Abstracts from the 2017 Society of General Internal Medicine Annual Meeting

Journal of General Internal Medicine, Apr 2017

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Abstracts from the 2017 Society of General Internal Medicine Annual Meeting

Abstracts from the 2017 Society of General Internal Medicine Annual Meeting SCIENTIFIC ABSTRACTS 3 0 Northwell Health , New Hyde Park, NY , USA 1 North Shore LIJ Health System , New Hyde Park, NY , USA 2 Hofstra NSLIJ SOM , Hempstead, NY , USA 3 A PCMH MIND AND A PCMH HEART”: PATIENT, FACULTY, AND LEARNER PERSPECTIVES ON THE DEVELOPMENT OF AN INTERPROFESSIONAL TEAM-BASED TRAINING PRACTICE Daniel J. Coletti 4 Hofstra University , Hempstead, NY. (Control ID , USA 5 Northwell Health , Great Neck, NY , USA S83 - BACKGROUND: The benefits of interprofessional education (IPE) and clinical training have been documented for learners, yet less is known about the perceptions of the faculty members who facilitate the educational experiences, or the perspectives of patients who receive this interprofessional (IP) care. Aligning the priorities of these three stakeholders would inform a truly patient-centered medical home and also develop an IP workforce skilled and comfortable working in a PCMH delivery model. The objective of this report was to use focus groups to compare stakeholder attitudes about IP education and training. METHODS: We conducted five groups with 42 participants (31 F, 11 M): A “learner” group, a faculty group and three patient groups. The learner and faculty group represented the disciplines of medicine (students and residents), psychology, pharmacy, and physician’s assistants. One of the patient groups was conducted in Spanish. This project was a formative research activity of IMPACcT (Improving Patient Access, Care, and cost through Training), a HRSA-funded program to expand the primary care workforce through IP education, training, and mentorship. Three raters analyzed group transcripts until common themes across the three groups emerged. RESULTS: Themes present in all stakeholder groups were labeled 1) team engagement, 2) the role of technology in care delivery, 3) insurance/cost of care, 4) involving patients in the learning process, 5) time constraints, 6) scope of practice, and 7) autonomy, interdependence, and decision-making. Both similarities and distinct perspectives emerged across stakeholders when discussing these issues and most attitudes were positive. Learners, faculty, and patients each emphasized the importance of defining roles within a team and communicating roles to patients. Learners were excited about IP work and anticipated high quality interactions with other professions. Patients noted that participating in a teaching clinic was “more than about me” and described benefits receiving care from supervised trainees. Faculty perspectives, however, were more ambivalent. They noted that IP “is not a new thing” and questioned their ability to integrate PCMH mandates with an authentic mission to provide patient-centered care: “there’s a difference between…checking off all the boxes for PCMH and…really incorporating the spirit of it…like having a PCMH mind versus a PCMH heart.” CONCLUSIONS: This is the first reported data comparing perceptions about IP education and care across these three stakeholder groups. Commonalities observed across the perspectives of patients, faculty, and learners suggests the need to attend to stakeholder priorities (e.g. regarding scope of practice and role definition) and bridging gaps between teaching PCMH principles and actually providing patient-centered, high quality care. Focus group material has been incorporated into project protocols for interprofessional huddling, communicating with patients, and in the content of our didactic curriculum. “CONVERSATIONAL ADVICE”: A MIXED-METHODS ANALYSIS OF MEDICAL RESIDENTS’ EXPERIENCES CO-MANAGING PRIMARY CARE PATIENTS WITH BEHAVIORAL HEALTH PROVIDERS Patrick Hemming1; Rachel Levine3; Joseph J. Gallo2. 1Duke University School of Medicine, Durham, NC; 2Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; 3Johns Hopkins University, Baltimore, MD. (Control ID #2704644) BACKGROUND: Integrated Behavioral Health Clinicians (IBHC’s) are increasingly common in residency primary care clinics. When IBHCs and residents co-manage patients, residents may learn new approaches to counseling and medical management. This survey sought to better understand the impact that patient co-management with IBHCs has on residents’ learning about behavioral health management. METHODS: Residents were surveyed from 2 Internal Medicine (IM) and 3 Family Medicine (FM) residency training programs with behavioral health integration in residents’ continuity clinics. To assess the degree of face-to-face interaction during their most recent co-managed case, residents were asked whether or not the co-management included (1) a shared visit with the IBHC and/or (2) meeting face-to-face to discuss the patient’s care. Respondents were asked about other features of the visit, including: (1) whether or not they received feedback from the IBHC on their management, and (2) to rate the episode’s impact on the patient’s care. Associations between the degree of faceto-face interaction and these two outcomes were assessed using multiple logistic regression and linear regression. Residents were asked open-ended questions regarding what they had learned from co-managing with an IBHC. Qualitative responses were coded thematically by two researchers using grounded theory. Associations were examined between face-to-face interactions and the frequency of each major learning theme category. RESULTS: 113 residents of 117 respondents had experience comanaging a patient and described their most recent experience comanaging a patient with an IBHC (overall response rate 72%, 117/ 163). Residents were significantly more likely to receive feedback on their patient management if they had a shared visit (Adjusted OR 3.0, 95% CI 1.2–7.6). Residents gave high ratings (mean rating 8.0/10) to the those who did not receive feedback to report themes of interpersonal patient impact of their co-management with no association to whether or communication skills awareness (yes 26.6% vs. no 9.4%) not they had a shared visit. Fourteen learning sub-themes were reported CONCLUSIONS: In residency clinic settings with BHI, residents have the from the following major themes: BH skills awareness, interpersonal opportunity for regular face-to-face co-management with IBHCs. Face-to-face communication skills awareness, and newly-adopted attitudes toward co-management can facilitate increased feedback on skills and management BH. Residents who reported receiving feedback were more likely than and positively influence residents’ attitudes and perceived skills. PROFESSIONAL DEVELOPMENT LEAD TO BETTER CAREER OUTCOMES FOR CLINICIAN EDUCATORS? A SURVEY STUDY O F A D E G R E E G R A N T I N G P R O G R A M I N M E D I C A L EDUCATION.” Amar Kohli; Maggie K. Benson; Alexandra E. Mieczkowski; Carla Spagnoletti; Rosanne Granieri. University of Pittsburgh, Pittsburgh, PA. (Control ID #2706562) Theme 2 Interpersonal Communication Skills Awareness No residents in this group reported this major theme “I learned to have a stronger communication with my patient’s family.” N “I learned different ways of addressing medication problems with the patient and how to approach her about her chronic pain.” Y “I learned different ways to presents medical information in ways that patients understand.” Y “I learned to ask what other concerns patient has- if there is a part that is missing from what the patient is telling me- that can help for therapeutic relationship.” Y “The BHC gave conversational advice in steering the interview.” Y “With BHI, patients have additional support and tend to be more compliant.” N “I developed more understanding of the impact of social stressors on health” N “The alternate perspective on disease often provides the key to treatment adherence” N “It is helpful to have a neutral party and to coordinate the message that the patient receives.” Y “I can delegate this aspect of care to the IBHC to free up time for me to deal with this patient’s complex medical conditions” N “I learned that behavioral health issues are complex and require special management considerations.” Y data about educational leadership positions, curriculum development and national dissemination of education-related work was abstracted. RESULTS: Out of 60 graduates, 47 completed the survey (78%) and out of those 45 uploaded their CV for analysis (75%). More than 90% of respondents agreed that due to completion of the program they were competent in applying principles of learning theory, clinical teaching, small group teaching, ability to give lectures, providing feedback to learners, curriculum development and evaluation, as well as conducting and evaluating educational research. 