Residents Learn to Improve Care Using the ACGME Core Competencies and Institute of Medicine Aims for Improvement: the Health Care Matrix

Abstract

Objectives: This article describes how internal medicine residents at Vanderbilt University Medical Center learn to assess and improve care using the Institute of Medicine aims for improvement and the Accreditation Council for Graduate Medical Education core competencies combined in a tool called the health care matrix. The most important and popular use of the health care matrix has been with suboptimal care, in which care is not safe, timely, effective, efficient, equitable, or patient centered.

Background: The core competencies provide a means of defining why care was not safe, timely, effective, efficient, equitable, or patient centered. The Institute of Medicine aims for improvement are also important because they are used to frame most publicly reported measures of quality. Few residents have an understanding of these public measures and how their futures will be affected by the growing trend toward quality report cards.

Intervention: To help the residents understand the significance of public measures of quality, they learn to assess their patients as a "panel," looking at the care they provide for patients with coronary artery disease and diabetes mellitus. Residents use the health care matrix to analyze 1 of their patients, and then as a group they select a health care matrix for their improvement project. The way the health care matrix is formatted and the sequencing of the core competencies allow for the analysis of the cells to lead to the final question "What was learned and what needs to be improved?" The residents are then taught the tools and methods of quality improvement and complete their project. Some of these projects have had a significant influence on external measures of quality for this organization. The article describes the 8-week course that residents complete, the use of the health care matrix, the analysis of the patient panel, and finally an example of a completed project in which they improve the timeliness of antibiotics administration to patients with pneumonia (a public measure of quality).

Figure 1

Curriculum Development Matrix for the Care of Geriatric Patients

Figure 2

A Resident Worked With Nurses in the Emergency Department to Understand the Process for Patients With Pneumonia