Background: Health systems science (HSS) is a burgeoning field in medical education, a movement spearheaded by the American Medical Association (AMA). Proposed as the Third Pillar of Medical Education alongside the two existing Pillars of Basic and Clinical Sciences, this field focuses education on how health care is delivered and improved on every level of the health care system. This includes education on large-scale quality initiatives, such as the American Heart Association’s Get With The Guidelines – Heart Failure program (AHA GWTG-HF). Here, we describe the experience of a GME-level Health Systems Science program utilizing the institutional goal of compliance with the AHA GWTG-HF initiative as an opportunity for HSS education and improvement science work.
Purpose: The Internal Medicine Residency’s HSS educational program seeks to educate residents on systems thinking, improvement science, and health care system structure and process at all levels, with the purpose of empowering them to enact positive change in a methodical fashion for patients and providers within healthcare. As a means of offering a practical experience to residents in this realm, the program collaborated with the institutional Heart Failure Performance Improvement team to improve adherence to the AHA GWTG-HF recommendations. This collaboration offered a mutually beneficial opportunity for both groups, allowing for hands-on education in HSS for residents and potentially improving institutional performance metrics in a national quality improvement program.
Description: Resident volunteers were solicited through email to engage in one of three Cardiology-related quality improvement projects focusing on improving institutional compliance with the AHA GWTG-HF program. These projects focused on improving discharge instructions for patients with heart failure, improving timely post-discharge follow-up appointments, and improving the rate of goal-directed medical therapy (GDMT) prescriptions on discharge. As part of this program, eight resident volunteers received faculty mentorship and focused education on improvement science, change management, institutional quality metrics, project design, goal-setting, and oral presentations of projects. Project progress was presented at routine Division of Hospital Medicine Performance Improvement Committee meetings and residents worked closely with the institutional Heart Failure Performance Improvement team. Two of the projects led to statistically significant improvements in rates of readmissions and GDMT prescriptions on discharge, and the third project helped to identify significant barriers to post-discharge follow-up appointments for heart failure patients.
Conclusions: The efforts by the Internal Medicine residency’s HSS educational program ultimately contributed to a significant improvement in compliance with AHA’s GWTG-HF program, resulting in the institution receiving the Silver Plus Award in the AHA program. Future efforts will seek to evaluate the effectiveness of this type of HSS education on learners and will continue to improve institutional performance in the AHA GWTG-HF program.