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Evaluation of AHRQ's Partnerships for Quality Program

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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.  

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