Medicine 2021 Annual Conference, here with Dr. Richard Bruno, our Highly Regarded Vice Chair. On behalf of ACPM Leadership and Planning Conference Committee, we have the honor to welcome you to PM21, Building Resilience, Preventing Pandemics, Health and Equity, and Climate Change. We are so excited to have you with us today and share with you some of the highlights of this year's conference and today's events. Now, while COVID precludes us from meeting in person, we're pleased to offer you an all-virtual conference. Our conference theme is Building Resilience, and sub-themes include Climate Change and Human Health, Social Justice and Health Equity, and COVID-19 Pandemic Preparedness. Our conference tracks, with sessions that run throughout the conference, include Population Health Management and Health Technology, Public Health Practice Innovation and Community Medicine, Research Evidence and Policy, Clinical Preventive Medicine and Lifestyle Medicine, Global Health and Environmental Medicine, and the Future of Preventive Medicine Training and Advocacy. Our oral concurrent sessions include updates from the U.S. Preventive Services Task Force, the Community Preventive Services Task Force, and the American Board of Preventive Medicine. Plenary sessions throughout the conference will highlight our conference theme and sub-themes, including Building Resilience During the COVID Pandemic, Climate Resilience and Environmental Justice, Building Vaccine Confidence with Outreach Efforts and U.S. Regulatory Safety Practices, Social Justice and Health Equity, and Building Public Health Resilience, featuring health officials on the front lines and legislative efforts behind the scenes. Keynote speakers include Allison Cassidy from the EPA, Chelsea Clinton from the Clinton Foundation, Peter Marks from FDA's CBER, Amanda Cohn from the CDC and ACIP, Wayne Frederick from Howard University, Anand Parekh from the Bipartisan Policy Center, Reuben Warren from Tuskegee University, Ursula Bauer from the Office of Surgeon General, Wilma Wooten from the San Diego Health Department, and Clarence Lam from the Maryland State Senate. The conference also includes scientific poster presentations on a variety of public health and preventive medicine topics and an opportunity to earn more than 25 CME hours to support your maintenance for certification and recertification. Our professional development events include a young career lecture, an advocacy training workshop, and there will also be networking opportunities during our conversation cafes, our congressional hill visits, and social events including a virtual museum tour. Our conference will close with our annual ACPM awards, recognizing outstanding member contributions to our college and profession, and remarks from our President-Elect, Dr. Tenette Castle-Wood. Be sure to create a profile and participate in the PM21 networking challenge, interacting with your colleagues, attending events and sessions, and earning points to be entered into a drawing to win a complimentary PM22 conference registration. We'll be starting conference events today with the State of the College with our CEO, Donna Grande, ACPM President, Stephanie Zaza, ACPM Treasurer, Doni Shen, and ACPM Secretary, Sandra Guerra. This will be followed by our KBS lecture featuring Dr. Aletha Maybank, the Chief Health Equity Officer and Senior Vice President of the American Medical Association. Dr. Maybank will also be featured in a plenary panel on building social justice and health equity on Tuesday afternoon. Remember to join us on social media and use hashtag PM2021. Concurrent sessions for today include a patient safety course, partnerships in public health, and managing stress and weight during COVID. And please join us this evening for the grand opening of our partner corner, the poster exhibits, and our virtual tour of the Smithsonian Museum of Natural History with our guide, Dr. Steve Rockauer. We're so glad you're here and hope you enjoy PM21. Thank you. 21 annual conference here with Dr. Richard Bruno, our highly regarded vice chair. On behalf of ACPM leadership and planning conference committee, we have the honor to welcome you to PM 21, building resilience, preventing pandemics, health inequity, and climate change. We are so excited to have you with us today and share with you some of the highlights of this year's conference and today's events. Now, while COVID precludes us from meeting in person, we're pleased to offer you an all virtual conference. Our conference theme is building resilience, and sub themes include climate change and human health, social justice and health equity, and COVID-19 pandemic preparedness. Our conference tracks with sessions that run throughout the conference include, population health management and health technology, public health practice innovation and community medicine, research, evidence, and policy, clinical preventive medicine and lifestyle medicine, global health and environmental medicine, and the future of preventive medicine training and advocacy. Our oral concurrent sessions include updates from the US Preventive Services Task Force, the Community Preventive Services Task Force, and the American Board of Preventive Medicine. Plenary sessions throughout the conference will highlight our conference theme and sub themes, including building resilience during the COVID pandemic, climate resilience and environmental justice, building vaccine confidence with outreach efforts and US regulatory safety practices, social justice and health equity, and building public health resilience, featuring health officials on the front lines and legislative efforts behind the scenes. Keynote speakers include Allison Cassidy from the EPA, Chelsea Clinton from the Clinton Foundation, Peter Marks from FDA's CBER, Amanda Cohn from the CDC and ACIP, Wayne Frederick from Howard University, Anand Parekh from the Bipartisan Policy Center, Reuben Warren from Tuskegee University, Ursula Bauer from the Office of Surgeon General, Wilma Wooten from the San Diego Health Department, and Clarence Lam from the Maryland State Senate. The conference also includes scientific poster presentations on a variety of public health and preventive medicine topics and an opportunity to earn more than 25 CME hours to support your