94% BACKGROUND: Medical school and residency training programs rely on of respondents believed that they were a more effective educator than peers skilled clinician educators to provide high quality educational experiences. While faculty development programs are common, as of 2012, formal degreewho did not complete a degree. CV abstraction revealed that 98% of respondents hold academic positions. Respondents represent more than 15 different granting programs in medical education existed at only ten institutions in the medical specialties, though the majority (40%) are general internists. Of United Stated. To date, there have been limited outcomes reported for participants of degree-granting programs. Beginning in 2002, the University of graduates surveyed, 76% held educational leadership positions. 93% published in peer reviewed journals, 67% published on an educationally related topic, Pittsburgh’s Institute of Clinical Research Education created both masters 87% participated in curriculum development, and 67% engaged in mentorship. and certificate level degree-granting programs in medical education, which 13 respondents won teaching awards at their respective institutions. now have more than 10 years of graduates. Courses include those focused on CONCLUSIONS: Because degree-granting programs in medical educateaching skills, medical education research skills, and faculty development. We tion require great resource investment, the outcomes of such programs sought to evaluate the program by surveying its participants with regards to their attitudes, self-reported skills, and career outcomes. are relevant for institutional support and sustainability. Graduates of the degree granting programs at the University of Pittsburgh reported, METHODS: All graduates of the program between 2004 and 2014 received because of their training, competence in several key domains crucial an email invitation to complete an anonymous electronic survey regarding their satisfaction with the program as well as their perception of whether the to success as a clinician educator. Abstraction of CV’s noted almost all hold academic positions in their representative specialties as well master’s program adequately prepared them in domains pertinent to medical as document their prolific nature in several domains essential to educators. Participants were also asked to upload their current CV from which academic success as a clinician-educator. “GETTING LOST” IN HOSPITAL IS A SOURCE OF STRESS AMONG PHYSICIANS AND NON-PHYSICIAN HEALTHCARE PROVIDERS Grigorios G. Anagnostopoulos3; Michel Deriaz3; Jean-Michel T. Gaspoz1; Dimitri Konstantas3; Idris Guessous1, 2. 1Geneva University Hospitals, Geneva 14, Switzerland; 2University of Lausanne, Lasuanne, Switzerland; 3University of Geneva, Geneva, Switzerland. (Control ID #2704923) BACKGROUND: Navigating around large hospitals has been shown to be a stressful and time-consuming experience for all users of the hospital, including staff members. In addition, navigation difficulties in a hospital highlight suboptimal organisation. When staff encounters navigation difficulties this can lead to cost and efficiency issues and potentially put patient safety at risk. Despite the provision of an array of in-hospital navigational aids, ‘getting lost’ continues to be an everyday problem in these large complex environments. Within the framework of developing a navigation mobile app for the largest university hospital of Switzerland (Geneva University Hospitals), we aimed to identify the navigational needs of, problems encountered by, and consequences to primary care staff. METHODS: A questionnaire was developed by a primary care physician and an indoor navigation specialist (both from Geneva University) based on factors identified through a review of the literature. The questionnaire was constructed to reflect all professional activities encountered in the primary care division and was sent in 2016 to both physicians and non-physician healthcare providers. The questionnaire includes the identification of current problems in way finding inside the hospital (stationary and ambulatory) and their impacts on the staff’s work. RESULTS: Out of 169 eligible collaborators, 111 (65.7%) answered the questionnaire, 61.3% were completed by physicians, 56.7% of collaborators had >5 years of work at Geneva University Hospitals, 70.5 were female, mean age was 39.5 years (SD 10.3). The majority (52.3%) of the participants answered that they had faced difficulties in finding their destination in the hospital (36.9% occasionally; 14.4% often, 0.9% all the time). Only 9.9% answered “never” and 37.8% “rarely”. On average, participants estimated that they spent 11.7 min per week on searching for their destination or answering questions of others trying to reach their destinations. About 70% of the participants reported that the difficulty of finding one’s way in the hospital could be a source of stress for staff members. The participants expressed a very positive view over the prospect of the creation of an application for mobile phones that would guide staff to their destination in the hospital. CONCLUSIONS: These results show that even for staff members of a large hospital, finding their destination is difficult, consume time, and might be a source of stress. Improving way finding could contribute to pursuing organizational change, improve efficiency, and decrease stress. “IT WAS A LOT OF DIFFERENT THINGS BUT BASICALLY WE WERE BEING EVICTED.” PRECURSORS OF HOMELESSNESS AMONG ADULTS AGED 50 AND OLDER: FINDINGS FROM THE HOPE HOME STUDY Irene Yen; Pamela Olsen; Angela Allen; John Weeks; Kelly R. Knight; Margot Kushel. University of California, San Francisco, San Francisco, CA. (Control ID #2705865) BACKGROUND: The median age of single homeless adults is approximately 50; little is known about older adults’ pathways to homelessness. Among older homeless people, 44% first experienced homelessness after age 50. We conducted in-depth interviews with older homeless adults about life course experiences and precipitants of homelessness, and examined whether these differed by age at first homeless. METHODS: We recruited 24 participants from the HOPE HOME cohort, a population-based study of homeless adults 50 and older; we sampled purposively so that 1/2 experienced homelessness before age 50. Our interview focused on childhood circumstances, family and social relationships, criminal and victimization history, social services, criminal justice, education and employment, substance use, and precipitants of most recent homelessness. We developed a codebook using open coding. Two researchers coded transcripts independently, and then met to discuss and reach consensus. The research team identified key themes using thematic analysis. RESULTS: Participants were 52–64 years old, 71% were African American. We identified five key themes: 1) adverse childhood experiences (ACE) had negative consequences throughout the life course; 2) substance use disorders derailed efforts at educational attainment, partnership, employment, and housing; 3) inadequate social ties with partners and family members limited housing options; 4) legal entanglements threatened employment, housing, and entitlement access; 5) institutional and structural racism impeded participants’ access to services and criminalized behaviors. Those with early onset homelessness reported a higher severity of ACE and earlier onset of mental health and substance use disorders which interfered with educational and occupational attainment and familial attachments. They were unable to identify discrete precipitants of homelessness. Those with late onset homelessness reported lower severity of ACE and behavioral health conditions. They reported discrete homelessness precipitants, including: catastrophic illness, marital dissolution, job loss, and eviction for non-financial reasons. Men with late onset homelessness reported feelings of shame and loss of masculinity, hampering their ability to seek assistance. African-American participants reported multiple experiences of racism which heightened their vulnerability to homelessness. CONCLUSIONS: Older homeless adults with early and late onset homelessness shared risk factors for homelessness that differed in severity and timing. Preventing homelessness among those with early onset homelessness requires early interventions for those with ACE and early onset behavioral health conditions. Efforts to prevent late-onset homelessness should focus on interpersonal (e.g. marital dissolution) and structural (e.g. eviction) high risk periods. Homelessness prevention efforts should incorporate structural responses to racism. “LET ME FINISH THIS NOTE AND THEN WE CAN TALK ABOUT THAT”: TRANSITIONS BETWEEN MULTITASKING AND SILENT ELECTRONIC HEALTH RECORD USE IN SAFETY NET VISITS Neda Ratanawongsa1, 2; George Matta1, 2; Courtney R. Lyles2; Kaylin Yu3; Jennifer Barton5, 6; Christopher Koenig4; Ed Yelin1, 1; Dean Schillinger1, 2. 