolina provided for ongoing enhanced reimbursement for improvements in clinical service delivery provided in the context of a patient-centered medical home (PCMH).

Department faculty have substantially expanded practice transformation into resident training, beginning with Post Graduate Year 1 (PGY-1) activities built on intentional patient panel assessment and a one-year longitudinal class project that focuses on improving one aspect of care for FMC patients.   For example, interns assisted the departmental QI Team with designing and implementing Plan-Do-Study-Act cycles related to improving hypertension management and outcomes for patients with this chronic condition during 2012/2013.  As part of this effort, PGY-1 residents also complete IHI Open School online modules to gain an introduction to the model of improvement and other QI methods. PGY-1 residents also begin work on a three-year METRIC29 project that requires completion of modules based on review of their own patient panel.

PGY-2 year residents begin work on a scholarly QI project, which carries through their PGY-3 year and has resulted in regional and national presentations of their work. Additionally, PGY-3 residents complete an analysis of their care quality using National Committee for Quality Assurance’s (NCQA) individual recognition for diabetes care.

Throughout their three years of training, residents are involved in monthly clinical team meetings focused on practice redesign issues and serve on periodic, topic-based process improvement teams. As a result of these program components, residents have helped develop and analyze quality metrics for the practice’s clinical dashboard, assessed patient flow and cycle time, determined ways to maximize efficiency from data collected by public health students, and identified high-risk cohorts of patients for enhanced care management.  Each of these achievements represents new competencies for the residency program. The department’s work in ambulatory QI curriculum development was recognized by the sponsoring institution, which granted approval and funding for a PGY-4 Healthcare QI fellowship. Fellows in this program have led QI teams in the health system and mentored residents and medical students, creating a new cycle of educational activities.

Medical student education has also improved through summer research programs in which students between their first and second year work with faculty on QI activities, and though a new third-year clerkship that instructs students on the PCMH model when they are paired with faculty who demonstrate these principles during clinical time in the FMC. The department’s clinical redesign work has also benefitted students studying other health professions including master public health/health administration and doctoral pharmacy students from the University of South Carolina, as well as medical assistant students from a local technical college.