maintenance certification and recertification. Our professional development events include a young career lecture, an advocacy training workshop, and there will also be networking opportunities during our conversation cafes, our Congressional Hill visits, and social events including a virtual museum tour. Our conference will close with our annual ACPM Awards, recognizing outstanding member contributions to our college and profession, and remarks from our President-Elect, Dr. Tenet Castle-Wood. Be sure to create a profile and participate in the PM21 Networking Challenge, interacting with your colleagues, attending events and sessions, and earning points to be entered into a drawing to win a complimentary PM22 conference registration. We'll be starting conference events today with the State of the College with our CEO, Donna Grande, ACPM President, Stephanie Zaza, ACPM Treasurer, Joni Shen, and ACPM Secretary, Sandra Guerra. This will be followed by our KBS lecture featuring Dr. Aletha Maybank, the Chief Health Equity Officer and Senior Vice President of the American Medical Association. Dr. Maybank will also be featured in a plenary panel on building social justice and health equity on Tuesday afternoon. Remember to join us on social media and use hashtag PM2021. Concurrent sessions for today include a patient safety course, partnerships in public health, and managing stress and weight during COVID. And please join us this evening for the grand opening of our Partner Corner, the poster exhibits, and our virtual tour of the Smithsonian Museum of Natural History with our guide, Dr. Steve Rockauer. We're so glad you're here and hope you enjoy PM21. Hi, everybody. Welcome to our patient safety panel for ACPM 2021. Thank you for joining us on this Sunday afternoon at 4 o'clock. It's really appreciated. My name is Shauna Levy. I'm going to be your moderator for today. I am a preventative medicine doctor, like all of us, and I currently work in the insurance industry as a medical director doing utilization management and patient safety reviews. This is the first session of the population health and IT track. The other two sessions, which are really awesome, are going to be on Tuesday. That is the telemedicine session, and then on Wednesday we're going to have looking under the covers with COVID data. So awesome sessions. Be sure not to miss those. So patient safety is more important now than ever. Families are being barred from hospitals. People are busy and overworked, and mistakes happen. So how are hospitals dealing with that? And this is very personal to me because my good friend's fiance actually died early in the pandemic from mistakes that would have been caught had she been allowed to go with him to his doctor's appointments to the hospital. So I'm going to introduce our speakers, and then we are going to hear them talk for about 15 minutes, and then we're going to have a Q&A session. So please feel free to type in your questions as we go. Our first speaker is Dr. Gunner. In November 2018, Dr. Gunner was selected to the position of executive director in the Veterans Health Administration National Center for Patient Safety. In this role, he provided oversight to the VHA, National Patient Safety Program, and promotes high-reliability organization principles and practice, authors VHA patient safety policy and guidance, administers the recall of medical products, manages two VHA patient safety education programs, and facilitates capture, reporting, and investigation of patient safety events across the organization. He previously served as VHA National Director of Surgery 2008 to 2018 with oversight of the VHA National Surgery Office and the VA Surgical Quality Improvement Program. Dr. Gunner graduated from Northwestern University, BAMS 1979, Northwestern University Medical School, and Loyola University of Chicago Law School with a certificate in health law. He completed training in general surgery at the University of Illinois, Cook County, and Jesse Brown VAMC hospitals, and in cardiothoracic surgery at Loyola and Heinz VAMC hospitals, and maintains a board certification in both specialties. In 1993, Dr. Gunner established a practice in cardiothoracic surgery in the Chicagoland area, and in 2003, returned to Heinz VAMC as the chief of cardiac surgery. He's a 2007 graduate of Leadership VA, holds a clinical appointment at the Ann Arbor VAMC, an academic appointment as adjunct clinical associate professor of cardiac surgery at the University of Michigan, is a member of the Illinois Bar, and a fellow of the American College of Surgeons and the American College of Healthcare Executives. Our second speaker, Dr. Claire Hoff, MDMPH, is board certified in family medicine and preventive medicine. She is an assistant professor at Tulane University. Her primary care clinic is located in Metairie, Louisiana. She's the director of the Southern Area Patient-Oriented Research Organization, SEPARO. SEPARO is a practice-based research network located in the Gulf South that focuses on research and quality improvement in the real-world clinical setting. She's also the program director of the Tulane Preventive Medicine Residency Program. Her research interests include making quality improvement feasible and accessible to boots-on-the-ground physicians, health disparities, and preventive care. When she's not working, she's at home with her husband and two daughters in New Orleans enjoying whatever toddlers like to do, which I know from experience, not what parents like to do. All right, take it away, Dr. Gunnar. Thank you, Shauna. Just to test, I assume I'm coming through. Somebody will notify me if I'm not, I suppose. What an honor it is to present on this panel to the American College of Preventive Medicine. The COVID-19 pandemic has been, has had significant impact on health and has had significant impact on the Veterans Health Administration and, as you'll see, influenced the National Center of Patient Safety, which I'm the executive director to, to really focus on those practices that really took us away from the way we normally do business. And in that lies significant lessons learned, not only in the current situation, but if this, if we're faced with this dilemma again in the future. Now, I'm gonna see if my clicker works. Am I