1UCSF, San Francisco, CA; 2University of California San Francisco, San Francisco, CA; 3Cornell University, Ithaca, NY; 4San Francisco State University, San Francisco, CA; 5Oregon Health & Science University, Portland, OR; 6VA Portland Health Care System, Portland, OR. (Control ID #2698401) BACKGROUND: Electronic health record (EHR) use affects communication, but the impact may depend on EHR use styles. We explored how clinicians transition between multitasking and silent EHR use during safety net visits and the benefits & risks of these dynamic EHR styles. METHODS: We conducted an observational study ≥2 months after certified EHR implementation in 5 academic public hospital clinics. We video-recorded encounters between English- and Spanish-speaking patients with chronic conditions and their primary and/or specialty care clinicians. Using Atlas.ti, we recorded durations of: multitasking EHR use (concurrent with patient talk or clinician talk); silent EHR use (clinician AND patient silent for ≥5 s); nonEHR tasks; and focused clinician-patient talk. We calculated median proporof visits. A median of 28% of the visit was spent in multitasking EHR use tions of the total visit spent in these segments. Two investigators independently (range 0–73%); 3% in silent EHR use (range 0–19%); 3.4% in non-EHR tasks analyzed 3 videos and generated codes (editing organizing style), negotiating (range 0–59%); and 31% in focused clinician-patient talk (range 2–81%). discrepancies to create a coding template. One investigator independently applied the template to the remaining videos. By consensus, we combined transition to silent EHR use; 2) breaking the silence; and 3) unaddressed patient codes into themes and selected representative quotes. concerns. RESULTS: We recorded 35 visits between 25 patients & 25 clinicians. CONCLUSIONS: Most safety net encounters involved both multitasking Patients averaged 57 years in age; 44% were women; 48% were Hispanic/ EHR use and transitions in & out of silent EHR use. Clinicians may be Latino; 28% reported < high school graduation; and 20% had limited health unaware these transitions are occurring. Some patients use the silence to recall literacy (LHL). Among clinicians, 72% were women; 48% were primary care or reinsert their concerns; this silence could be particularly beneficial to LHL providers; 88% physicians; and they averaged 16 years since earning degrees. patients or introverts who need space to process and voice their thoughts. The median visit length was 25.5 min; 17% visits were in Spanish. The However, both EHR use styles pose risks to missing patient concerns. Future proportion of visit time with clinician EHR use was: 0% in 3 visits, ≤ 25% research should explore how different EHR-use styles affect clinician cognitive in 9 visits, >25–50% in 17 visits, and >50% of visit time in 6 visits. workload - including outcomes related to safety and clinical decision-making Multitasking EHR use occurred in 91% of visits, and silent EHR use in 60% as well as patient engagement and satisfaction. Themes Related to EHR Use Styles Varying clarity in signaling the transition to silent EHR use Breaking the silence Some clinicians overtly voiced a need to pause to use the EHR, Most clinicians gave non-verbal signals (e.g., turning body or gaze) without verbal warnings. Some clinicians drifted into silence without signaling awareness they were halting conversation with patients. Clinicians & patients may break silent EHR use, leading to multitasking. Clinicians may emerge from EHR tasks to re-engage patients. Patients often interjected “chit-chat,” but also voiced biomedical or psychosocial concerns. Unaddressed patient concerns Both multitasking and silent EHR use offer risks of unaddressed patient concerns. “WHY DON’T YOU LOOK THAT UP?” VERSUS “COLLABORATIVE SELF-DIRECTED LEARNING:” THE IMPACT OF RESIDENCY TRAINING CONTEXT ON SELF-DIRECTED LEARNING Adam P. Sawatsky; John T. Ratelle; Sara Bonnes; Jason Egginton; Thomas J. Beckman. Mayo Clinic, Rochester, MN. (Control ID #2698863) BACKGROUND: Self-directed learning (SDL) is an important component of the Accreditation Council for Graduate Medical Education practice-based learning and improvement competency. Previous research has elucidated the significance of personal characteristics and learning process within SDL. However, there is a need to understand the impact of learning context on SDL within residency training. Therefore, we explored resident physicians’ perceptions of the learning context to characterize the roles of faculty and training programs in supporting resident SDL. METHODS: We drew upon existing principles of SDL and used constructivist grounded theory to explore the effects of context on SDL during residency training. We conducted 7 focus groups (FG) with 46 internal medicine residents. FG guides were developed from literature and expert review. A trained facilitator moderated the FGs, which were transcribed verbatim. Transcripts were explored “ I’m going to look into the computer for a second, okay?” “ Give me a minute, I want to review in the computer what we’ve done before.” “ Let me just…oops…hold on one second.” After period of multitasking history- taking: “So…umm…we…” & drifts into 17 sec silence while typing. “ There aren’t specific treatments…but they’re going to…uh…uh…uh…” After 43 sec, clinician explains: “I’m going to send this to your pharmacy now, ok? This is the new dose of the furosemide.” After 25 sec, pt asks “So are you ready for Christmas?” After 32 sec, pt asks: “So they didn’t talk to you either about my pap machine?” After 12 sec, pt lifts his foot “My [primary] doctor was worried about this…”. Clinician replies “Oh yeah…when did this happen?” and examines it. Multitasking EHR Use: Pt describes friend who had a stroke: “He called me to tell me what happened.” Clinician: “So let’s just review, you’re taking simvastatin which is a cholesterol medicine…” “ Yes and sometimes I have tremendous pain.” Clinician: “Mm-hm.. and you’re still taking…?” Silent EHR Use: Pt explains problems with getting medications on time from pharmacy. Clinician: “That’s weird” & resumes silent EHR use. using open coding and analytic memos to guide subsequent FGs. Constant comparison and axial codes revealed themes related to SDL context. Themes were organized within a theoretical model of SDL to understand the impact of residency training context. The findings were confirmed with member checks. RESULTS: Residents identified the roles of Individual faculty members and residency programs in supporting SDL throughout the learning process, including triggering SDL, identifying learning objectives, formulating learning objectives, utilizing resources, applying knowledge, and assessing learning. Three archetypes of faculty support for SDL emerged: 1) role modelling personal SDL; 2) challenging learners by asking, “Why don’t you look that up?”; and 3) engaging learners in “collaborative SDL.” These archetypes incorporate slightly different approaches to supporting SDL, and were seen as complementary means for engaging learners. Residents discussed the importance of residency programs creating and supporting a culture of SDL by providing time and resources for learning, structuring teaching opportunities that deliver a framework for future learning, incorporating opportunities for self-assessment, offering social learning opportunities, and teaching SDL skills. CONCLUSIONS: SDL is viewed by residents as an internal orientation to learning that integrates process and personal characteristics, like motivation. This study highlights the effect of contextual factors, including the role of individual faculty members and the residency program, on the process of SDL during residency training. Residents elaborated archetypes of faculty involvement in SDL, and provided perspectives on achieving these strategies. The current findings can be used to assist residency programs with faculty development and creating a culture of SDL. CROSS-DISCIPLINARY ROLE AGREEMENT IS STILL LACKING IN THE VA PCMH Karleen Giannitrapani6; Linda Kim3; Alexis K. Huynh5; Susan E. Stockdale2; Alison Hamilton4; Lisa V. Rubenstein1. 