connected? Connection lost. Let me reboot and see if I can get it again. So that's a summary of what you had. So to begin with, it's, I've been working in a central role for the Veterans Health Administration now going on 14 years. And I'm forever just humbled by the size and breadth of the work that the Veterans Health Administration does. You all may have your own personal bias or your own personal experience, but I thought I'd start with just some numbers and perspective at a high level. The Veterans Health Administration, its mission is to honor Americans veterans by providing exceptional healthcare that improves their health and wellbeing. There are four statutory missions, healthcare, education and training, research and emergency management. For those who, our fourth mission became front and center of much that we did in the last year and a half when we supported our local communities by taking on non-veteran beneficiaries into our care and to support the community. Those became evident in multiple areas and the major cities as you can imagine around the country. There are Veterans Health Administration has 170 VA medical centers. And you can look down the list and you can look down the list of there. There are 170 acute care facilities, almost 1300 total sites of care. You can see that there's outpatient, all the outpatient areas that in healthcare centers and outpatient clinics, et cetera. VA is arranged into 18 veteran integrated facilities and integrated service networks. So you can see the regions for each of those. There's VISNs one through 23, but many have been combined. And when I started as National Director of Surgery in 2008, there were actually 21, but they were compressed to some were combined to 18. The general rule is that there's a number of veterans that are cared for that receive healthcare in those regions is somewhat balanced. And you can see why the, as you move west, the actual area of each of these VISNs becomes significantly expanded. In 2018, there were 9.2 million enrollees, almost six and a half million veterans use the VHA for their healthcare. That's what we term a unique, anyone who access the healthcare system during that fiscal year was counted as a unique patient. There were 80, 86 million outpatient visits. Just let that sink in for a second. When you're thinking about getting everything absolutely correct, there's, if you got it 99.99% correct, there'd still be enough to on a daily basis to raise your eyebrow that, boy, I could do better. Hospital discharges, almost 550,000. And in FY 2018, we were actually one of the significant leaders in the utilization of telehealth. Primarily mental health was delivered. A significant amount of that telehealth, 782,000 encounters was delivered for mental health. And with the pandemic, just take a second to think about that, we moved, we increased that volume to 38,000 encounters per day. It took our IT folks a few days to weeks to try to figure out how to manage the bandwidth on that, but they did a dramatic and wonderful job in making that happen. So a substantial amount of what was delivered during the time of COVID, the last year and a half has been substantial, has been through telehealth. Next. Oh, my slide. So the VHA National Center of Patient Safety, what does, what's our mission? And we are the, it's to guide the VA organization and external stakeholders on policies and strategies to measure and mitigate harm to the veteran and those who support the care. We promote best practices for safe patient care and optimal patient care utilization throughout the organization. Accordingly, we guide the VHA and external stakeholders on policies and strategies to do the following. One, measure and mitigate harm to the veteran and those who support the care. Two, track and utilize and address deficient patient admission and discharge practice. Three, model characteristics of high reliability organization, including promotional clinical team training and adjust and save culture. And four, evaluation of healthcare solutions, technology and innovations from a patient safety and value-based perspective. So that's the context upon which we then went to work in evaluating patient safety concerns throughout the organization when in the early, the mid-winter of 2020, this, we were faced with a unique challenge. And so there were two places that we, NCPS, looked to for these, for an indicator of what's going on. We knew that, as we all do, we knew all of the things that were happening, right? Elective surgery was being pushed out. COVID patients were demanding more and more of our intensive care, as well as our acute care. The way in which we did, we practiced changed because of this unknown and very dramatic change in a remarkable enemy that we were facing that could impact and take any one of us, any one of the providers, as well as spread without real notice through asymptomatic vectors. And so we didn't know in the National Center of Patient Safety what the impact of that was, but we have a couple of mechanisms to be able to chase that. The first is issue briefs. So in the field, when at any one of the 170, and all the outpatient facilities roll up under the acute care facilities, when an event occurs that is noteworthy, and there is a issue brief process that can be, the facility writes an issue brief and sends it up from the facility to the VISN to the central office. So there are issue briefs that we were able to evaluate, and that's the top chart, run chart, where you can see the number. If you look at the dates on the bottom, you've got from February through June, right? Of that, it's even small for me to see. And you see that in March, you see the bump in issue briefs that relate to COVID. So we used, not only do we have access to the issue briefs, we use natural language processing to look at those on a weekly basis, really in real time. And then examine those. The second is, we have a patient safety reporting system called the Joint Patient Safety Reporting System, JPSR. It's a Datix commercial solution. And we were running a similar track on that, and you can see that there was a similar bump. At the same time, what's interesting about JPSR is that those persistent, it went up, and then sort of continued with people putting in patient