1GLAVA, North Hills, CA; 2Greater Los Angeles VA Healthcare System, Sepulveda, CA; 3VAGreater Los Angeles, Los Angeles, CA; 4Veterans Administration, Los Angeles, CA; 5Veterans Affairs, Sepulveda, CA; 6Veterans Health Administration, Menlo Park, CA. (Control ID #2707577) BACKGROUND: With increasing demand for primary care services and a deficient supply of qualified providers to meet this need, new interdisciplinary team based models of primary care delivery, including the Patient Centered Medical Home (PCMH), have emerged. Under PCMH, the roles of supporting teams members expand in include topof-license tasks allowing some tasks that historically fell to only physicians to be shared or redistributed. We explore the role expansion of clinical associates (CAs) (licensed practical nurses, health technologists and medical assistants). Specifically, in this study we query team members of a newly implemented patient centered medical home (PCMH) to identify facilitators and barriers of role self-efficacy, a belief of possessing the capacity to execute their new team based roles effectively. METHODS: We employ longitudinal qualitative analysis involving two waves of 105 semi-structured interviews with interdisciplinary providers based in Veterans Health Administration (VA) PCMH teams. Primary data were collected in 2011–2012 (wave 1) and 2014 (wave 2). We assess team member experiences approximately 1 year after the implementation to identify facilitators and barriers to role self-efficacy; we compare these with facilitators and barriers identified 4 years post implementation. RESULTS: In wave one, three themes that functioned as facilitators/barriers to the self-efficacy necessary for successful role expansion of CAs were identified: 1) role training 2) time and resources for roles and 3) cross-disciplinary role agreement. By wave two, most training complaints were resolved. Time and resources to complete expanded tasks as well as cross-disciplinary role agreement persisted as challenges. Specifically, insufficient coordination between medicine and nursing or administrative leadership about staff roles was unresolved. CONCLUSIONS: The goal of freeing up physician time by sharing tasks effectively across a team, will likely not be realized without team member role self-efficacy, specifically time and resources to completed expanded role tasks and cross-disciplinary agreement about roles. When implementing interdisciplinary teams in primary care, existing disciplinary paradigms and leadership pathways are impacted and in turn impact team member role-self efficacy and ultimately team functioning. Investing resources in engaging managers and in interdisciplinary leadership approaches may be an important strategy for supporting PCMH team member role self-efficacy. CROSS-SECTIONAL STUDY OF PHYSICIAN BURNOUT AND ORGANIZATIONAL STRESSORS IN A LARGE ACADEMIC HEALTH SYSTEM Kristine Olson3; Seppo Rinne4; Mark Linzer2; Christine Sinsky1; Sandip Mukherjee3; Michael Bennick3; Ronald Vender3; Harlan M. Krumholz3; Theodore Long3. 1American Medical Association, Chicago, IL; 2Hennepin County Medical Center, Minneapolis, MN; 3Yale University School of Medicine, New Haven, CT; 4Center for Healthcare Organization and Implementation Research, Bedford, MA. (Control ID #2703601) BACKGROUND: Physician burnout is common nationwide and tied to adverse outcomes for physicians, patients, and healthcare systems. The aim of this study is determine the prevalence of burnout among academic faculty, hospital employed, and community private practice physicians, and to identify remediable workplace stressors associated with physician burnout. METHODS: This was a cross-sectional survey via email of the estimated 4118 clinicians affiliated with a large non-profit academic tertiary medical center. The sample represented three cohorts: academic faculty, hospital employed, and community private practice physicians. Burnout wa s mea sured by the Maslac h Burnout Inventory, calculated as defined by a score ≥ 27 on emotional exhaustion or a score of ≥ 10 on depersonalization, or both. The perceived presence of seven workplace stressors was measured by the Mini-Z survey, and odds ratios for burnout were determined by separate multivariable logistic regression models, adjusting each for age, gender, full-time equivalent (FTE), and group (academic, employed, private practice). RESULTS: Of the estimated 4118 clinicians invited by email, 1252 received the survey having clicked the link, and 557 responded (45% completion rate). The prevalence of burnout was 58.6%. Physicians who perceived poor control over workload (53.9%) were more likely to experience burnout (80.4% vs 33.1%, OR 7.6, 95% CI 4.7–12.2, p < 0.001). Physicians who perceived team effectiveness as unsatisfactory (16.8%) were more likely to experience burnout (84.3% vs. 53.4%, OR 7.2, 95% CI 3.1–17.1, p < 0.001). Physicians who perceived work atmosphere as hectic-chaotic (51.7%) were more likely to experience burnout (74.8% vs. 41.4%, OR 4.3, 95% CI 2.7–6.7, p < 0.001). Physicians who felt their values were not in alignment with department leadership (42%) were more likely to experience burnout (72.7% vs 48.0%, OR 3.2, 95% CI 2.0–5.1, p < 0.001). Physicians who felt their time for documentation was unsatisfactory (64.6%) experienced more burnout (68.4% vs. 40.7%, OR 4.2, 95% CI 2.6–6.9, p < 0.001), as did the 53.4% of physicians who felt the amount of time on the EMR at home was unsatisfactory (65.7% vs. 50.6%, OR 2.1, 95% CI 1.4–3.3, p = 0.036). Academic faculty experienced more burnout than those in private practice (62.2% vs 43.7%, p = 0.006). Burnout was most prevalent among trainees, early career physicians, and women. CONCLUSIONS: In this cross sectional study, the prevalence of physician burnout was 58.6%, and highly associated with lack of control over workload, team effectiveness, a more chaotic work atmosphere, unsatisfactory time for documentation, a lack of value-alignment with departmental leadership, and the presence of EMR stress. Private practitioners experienced less burnout than academic faculty or hospital employed physicians. Academic faculty were most affected. Organizational leadership commissioned this work to guide interventions and begin serial monitoring. Average verbal participation events, with and without inclusive comments by facilitator (per student per session), normalized for group gender composition G E N D E R D I S PA R I T I E S I N S M A L L G R O U P V E R B A L PARTICIPATION AMONG 1ST YEAR MEDICAL STUDENTS Mary Clare Bohnett; Sylvia Peterson-Perry; Molly R. Rabinowitz; Mariah Peterson; Shadi Dowlatshahi. OHSU, Portland, OR. (Control ID #2698509) GEOGRAPHIC VARIATION IN PRESCRIPTION OPIOID USE DURING THE POSTPARTUM PERIOD Nora V. Becker2; Brandon Maughan1, 2. 1Emergency Physicians Integrated Care, Salt Lake City, UT; 2University of Pennsylvania, Philadelphia, PA. (Control ID #2709687) BACKGROUND: It has been shown that gender disparities exist for female clinicians today and that female trainees are disadvantaged by the so-called “hidden curriculum”. However, research is lacking on specific targets at which to aim interventions. Class participation has been correlated with academic success, but it is unknown whether participation disparities exist during preclinical medical education, or whether increasing participation may be a locus for combating gender disparities. This descriptive pilot study explores gender disparities at the level of preclinical medical education, using verbal participation as a proxy metric. It aims to (1) quantify any gender disparities in verbal participation; (2) examine whether factors such as facilitator gender or inclusive facilitation impact verbal participation; and (3) encourage medical education initiatives that address gender gaps before the hidden curriculum widens them later in training. METHODS: Observational data was collected over a 4-week period during a first year medical school course. Ten small work group sessions were observed and unique verbal participation events were counted by gender. Facilitator gender, gender composition of group, and inclusionary comments by facilitator were also recorded. RESULTS: Descriptive statistics analysis revealed a disparity in average verbal participation between males and females of 2.5:1, when normalized by group gender composition. At least one instance of inclusive facilitation per session increased female participation, while a lack of inclusive facilitation doubled the disparity. CONCLUSIONS: Verbal participation disparities exist, but are somewhat mitigated by inclusive facilitation. More research is needed on implications and interventions to promote gender equity. BACKGROUND: Morbidity from prescription opioid use varies substantially by geography. There is a lack of published literature on opioid use in the immediate postpartum period. METHODS: We extracted claims data from the Optum Clinformatics Data Mart, a database of approximately 14 million commercially-insured individuals. The sample included women with claims for vaginal or Cesarean delivery during 2001–2013. Extracted data included age, race, inpatient diagnosis and procedural codes, and type of filled prescriptions. Primary outcome was proportion of women who filled an opioid prescription within four days of discharge. Outcomes were stratified by mode of delivery (uncomplicated vaginal, complicated vaginal, uncomplicated Cesarean, complicated Cesarean) and compared across US census divisions using two-tailed tests of proportions. RESULTS: Among women with uncomplicated vaginal delivery (n = 905,584), 28.3% filled opioid prescriptions. Opioid use differed by 459% between the lowest-use division (Middle Atlantic, 10.7%) and highest-use division (East South Central, 49.2%) (p < 0.0001). Complicated vaginal deliveries (n = 80,510) had higher opioid use (42.1%) and similarly large variation among divisions (19.2% vs. 61.9%, p < 0.001). Opioid use after uncomplicated Cesarean (n = 357,813) and complicated Cesarean (n = 85,388) was similar (76.2% vs. 77.0%). The Middle Atlantic division had lower opioid use rates for Caesarean deliveries (61.0 and 60.1%, respectively) compared to other divisions (rates of 76.2–79.6 and 76.8–80.2%, respectively). CONCLUSIONS: There is significant geographic variation in prescription opioid use following vaginal delivery. This variation in prescription opioid use may identify opportunities to improve prescription safety and reduce opioidrelated harms among women in the postpartum period. IMPLEMENTATION OF THE RURAL VA MULTICENTER MEDICATION RECONCILIATION QUALITY IMPROVEMENT STUDY (R-VA-MARQUIS) Caroline Presley2, 4; Kathleene Wooldridge2; Susan Byerly2; Amy R. Aylor3; Christianne Roumie2, 4; Robert S. Dittus4, 2; Amanda S. Mixon1. 1VA Tennessee Valley Healthcare System and Vanderbilt University, Nashville, TN; 2Vanderbilt University Medical Center, Nashville, TN; 3Veterans Engineering Resource Center (VERC), Indianapolis, IN; 4VA Tennessee Valley Healthcare System, Nashville, TN. (Control ID #2704394) BACKGROUND: Unintentional medication discrepancies at care transitions can contribute to adverse drug events. High quality medication reconciliation can decrease unintentional medication discrepancies but is difficult to implement. METHODS: R-VA-MARQUIS was a feasibility study to improve inpatient medication reconciliation practices using a mentored-implementation design conducted from 2014–2016 in three VA hospitals caring for rural Veterans. An evidence-based toolkit of best practices in medication reconciliation was adapted to the VA setting. Distance mentors evaluated baseline medication reconciliation practices and guided local improvement teams as they implemented toolkit interventions through monthly site phone calls and yearly site visits. At each site, the number of unintentional medication discrepancies per Veteran was collected in a sample of control and intervention patients to monitor response to the interventions. These data were obtained by comparing a Best Possible Medication History (BPMH) taken by trained pharmacists with the medication lists in provider notes and orders upon admission and discharge. Data analysis was performed using traditional QI methods; unintentional medication discrepancies per Veteran were plotted on run charts and XmR charts for each site. Student’s t-test was used to compare control and intervention patients. RESULTS: Sites 2 and 3 successfully implemented several toolkit components. Site 2 utilized pharmacy students to take BPMH on admission, implemented risk stratification, and trained providers on how to take BPMH. Site 3 implemented standardized discharge process and documentation, trained providers on how to take BPMH, and, most importantly, hired an inpatient clinical pharmacist. Facilitators of implementation at Sites 2 and 3 included committed multidisciplinary improvement teams and support from senior leadership. Site 1 was unable to implement any toolkit interventions and faced barriers of high turnover of staff and lack of multidisciplinary engagement on the improvement team. Data was collected on a total of 797 patients across the sites. Patients were 68.7 years old on average; 94.5% were male. Patients were on a mean of 10.1 medications at admission; 45.6% had been admitted at least one time in the previous year. At Site 2, unintentional medication discrepancies per Veteran were not improved in intervention patients compared to control (4.45 vs. 3.5, p = 0.012). At Site 3, unintentional medication discrepancies per Veteran were reduced in intervention patients compared to control and this reduction was sustained over the course of the study (1.79 vs 4.77, p < 0.001). CONCLUSIONS: The mixed results by site highlight the complexity of implementing evidence-based practices for medication reconciliation. This study adds to understanding of how to implement best practices to improve medication reconciliation in smaller hospitals caring for rural Veterans. UTILIZATION OF PRIMARY CARE AND PREVENTIVE HEALTH SERVICES AMONGST INDIVIDUALS IN SAME-SEX AND OPPOSITESEX PARTNERSHIPS; A CROSS-SECTIONAL OBSERVATIONAL ANALYSIS OF MEDICAL EXPENDITURES PANEL SURVEY (MEPS), 2003–2001 Ani Abrahamyan1; Igor I. Bussel1; John R. Blosnich2, 1; Janel Hanmer1. 1University of Pittsburgh Medical Center, Pittsburgh, PA; 2VA Pittsburgh Healthcare System, Pittsburgh, PA. (Control ID #2706132) BACKGROUND: The health of sexual minorities is national priority in the US. Prior publications reported health disparities amongst sexual minorities, including health risk behaviors, health service access/utilization, and differences in the prevalence of medical conditions. However, little evidence exists about differences in utilization of primary care and preventative health services. The objective is to describe the differences in utilization of primary care and preventive health services amongst individuals in same-sex (SS) and opposite-sex (OS) partnerships and to elucidate perceptions of the quality of care received. METHODS: An observational cross-sectional analysis of the Medical Expenditures Panel Survey (2003–2011) was conducted on matched cohorts of 494 individuals in SS and OS partnerships. Measures included identification of a PCP, basic preventive care utilization, and perceptions of quality. Descriptive analysis was performed to determine frequencies for categorical variables and means for continuous variables. RESULTS: SS partnered men had a higher rate of compliance with colon cancer screenings (i.e., FOBT or colonoscopy) than OS partnered men (50.3% vs 30.2%, P = 0.001). The rate of flu shots within the last 2 years was greater amongst SS partnered men compared to their OS partnered cohorts (35.5% vs 53.1%, P = 0.001). There were no differences among men or among women in the perception of quality of care, which was assessed by responses to the perceived timeliness and necessity of care, perceptions about providers listening, explaining, and showing respect, as well as the ease of seeing a specialist. CONCLUSIONS: In sexual minorities who identify themselves as SS partnered, there appears to be minimal difference in utilization patterns of primary care and preventive health services with the exception of greater utilization of colon cancer screening and flu shot compliance by SS partnered men. These differences may be driven, in part, by HIV status and an overlap in screening modalities used to diagnose problems associated with receptive anal intercourse. The lack of differences in perception of quality of care is in conflict with earlier studies that showed greater dissatisfaction with care amongst SS partnered people. This could be explained by a changing political climate with increasing equality and improved quality of life for sexual minorities or it may simply be due to the use of a different sample of same-sex partnered people. These findings are based on a subset population that is in a partnership and identifies themselves as such, thus it may not necessarily be representative of sexual minorities as a whole. 