safety concerns during this period. So from those, significant issue brief themes that came out of, or themes that came out of the issue briefs were, and I think these were fairly caught, I mean, the media caught these as well, is that state veterans home and community nursing homes had COVID deaths that we needed to address. And the second was personal protective gear that was not only acquiring it early on, but, and how to best protect our staff from the patient safety reporting system, our primary themes were delays in care and modified practice from the way we normally do business. That led us in NCPS to publish a number of patient safety notices to the field. Heads up, these were guidance to help people on how to, you know, as a reference point for when they were, for issues that were bubbling up from these issue briefs and patient safety reports. And so we published six of these between April and July, and you can see the dates and what those were entitled. The first was really around PPE and what do you do, how do you, what can you reuse? What do you do, what alternatives can you use in a pinch and to protect yourself and to protect those around you? The next had to do with use of smart pumps and fusion pumps outside of patients' rooms so that you wouldn't have to burn up PPE to go into the room, they would bring the pump outside the room and with a long IV tubing to the patient. And you can just imagine the potential heads up that would need to be an awareness that would come with that process. The next was the varying type of screening for temperature, how to, what variability occurs across the different types of temperature screening devices. The next had to do with safety concerns regarding anything that was insufflated. So that was, and the use of PAP or respirators and being, really ensuring that proper cleaning, proper awareness about having the filters in place, there, so you didn't put one on without replacing or having a correct filter in line. And then the last is really who would have ever guessed that the use of masks on mental health wards are presented a potential suicide risk because depending on the type of mask you use, if it had long strings or the elastic or whatever, however, it may have been used to, as a device for someone to impose harm on themselves. And so that was a guidance we added based on really the fact that we have somewhere around 80,000 mental health admissions a year to our mental health wards. So that's the overview. I look forward to the conversation today. And Shauna, I turn it back to you. Hello, we'll wait until my slides come up or my clicker gets activated. Here we go. Anyways, I'm Dr. Clarissa Hoff. I like to go by Claire. And I do a lot of work in quality improvement, especially with family medicine residency programs and in teaching. And so I kind of wanted to do an overview of patient safety and quality improvement in the time of pandemic. And this is just kind of a case study of how we addressed it or how, yeah, how we addressed it in our practice-based research network. And we, mostly I'm dealing with this in the context of COVID. Once I had to deal with a hurricane issue and things like that, I won't go into that because that was site-specific and not always relevant to everyone else outside of Louisiana. But let me get started here. So who are we? We're Sapporo Southern Area Patient-Oriented Research Organization. We are not the beer. We only have one R. We do work mostly in Southern Louisiana. So yes, unfortunately, we probably have a little bit too much alcohol intake. That's a public health issue that we have to deal with, but we're not going to talk about that today. We work mostly in Southern Louisiana. We have hopes to spread to the Gulf South in general, especially working, talking with some other practice or other family medicine residency programs in Alabama and Mississippi. What is a practice-based research network? If you're not familiar with it, practice-based research networks are groups of primary care clinicians and practices working together to answer community-based health care questions and translate research findings into practice. So PBRNs engage clinicians in quality improvement activities and evidence-based culture in primary care practice to improve health of all Americans. So we tend to take the pie in the sky research and move it down to kind of the real world boots on the ground. How do you make this actually work? And a lot of times we actually, we'll actually, you know, ask the questions that the, you know, the academic centers just don't have the time or the interest to ask, but that actually need to be asked to make primary care work for the regular physician. In our case, we have one, two, three, four, five, sorry, one, two, three, four, five, six different institutions. One's just a single primary care practice. We have East Jefferson Family Medicine Residency Program. We have the Family Medicine Clinics at Tulane University, doesn't actually have a residency program. It's all faculty. We have four different Family Medicine Residency Clinics under LSU, and we have the Baton Rouge General Family Medicine Residency Clinics. So as you can see, we are spread out all over Southern Louisiana. For those of you who aren't that familiar with Louisiana geography, that's spread out by four or five hours apart. It ends up being six Family Medicine Residency Programs, one private practice, and about four Family Practice Programs in academic medicine. It's a very good mix of rural, urban, and suburban sites. It's a strong mix of Medicaid, Medicare, and private insurance. And when we have a project going, we have well over 100 residents and faculty involved in a project at any one time. So just to kind of give you an overview of how we actually do a QI project, we have about a six-step project. We have kind of three main goals. The first one, obviously, is to actually do a QI, to improve a process at every site. So we have, you know, every site has a site lead, and we'll kind of, as a group, pick something that we want to improve at the at the clinics. The second is if we usually attempt to obtain some ACGME goal for the family medicine residency clinics so they could click off some milestones because killing two birds with one stone is