10 year ASCVD RISK AND INCIDENT ASCVD IN THE SYSTOLIC BLOOD PRESSURE INTERVENTION TRIAL (SPRINT) Timothy B. Plante; Stephen P. Juraschek. Johns Hopkins University, Baltimore, MD. (Control ID #2706812) BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) is the top cause of disability and death in the US. Guidelines recommend integrating 10y ASCVD risk into primary prevention counseling. Observational studies have shown fewer ASCVD events with lower SBP levels but it’s unclear if intensive SBP control below 140 mm Hg will further reduce risk. SPRINT randomized adults to standard or intensive BP control. A composite ASCVD outcome has not been reported. Whether intensive BP control reduced risk of incident ASCVD for SPRINT participants is unknown. METHODS: SPRINT randomized 9,361 adults without diabetes or stroke to standard (135–139 mm Hg) or intensive (<120 mm Hg) SBP control. After excluding baseline ASCVD or ages outside of the risk estimator validated range, we calculated 10y ASCVD risk. HR compared intensive vs. standard BP control and ASCVD events, ASCVD or death, and death alone. Visualization of HR by level of 10y ASCVD risk for ASCVD events used a restricted cubic spline model with 95% CI relative to the median 10y ASCVD risk using Harrell’s method. Kernel density plots depicted distribution of 10y ASCVD risk. RESULTS: After excluding ASCVD at baseline or age >79y, 6,911 participants remained. Mean age was 65y, 37% were female, 35% were Black, median 10y ASCVD risk was 16%. There was a trend towards fewer ASCVD events in the intensive BP control arm (n = 105 v. 136; HR 0.78; 95% CI 0.61–1.01). ASCVD events or death was reduced (0.80; 0.65–0.99) but not death alone (0.82; 0.61– 1.10). The spline model showed increasing hazard of ASCVD events with increasing baseline 10y ASCVD risk. Intensive but not standard BP control showed increased hazard of ASCVD events at a 10y ASCVD risk level >30%. CONCLUSIONS: Among adults at increased risk for ASCVD, intensive BP control is associated with a non-significant trend towards reduction in incident ASCVD. Modeling of treatment effects across levels of baseline risk demonstrates a positive association between intensive BP control and incident ASCVD events among those with the highest baseline risk, though few were in this risk range. Further investigation to delineate levels of risk that may benefit from this intervention are warranted. 5-STAR NURSING HOME (NH) REPORT CARD ASSOCIATED WITH PREVENTABLE HOSPITALIZATIONS FROM POST-ACUTE CARE Kira L. Ryskina1; Tamara Konetzka3; Rachel M. Werner2. 1University of Pennsylvania, Philadelphia, PA; 2University of Pennsylvania and Philadelphia VA, Philadelphia, PA; 3University of Chicago, Chicago, IL. (Control ID #2697507) BACKGROUND: In an effort to better inform consumers, Medicare began publicly reporting NH quality using a simple-to-understand 5-star rating. This resulted in increased attention to NH ratings from consumers and NHs themselves. While NH star ratings increased substantially since they were first published in December 2008, whether this represents improvement in quality or, instead, “teaching to the test” is unknown. Our objective was to test whether improvements in star ratings were associated with improvements in patient outcomes. METHODS: We used Medicare hospital claims and NH clinical assessment data for 2,143,217 fee-for-service Medicare beneficiaries receiving post-acute care in 15,318 NHs Jan 2007 - Jun 2010. We used these data to recreate NHs’ star ratings over the study period and to observe hospitalizations and risk-adjustment variables. To account for the differences in patient exposure to NH care, our primary outcome was number of potentially preventable hospitalizations per 100 patients per month (pppm), weighted by the number of days in the NH. We compared the correlation between star ratings and hospitalizations before vs after Dec 2008 by estimating hospitalizations as a function of NH star ratings, an indicator for whether the hospitalization occurred before or after ratings were released, and the interaction between the two. All analyses included risk adjustment from the NH clinical data and NH fixed effects to account for heterogeneity across NHs. Standard errors were adjusted for clustering within NHs. RESULTS: The association between the number of preventable hospitalizations and a NH’s star rating weakened after the ratings became public: the number of hospitalizations was 0.58 pppm higher in 5-star (best-rated) NHs (95% CI 0.06 to 1.11, p = 0.029) and 0.51 pppm lower in 1-star (worst-rated) NHs (95% CI −0.86 to −0.16, p = 0.004) after star ratings release vs. before (Figure). When stratifying stays by baseline characteristics, these differences were concentrated in NHs with low baseline quality and staffing levels. CONCLUSIONS: Recent improvements in NH star ratings were not accompanied by improvements in preventable hospitalizations for post-acute care patients. This suggests improvements in star ratings were driven by potentially superficial changes that impact ratings, but not the underlying quality of care. A COMMUNICATION INTERVENTION AIMED AT MEDICINE DOCTORS AND NURSES IMPROVES PATIENT SATISFACTION SCORES Jill Allenbaugh2; Jennifer Corbelli2; Laurie Rack2; Carla Spagnoletti1. 1University of Pittsburgh, Pittsburgh, PA; 2University of Pittsburgh Medical Center, Pittsburgh, PA. (Control ID #2703658) BACKGROUND: Patient satisfaction continues to play an everexpanding role in healthcare, from reimbursement to hospital rating. However, effective strategies to improve Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) remain scarce. At the University of Pittsburgh Medical Center, a multidisciplinary patient experience committee aims to improve patient experiences through targeted interventions. The committee identified communication-specific HCAHPS scores, specifically for items “Doctors (nurses) explained things in a way you could understand,” as an area for intervention. We hypothesized a lack of adequate training in beside communication and identification of poor health literacy as reasons for suboptimal communication scores. The aims of our study were to (1) develop a multidisciplinary curriculum to teach physicians and nurses to best deliver complex medical information and (2) evaluate the effectiveness of the curriculum by examining HCAPHS scores for doctor and nurse communication. METHODS: A clear health communication curriculum was developed for 112 internal medicine (IM) residents and 120 nurses from the general medicine wards. The curriculum was disseminated through 60–90 min workshops that were facilitated by IM clinician educators and a nurse educator. The content included didactic teaching on health literacy, small group discussion and simulated videos of optimal communication skills during bedside rounds and the discharge process. Data was collected from 422 HCAHPS surveys from patients discharged from these wards over a 6-month period. We compared that percentage of “top-box” scores (corresponding to a rating of 9 or 10 on a 10point scale) on communication items between 3 months pre and 3 months post curriculum. RESULTS: A total of 76 residents (participation rate 68%) and 80 nurses (participation rate 67%) who work in 5 wards across 3 hospitals attended. Percentage of “top-box” scores improved for all doctor and nurse communication-specific HCAHPS items after the intervention (See Table). CONCLUSIONS: Our data shows that a multidisciplinary clear communication curriculum with a focus on health literacy can significantly improve doctor and nurse communication specific HCAHPS scores at a large academic hospital. As communication skills are essential to providing quality patient care, our curriculum has value for any medical specialty or healthcare system seeking ways to improve the patient experience. CONCLUSIONS: This study fills an important gap in understanding the patient’s perception of telephone follow-up care, and represents a critical first step in mobilizing health plans to pay for telephone visits. Pvalue 0.525 0.10 <0.001 0.92 Doctors explained things in a way you could understand Doctors listened carefully to you Doctor treated you with courtesy and respect Overall communication with doctor Nurses explained things in a way you could understand Nurses listened carefully to you Nurses treated you with courtesy and respect Overall communication with nurses 66 80 70 59 60 74 65 BACKGROUND: Scheduled telephone follow-up visits are one strategy for improving access to specialty care practices, primarily because telephone follow-up visits can be completed in less time (4–6 telephone visits per hour vs. 2–3 office visits per hour, for instance) with lower overhead costs. However, there is limited data on the relative advantage to patients from such a program. To inform ongoing improvement of the program, and to share the experience with payers, who do not currently reimburse scheduled telephone visits, we conducted a survey to evaluate patient-reported outcomes associated with telephone and office follow-up visits. METHODS: Scheduled telephone follow-up visits were introduced in January 2015 as a substitute for some scheduled follow-up office visits in specialty care practices at UCSF. Physicians determine the appropriate patients based upon clinical condition and patient acceptability. Patients are not charged for the service and the UCSF physician receives a modest internal RVU credit. English-language surveys were delivered to all patients (>18 y.o.) who completed a follow-up visit (either telephone or office) at UCSF in Endocrinology, Hepatology, or Multiple Sclerosis clinics between March and May 2016 (n = 2741). Patients with email addresses on file were sent the survey electronically (Qualtrics LLC), and those without were contacted by phone. RESULTS: 96% of patients had email addresses, of which 16% (n = 426) responded. An additional 8 patients without email addresses completed telephone surveys. The final study sample included 13 and 17% of patients with telephone visits and office visits, respectively. Respondents and nonrespondents were similar with regard to clinic, sex, and mean age. Main results are show in Table below. Among telephone visit respondents, 87% reported that it replaced the need for an office visit. When telephone visit respondents were asked about their out-of-pocket costs and total time spent for previous office visits, they had similar responses as office visit respondents. 