always useful. And the third is if it's feasible I'll register this for MOC for credit with the American Board of Family Medicine which also get American Board of Preventive Medicine credit so that everyone can get MOC for credit for this for a project if it's a if it's a quality improvement project. So step one, whoops I'm sorry, will be we're gonna use my the colon cancer project which we kind of wrapped up last year. It was actually quite a successful project. We got all our faculty above the 80% screening rate which is the national gold standard and then we had about you know kind of depending on the site about like a seven to nine percent increase in colon cancer screening across the clinics which was really quite good. We tried to reach 10% didn't quite make that but overall it was a very significant improvement in colon cancer screening. So step one was I physically went to each elect each site which is quite a bit of driving usually half day off of clinic. Gave a lecture on the United on colon cancer screening. I used the United States Preventive Service Task Force guidelines because I'm a preventive medicine physician at heart and then we described the quality the PBRN quality improvement project to all the residents and faculty. Everyone had a chance to ask questions, things like that. This was an in-person lecture and then step two was we sent out the surveys through Qualtrics and everyone gathered data on ten patients. They're given a specific time to start and a systematic way to go through their patient lists and identify patients who qualified for colon cancer screening and identify if they properly screened or did not screen and enter that information into the Qualtrics survey. And then every site was supposed to start discussing you know what kind of quality improvement intervention they did or didn't want to do for their site. And every site got to choose their own individual intervention because every you know every site had a completely different situation, completely different EMR, completely different administration, residency program, etc. And then of course we had monthly phone conferences that you know were anywhere from 15 minutes just to a half hour just to address any technical problems or issues that came up. Step three, I gathered the baseline data for each site and then I again drove out in person to every site and presented this baseline data. Here's where it got kind of fun because I compared every site to their to the other sites. I didn't do individuals obviously but I could compare faculty to residents. I could compare on each site to every other site. I compare LSU to Tulane which is a big rivalry between those two. Obviously physicians tend to be a little bit competitive so this kind of created some friendly competition. People actually really seem to enjoy it for the most part. And then I went through and gave a lecture on the Plan, Do, Study, Act technique. Actually I gave you a sample lecture of how I did that at the end of this so you can kind of look over and see what I did for that. I probably won't have time to go over it in its entirety. And then step four I gave every site we and then during that Plan, Do, Study, Act lecture it was very interactive. They finalized what interact QI interventions they wanted to do for their site. And then the step four they actually implemented their QI interventions for at least two months. And so for example when most of them put up posters or put out pamphlets or had physician pocket cards with just like basic information to share with patients or reminders on who did and didn't qualify for screening to put in their pockets. One site just incidentally was already hiring a QI coordinator. One site was instantly having a colon cancer awareness day put on by the hospital. But little was done in additional education for the residents and faculty. Again we continue to have phone conferences. Step five was a second survey was sent out through Qualtrics where they gathered data on another ten random patients. So I did paste intervention and then I again went out post intervention with the data and presented it again. Comparing and contrasting how they did to their fellow colleagues, residents versus faculty, etc etc. Again they seem to really enjoy that. And then step six we had an annual research day where everyone came into New Orleans. We had a guest speaker who were able to bring in who did a lecture on mixed methods research. And we had a workshop to develop the next research idea which was AAA screening which was going to include point-of-care ultrasound screening. So that was kind of like a cycle that we had developed. But then COVID hit. And so it kind of destroyed the whole in-person how do we how do we do point-of-care or how do we do this. So we transitioned. So we had to do a lot of transitioning. Some of it was good. Some of it was bad. We had we had attempted to do a Zoom lectures or something of the sort prior to COVID which just was not feasible. They didn't have the setup. They didn't have the technical knowledge. But COVID kind of forced that upon everyone. And all of a sudden everyone knew how to use Zoom or an equivalent platform which actually made the monthly phone conferences better. When people called in I could mute everyone. I could pull up examples on Zoom on on how the lecture or on the how the Qualtrics survey was supposed to work. I could show them things like that. People didn't have to be cognizant of how to unmute their own phone. I could just do it for them so there was no annoying background noise. So that actually worked out better. In-person lectures in the sense that it saved me time and money away from clinic and everyone actually knew how to work Zoom or other similar platforms. I could do it all that way. It did work out. And people were quite interactive. QI material. We didn't have to print out the pamphlets and posters. People figured out how to print them on their own at the sites and bring up the pamphlet which actually ended up being quite okay. It saved us on time and money and we're gonna continue to do it that way in the future. Educational material. This actually ended up being quite useful. We ended up doing quite a few lectures and just posting them to YouTube which ended up working out really well because every individual site could use it as they saw fit and allowed us to create additional educational material. In the Qualtrics survey we actually embedded quite a bit of additional education material. We had a pre and post quiz that we put in the surveys that had they would answer the question then of course the they would tell them if they answered it correctly or not and give an explanation as to the correct answer. So they really learned for the to this triple-a cycle like appropriate triple-a screening and the different contexts in which you do it. There were drawbacks though. I mean the benefits and improve the monthly phone calls. Saved on time and money with travel which will be useful in the future. It was a less time away from the clinic which made my boss happy and allowed for remote sites to join us for Sapporo Research Day which is upcoming. And it definitely forced a level of tech savvy that was not there before which will continue to be useful in the future. But there were limitations like it really will kind of limit Sapporo Research Day which is going to be entirely remote this year because it was it really is workshop based and interactive based which is going to be much harder to do through Zoom. And we had originally when we did this triple-a screening project that we're doing this year we were going to have in-person point-of-care ultrasound training that obviously could not be done very well online. And to do it online or there were companies that did it online but it was going to require a lot of like investment in technology and money that we did not have. So we're unable to do it at that time. We saved a lot of time and money on printing and shipping because people just did it themselves at their site when it came to the posters and things like that. And allowed we actually had a lot more flexibility and how they used everything. It really upped my game as far as education material. We embedded education teaching into the Qualtrics. I'm sorry that's just that embedded teaching educations about the triple-a screening not the cancer screening for this time around. And added more opportunities for education tools that we were able to put online and things like that. Limitations that required more actual motivation from each site to implement like it really depended on each site leaders who do it which some sites really took it on and then other sites were not so involved. They were just a little bit more overworked and couldn't get as involved in it. Tech fatigue is real and it does really just you just really need to show up in person. So and there still is some technology that needs that everyone has to have and so some sites are better at it than others. And so it was more easily done at some clinics and other clinics. So moving forward while the improvements still possible in the pandemic you can do it remotely and you can work with sites to do it. Technology was very useful and at times it was even more useful than the old way of doing things. In the pandemic for as awful as it was it did force technology awareness that we need to continue to utilize in the future. It can't stop all our problems. You still need in-person things at times you still need to show up at times in person to do focus training or just to like be a human being and have a human interaction. And I think this next QI cycle will be really nice because we'll actually be able to combine in-person and technology when we move forward with our next kind of QI cycle which will probably be osteoporosis screening. So hand it over to you Shauna. I think thank you guys those were great presentations. I'm not sure if everyone who's attending knows how to put in a question. It's under social Q&A so it's on the side. We also have a couple polls up if you want to answer the polls. And the first question I have is what lessons learned from from this whole process with the pandemic are you going to take going forward? I know Clarissa just kind of talked about it. Am I on? Can you? Yeah I can hear you. Wonderful. Well it's you know it's we're still not through it. So and the practices that evolved over the last year and a half are still in play. So we've got a remarkable amount of PPE available to our providers. And I think that preparedness how do you how do you not go forward thinking what it takes to deliver with this to manage this kind of virus if you know without having you know you can you can run practice drills all you'd like. But I just think that the lessons learned for health care workers across the nation have have been life changing. I don't mean to be contrite it just is I just think it was so dramatic how the whole entire health care industry had to change to meet this challenge. And who would have ever thought we'd be you know testing in parking lots and delivering vaccines in parking lots and sit standing up the Javits Center or or these ICUs and in cafeterias or wherever those areas had to be developed to care for this this dramatic amount of influx on a remarkable enemy. To give some context to this just so people I checked these numbers on Friday. We've had a total within the our organization within the Veterans Health Administration those enrolled veterans we've had two hundred fifty eight thousand veterans who have who were positive. We we had nineteen thousand three hundred ninety seven that used acute care services so were hospitalized. And ninety seven hundred that were ninety seven hundred that ended up using the intensive care unit. Our overall deaths as of Friday were eleven thousand nine hundred eighty three in our enrolled veterans which is about four and a half percent of the of the the total positive. And we still have twenty eight hundred almost twenty nine hundred veterans who have an active infection still. Our peak and we were we ran the highest across the country was around eighteen thousand and we had two peaks. One in the middle of December probably post Thanksgiving in 2020 and then the second was the January second hump after Christmas the holiday season. We ran up around eighteen thousand active cases again but now we're as I said we're down to twenty twenty nine hundred and it's and it continues to decline. So I I think we're I think we're actively using our lessons learned that