87% of telephone visit respondents and 85% of office visit respondents agreed that insurance companies should pay for telephone visits that substitute for an office visit, and more than half were willing to pay a co-payment of approximately $20 (median). *imputed based on 10 min scheduled telephone visit time, and request of patients to be available for phone visit 30 min before and after scheduled visit time. A COMPARISON OF MEDICATION-BASED VERSUS MEDICAL CLAIMS-BASED RISK ADJUSTMENT TO PREDICT 1-YEAR MORTALITY AMONG VETERANS DUALLY-ENROLLED IN VA AND MEDICARE PART D Thomas R. Radomski3, 4; Xinhua Zhao4; Joseph T. Hanlon3, 4; Joshua M. Thorpe2, 4; Carolyn T. Thorpe2, 4; Florentina Sileanu4; John P. Cashy4; Jennifer A. Hale4; Maria K. Mor4; Leslie R. Hausmann4, 3; Julie M. Donohue6; K J. Suda1; Kevin T. Stroupe1; Chester Good4; Michael J. Fine4, 3; Walid F. Gellad5, 3. 1Hines VA Hospital, Hines, IL; 2University of Pittsburgh, Pittsburgh, PA; 3University of Pittsburgh School of Medicine, Pittsburgh, PA; 4VA Pittsburgh Healthcare System, Pittsburgh, PA; 5VA Pittsburgh/University of Pittsburgh, Pittsburgh, PA; 6University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA. (Control ID #2700094) BACKGROUND: There is systematic undercoding of medical comorbidities within administrative claims in the Veterans Health Administration (VA) as compared to Medicare. This undercoding may lead to bias when applying claims-based risk adjustment indices in studies of Veterans who dually use both VA and Medicare services, or when comparing medical outcomes between VA and Medicare. Medication-based risk adjustment models may be an unbiased method of risk adjustment in these circumstances or when medical claims are not uniformly available. Our objective was to adapt a medication-based risk index for use with combined VA and Medicare data and compare its prognostic accuracy to commonly used claims-based risk adjustment methods in predicting 1-year mortality. METHODS: Our cohort was all individuals enrolled in both VA and Medicare Part D who filled at least one opioid prescription from either system in 2012. We adapted an existing VA-based medication risk index (Rx Risk-V) to also incorporate Medicare pharmacy and durable medical equipment claims. VA and Medicare medications/supplies were classified into 1 of 45 disease categories, applying previously derived category weights. Using the C-statistic (C), we compared the prognostic accuracy of the adapted Rx Risk-V + demographics (age, gender, race, Medicaid eligibility, and disability status) in predicting 1-year mortality to models that included demographics with and without alternative risk adjustment methods (prescription count, Charlson index, or Elixhauser index). We also compared the adapted Rx Risk-V model to models that included demographics, adapted Rx Risk-V, and Elixhauser or Charlson. We conducted a sensitivity analysis by restricting our cohort to dual enrollees who had a clinical encounter and/or received a medication within both VA and Medicare (i.e. dual users), as we expected the adapted Rx Risk-V model may perform better among this cohort. RESULTS: The 271,343 Veterans in the overall cohort had a mean age of 70.5 years; 96.1% were male, 81.7% were non-Hispanic white, and 63.4% were dual users. Overall, 9.4% died within 1 year. The prognostic accuracy of the adapted Rx Risk-V (C = 0.76) was significantly greater than models using demographics alone (C = 0.72) or a prescription count (C = 0.74), but significantly lower than models using Charlson (C = 0.79) or Elixhauser (C = 0.79) (P < 0.001 for all comparisons). The model combining demographics, adapted Rx Risk-V, and Charlson provided significantly greater prognostic accuracy than all other models (C = 0.80, P < 0.001). We found similar patterns of relative model performance in analyses limited to dual users. CONCLUSIONS: The adapted Rx Risk-V index, when used in combination with common claims-based indices, enhances prognostic accuracy in regard to 1-year mortality. Using this model in place of claims-based indices marginally lowers prognostic accuracy, but remains a viable method of risk adjustment when medical claims are not available or the use of claims-based indices may lead to bias. A COMPARISON OF QUALITY END-OF-LIFE CARE IN PATIENTS W I T H H E M AT O L O G I C A N D S O L I D M A L I G N A N C I E S : IDENTIFYING DEFICIENCIES IN PATIENT CARE Ramy Sedhom1; Daniel Sedhom1; David Barile2. 1Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; 2University Medical Center of Princeton at Plainsboro, Plainsboro, NJ. (Control ID #2670839) BACKGROUND: Limited data is available on the differences in end-of life care for patients with hematologic and solid malignancies. We retrospectively analyzed and compared the quality of end-of-life care between patients with hematologic malignancies and those with solid tumors. METHODS: All adult patients who died of advanced cancer between 1/1/ 2015 and 5/1/2017 at our institution were included. We collected baseline demographics and indicators reflective of quality end-of-life care including: hospitalizations, emergency room visits, admissions to the intensive care unit, and chemotherapy use during the final 30 days of life. Data analysis included descriptive statistics, Chi-square tests, and multivariate logistic regression. RESULTS: 57/316 (18%) of patients who died had hematologic malignancies. In the final 30 days of life, patients with hematologic cancers had more visits the emergency room (56%vs. 41%, P = 0.03), admissions to the hospital (84% vs. 45%, P < 0.001), >2 admissions (26% vs. 11%, P < 0.001), extended lengths of stay (48% vs. 6%, P < 0.001), transfers to the intensive care unit (42% vs. 8%, P < 0.001) and death (35% vs. 4%, P < 0.001). They also had more frequent chemotherapy use (48% vs. 12%, P < 0.001) compared to patients with solid tumors. In addition, patients with hematologic malignancies were less frequently referred to palliative care (5% vs. 21%, P = 0.02) or hospice (4% vs. 20%, P = 0.02). Chart review, and multivariate analysis, revealed more aggressive care among patients with hematologic malignancies. CONCLUSIONS: Patients with hematologic malignancies receive different treatment at end-of-life and are less likely to receive palliative services when compared to patients with solid malignancies. Future research is needed to identify differences in overall patient care in order to provide higher quality care. A CRITICAL APPRAISAL OF GUIDELINES FOR ELECTRONIC COMMUNICATION: DO CURRENT RECOMMENDATIONS NEED MODERNIZATION Joy L. Lee2, 1; Nir Menachemi3; Michael Weiner1, 2. 1Indiana University, Indianapolis, IN; 2Regenstrief Institute, Indianapolis, IN; 3Richard M. Fairbanks School of Public Health at IUPUI, Indianapolis, IN. (Control ID #2704852) BACKGROUND: Patients are increasingly interested in electronic access to providers (e.g., via emailing, secure messaging, or texting), and federal policies are encouraging secure messaging. Nevertheless, little is known about how providers should use electronic tools to communicate with patients. We sought to identify published evidence that underpins guidelines for electronic communication, and to evaluate evidence-based recommendations for electroniccommunication between patients and members of the healthcare team. We identified a dearth of published work in both areas and instead critically appraise existing published guidelines and suggest an agenda for future work in this area. METHODS: We performed a narrative review of provider-targeted guidelines on electronic communication, searching Ovid MEDLINE, EMBASE, and PubMed databases using relevant search terms (e.g. ‘patient’ and ‘email,’ ‘webmail,’ or ‘messaging’ and ‘guideline,’ or ‘standard’). We limited the search to articles published in English. We also manually searched the citations of relevant articles. We identified the themes and suggested practices of each guideline, and evaluated whether promoted practices reflect current practice. RESULTS: We identified 11 guidelines on electronic communication between providers and their patients. Although many articles referenced emerging evaluations of electronic communications, no recommended practices were underpinned by evidence of the effectiveness of the practices. Within the guidelines, privacy and data security were major themes. Most guidelines recommend a discussion with patients regarding expectations for