we've gathered over the last year and a half but I don't know that you ever could really prepare for that. So what are the ideal features needed from a virtual environment to effectively support multi-site QI projects? Claire. One is you need people on both ends that know how to use it. I would say Zoom does a very good job at like Zoom has the ideal like you needed a way to talk back and forth two ways and I think you need to be able to talk back and forth in a live like actually speak. I know typing does well but I think you actually need to be able to speak and and get people's live reaction. So that is what worked that's what worked best. I needed to be able to share my screen I needed to be able to jump back and forth between like this Excel spreadsheet and that Excel spreadsheet so I could show them what was going on with the data and I could show them what was going on you know with the you know why the data changed or how it changed between different groups. So it has to be very flexible in that sense and then yeah and so a lot of it and also you need someone on the other side who's very proactive and they're on their on their end and we had that in the sense that we put in the incentive of if you did this you got mock for credit which helped a lot and a lot of them are residency programs so they need to meet ACGME requirements. So it it kind of had that extra push on that side that they needed to do this in order to keep the program kind of going or keep the QI requirements of their program going. So, I'd say it's not so much the technology, it's the people. So, I can, if you've got a couple of, now a good time to jump in? Yeah, Kirk, go ahead. All right. So, in the midst of all this, of the pandemic, the Veterans Health Administration proceeded with it, we have a national initiative to bring our organization to advance us along the high reliability organization continuum, if you will. And so, you know, following the Chaston and Lowell mental model of leadership commitment and driving a culture of safety and continuous process improvement, NCPS converted its face-to-face clinical team training, its crew resource management training to a virtual platform. We have trained almost 1,100 CTT master trainers that are now beginning to drive CTT unit by unit across the organization. We developed a platform, a repository for each unit that generates a, you know, finishes so we can track the number of individual staff members who have received CTT and then each unit is to start on a unit-based safety project. And so, we're tracking those in a central repository that allows sharing amongst it. So, the first key is tracking, the second is sharing so that you can see what facility is and what unit is doing what type of standardized safety project. And then, if you want to talk to them or contact them and gather additional information, you can. The second is then in the CPI world, once the third pillar, if you will, we've also started another repository for those similar finding that or similar process that you can collect your CPI projects across the country in this repository and you can look things up and see what people are doing and then connect to them. For perspective, we published our high reliability hospital model in the Journal of Patient Safety last year. And in follow-up, we knew that we had started pushing CPI improvement projects at Truman Medical Center and our relationship with them. And it just, you could see on an annual basis they were pushing, you know, by the early 2000s, a thousand CPI projects a year out of that facility. So, a couple messages. One is tracking, two is sharing successes and celebrations, three is virtual environment is challenging but can be, if you bring attention to it and connect, you can still make it happen. It's not as, it doesn't, it's not as rich as this is, right? I mean, we would, if we were in a room, the interaction would be not so limited. Unidirectional or would seem like we'd have a lot more engagement. But that being said, we can deliver the major points. Yeah. We work across multiple EMRs, which we're just not going to like interact. So, we use a lot, like Qualtrics, we use Qualtrics, but RedCap is another one. If you want to like gather data in a HIPAA compliant database from multiple sites, but people have to, you know. So, how do your organizations tie patient safety to quality improvement metrics? Claire? Me? Yeah. We haven't really done that as much, honestly, because we do mostly, well, I mean, increasing patient quality improvement is increasing patient safety. The more people that get screened, the more, or the more people that get appropriately screened is improving patient safety, in my opinion, because, you know, you're improving, you know, the quality of care that you're providing. And so, I think, you know, I think, you know, in my opinion, because, you know, you're improving, if you're improving your screening rates, you're improving patient safety by ensuring that they get checked. We haven't chosen to do a specifically a patient safety project yet, in that sense. And so, yeah, I guess we have been trying, we have used the data to talk with, it's hard when you're working with multiple administrations to try and, like, we have, we literally have, like, 10 different administrations that we're working with. So, we give each site their data, and they've each used it in different ways. And so, it's very tricky, and every site uses it differently. That's, I guess, my answer. Sorry. Yeah, I think it's an interesting question. The, I still think you can pick certain things to work on as an organization and drive improvement, right? You can't, you can't eat the entire elephant all at once, right? And you're always going to have challenges and certain, you know, there's a variability across, you know, against the mean that you have to deal with. There's this, that people have, you know, it's just, there's, you can't drive to, you know, perfection is aspiration, right? So, but that being said is that, so, in our, the context of our high reliability organization initiative, we're tracking selective patient safety indicators, C-diff rates, fall rates, and that's where it is today. And we're tracking across all of our facilities, both the ones that are selected, a portion, 72 of our facilities now are currently actively engaged in these HRO initiatives. The others are participating, but not, we're not, we haven't, we will expand the program to those, it's graded, right? It's sort of, you know, we started with 18, we moved out to another 54, and now we're going to expand in the years to come. But that being said, we're tracking various quality outcomes, that patient safety quality outcomes, and I think that building toolkits around those, and helping people with how to focus, you know, in areas where you may, it's a select group of metrics, if you, and you can see where, what the expectations are, and if your own data is not as good, then it's reported and tracked, and you have to drive that initiative for improvement locally, if that makes sense. Okay, so we only have three minutes, but this is an interesting question. Do your organizations have mandatory vaccine requirements or COVID testing? Should this be implemented or continue post-COVID? I think you can have a whole hour on that one. Yeah, no, I think it, so as you know, the Save Lives Act, for the VA, we expanded from our own providers and beneficiaries to all veterans, so the 20 million veterans, plus their spouses and their caregivers. So we anticipate vaccinating approximately, if everybody comes forward, about 30 million people, up from a much smaller number. I think the, the, until this is, once, once, you know, it comes off its emergency use authorization and is approved, then I think you're going to see requirements, just like there are for vaccines, other, you know, types of vaccines we're all familiar with. I just, I just don't, I think once that happens, we had a requirement before the, interesting, before the pandemic hit, so our flu vaccine in the VA, if you're a provider in the VA, you are mandated that, and giving, and providing care, you had to have your flu vaccine. So I see there being a very similar, that I'm not making the decisions, but it would not surprise me if that's where we ended up at the end of the day. Yeah, I know at Tulane, there's no mandatory vaccine, but we're currently still all mandatory masks in every two-week testing, and I think they're going to wait until it comes off the mandatory, off the emergency. My guess would be until it gets actually fully accredited, like approved, and comes off the emergency authorization before they start, because the flu vaccine, the way they do it is you either have to have the flu vaccine or you have to wear a mask. So my guess is, is that they will say you have to have the COVID vaccine or you have to have a mask. You know, it's really interesting. I have, I have a 14, 14-year-old son, eighth grade, and a 12-year-old daughter. My son is actually in the championship game as we speak, and they're, they're up five to nothing with what happened a week ago. But anyway, the, when I said to, when I said to, to my son and daughter, I said, what do you think about getting the, they're gonna approve, you know, this is a week and a half ago, and they said, well, that's a no-brainer. We're, we're, just sign us up. So they're signed up for Wednesday, right? They're, so it's, I think that the younger generation is, it doesn't have at least, far less hesitancy, certainly in this household, than I anticipated, that maybe they would have blocked at it, but not at all. Well, thank you guys. We are out of time. Thank you for this interesting discussion, and thank every, I like to thank everyone who put questions up. I'm sorry we couldn't get to all the questions, and we also had some answers to our poll. I asked, have you personally seen a patient safety issue come up that would not have happened pre-pandemic, and someone wrote rapid COVID testing for employees. Not sure what the patient safety issue was with that, but if we were live, we could, if we were in person, we could ask. All right, I guess that was it. Take care. Have a good day. Good afternoon. I'm Katrina Rhodes, Chair of the American College of Preventive Medicine 2021 Annual Conference, here with Dr. Richard Bruno, our highly regarded Vice Chair. On behalf of ACPM Leadership and Planning Conference Committee, we have the honor to welcome you to PM21, Building Resilience, Preventing Pandemics, Health Inequity, and Climate Change. We are so excited to have you with us today, and share with you some of the highlights of this year's conference and today's events. Now, while COVID precludes us from meeting in person, we're pleased to offer you an all-virtual conference. Our conference theme is Building Resilience, and sub-themes include climate change and human health, social justice and health equity, and COVID-19 pandemic preparedness. Our conference tracks, with sessions that run throughout the conference, include population health management and health technology, public health practice innovation and community medicine, research evidence and policy, clinical preventive medicine and lifestyle medicine, global health and environmental medicine, and the future of preventive medicine training and advocacy. Our oral concurrent sessions include updates from the U.S. Preventive Services Task Force, the Community Preventive Services Task Force, and the American Board of Preventive Medicine. Plenary sessions throughout the conference will highlight our conference theme and sub-themes, including Building Resilience During the COVID Pandemic, Climate Resilience and Environmental Justice, Building Vaccine Confidence with Outreach Efforts and U.S. Regulatory Safety Practices, Social Justice and Health Equity, and Building Public Health Resilience, featuring health officials on the front lines and legislative efforts behind the scenes. Keynote speakers include Allison Cassidy from the EPA, Chelsea Clinton from the Clinton Foundation, Peter Marks from FDA's CBER, Amanda Cohn from the CDC and ACIP, Wayne Frederick from Howard University, Anand Parekh from the Bipartisan Policy Center, Reuben Warren from Tuskegee University.

Medicine 2021 Annual Conference

PM21

Building Resilience

Preventing Pandemics

Health Inequity

Climate Change

Climate Change and Human Health

Social Justice and Health Equity

COVID-19 Pandemic Preparedness

Population Health Management

Health Technology

Public Health Practice Innovation