communication. They focused little on suggested practices regarding the content of electronic communications, communication delivery, and how best to achieve communication functions such as providing information and emotional support. Many guidelines are out of step with current practice regarding both how email is used and how patients and clinicians interact. For example, they include suggestions that providers should direct patients to use the auto-reply e-mail feature to acknowledge reading messages and to also direct patients to use specific subject headings in electronic communications. CONCLUSIONS: Although current guidelines for electronic communication may be rooted in a solid conceptual basis, they have three major flaws: a) the guidelines are not founded on evidence, b) they offer little guidance on how best to use electronic tools to communicate effectively, and c) many guidelines are out of line with current practice. Just as clinicians and clinical trainees are being taught face-to-face communication with patients based on an evidencerich foundation, the same rigorous work needs to be applied to electronic communication. Researchers need to evaluate and identify effective practices systematically, create a framework to evaluate quality of communication, and test the relationship between electronic communication delivery and quality of care. BACKGROUND: Although substantial research demonstrates the effectiveness of integrated care models, there are very few studies that compare clinical outcomes in depression for a co-location model versus a collaborative care model (Krahn, Bartels, Coakley, et al., 2006; Unützer, Katon, Callahan, et al. 2002) As health care reform efforts support integrated model sustainability and scalability, understanding whether there are differential outcomes achieved can help practices allocate resources appropriately. An academic medical center with large ambulatory primary care practices (N = 19), serving primarily Medicare and Medicaid recipients with significant racial and ethnic diversity, began offering integrated care primarily through co-location (usually a licensed clinical social worker and a part time psychiatrist) in the Fall of 2014. In February 2015, 7 sites were chosen to begin implementation of the integrated collaborative care model (CCM) as part of a Health Care Innovations Award from the Center for Medicare and Medicaid Innovations. The CCM program aimed to improve care quality through the addition of a care manager to the behavioral health team, allowing enhanced “between visit” care and case reviews in a multidisciplinary team, facilitated by a measurement-informed care patient registry. METHODS: A cross sectional natural experimental design compared depression symptom severity outcomes for patients attending Montefiore primary care sites employing co-located care (N = 12) and sites utilizing CCM (N = 7). Depression symptom severity was measured with the Patient Health Questionnaire 9 (PHQ-9). Patients were enrolled in the study if they scored 10 or above on the PHQ-9, indicating moderate to severe depression. Eligible patients receiving both intervention types had access to short-term, psychotherapy, concrete social services, and medication management. At 10 to 16 weeks (mean = 12 weeks) following enrollment, patients were readministered the PHQ-9 by a trained and blinded independent assessor over the phone. RESULTS: A total of 240 participants were enrolled (N = 122 at co-location sites; N = 118 at CCM sites). Significant within group reductions in depressive symptoms were observed in the co-location sites (difference, 2.23, p < 0.0003) and the CCM practices (difference, 5.04, p < .0001). Between group differences indicated patients in CCM sites demonstrated significantly greater reduction in depressive symptoms compared to patients at the co-location sites (difference, −2.81; p = .0005). CONCLUSIONS: The CCM intervention appears to result in a significantly greater reduction in depressive symptoms compared to the co-location model across a range of Montefiore primary care clinics serving low income, diverse patients. Replication will be necessary in larger samples to further support these findings. A CROSS SECTIONAL STUDY REVEALS AN ASSOCIATION BETWEEN ELECTRONIC CIGARETTE USE AND MYOCARDIAL INFARCTION Taher M. Tayeb; Talal Alzahrani; Nardos Temesgen; Ivan Pena. The George Washington University, Arlington, VA. (Control ID #2689119) BACKGROUND: Electronic cigarettes (E-cigarettes) have grown in popularity as an alternative to traditional cigarettes especially among consumers who want to reduce the risk of morbidity and mortality associated with smoking. Nonetheless, a recent study showed that both E-cigarettes and traditional cigarettes cause an increase in oxidative stress and endothelial dysfunction, however this effect is less pronounced with E-cigarettes. Currently, there is a limited study that shows the impact of E-cigarette in the cardiovascular system. Therefore, data from the 2014 National Health Interview Survey (NHIS) was used to evaluate the effect of E-cigarettes on the cardiovascular system, specifically the effect on myocardial infarction(MI). METHODS: Analysis of the 2014 National Health Interview Survey (NHIS) database was performed to examine the effect of E-cigarettes on MI. Initially, subjects were assigned to one of two groups: those with a history of MI and those without a history of MI. The t-test and chi-square test were subsequently applied to compare the different demographics and health characteristics between these two groups. A logistic regression model was then used to measure the association between E-cigarettes and history of MI. Data was adjusted for multiple risk factors for MI including age, gender, race, body mass index, income, the status of smoking cigarettes, and history of hypertension, diabetes, and hypercholesterolemia. RESULTS: A total of 35,156 subjects were included in the final logistic model. [Summarize a number of baseline variables with respect to health and demographic characteristics] Analysis showed that increasing age (OR, 1.04; p <0.001), history of hypertension (OR, 2.72; p < 0.001), high cholesterol (OR, 2.19; p < 0.001), and diabetes (OR, 1.68; p < 0.001) are associated with an increased odds of myocardial infarction. With respect to smoking, increased frequency of smoking was associated with increasingly higher odds of MI when compared to patients who had never smoked: every day smokers (OR, 2.75 p < 0.001), some day smokers (OR, 2.39; p < 0.001), and former smokers (OR 1.80; p < 0.001.) In contrast, females (OR, 0.49; p < 0.001), Hispanics (OR, 0.62; p < 0.001), and people with higher incomes (OR, 0.93 [95% CI, 0.90–0.96]; p < 0.001) have lower odds of heart attack. With respect to Electronic cigarette use and MI, analysis revealed an odds ratio of 1.42 with p = 0.017. CONCLUSIONS: Our findings indicate that Electronic cigarette use, when adjusted for other risk factors, is associated with a 42% increased odds of myocardial infarction. This increase in odds is consistent regardless of traditional cigarette smoking history. More studies are needed to further assess this risk. A C R O S S - S E C T I O N A L S T U D Y O F S E L F - R E P O R T E D COLORECTAL CANCER SCREENING STATUS IN US ADULTS WITH AND WITHOUT DISABILITIES Bliss Temple2; Lisa I. Iezzoni1. 1Harvard Medical School, Boston, MA; 2University of California San Francisco, San Francisco, CA. (Control ID #2703635) BACKGROUND: Colorectal cancer screening is a life-saving aspect of primary care recommended for most adults 50 to 75 years old. People with disabilities face difficulties accessing health care services and disparities in rates of cervical and breast cancer screenings. This study used a large, nationally representative database to examine rates of self-reported colorectal cancer screening to determine whether there are disparities for people with disabilities compared to those without disabilities. METHODS: This was a secondary analysis of cross-sectional data from adults 50–75 years old in the 2013 National Health Interview Survey, which uses a multistage area probability design to sample the civilian non-institutionalized US population. The outcome was self-reported current colorectal cancer screening status. The main predictor was self-reported limitation in functional abilities (i.e. disability) in at least one of 12 domains. Severe disability and type of disability (physical, sensory, cognitive/intellectual, chronic disease, mental health) were secondary predictors. Covariates included age, sex, race, Hispanic ethnicity, and seeing a primary care provider (PCP) in the previous year. Logistic regression analyses were used to model the odds of current screening status. The model was evaluated for interactions, collinearity, goodness of fit, and misspecification. RESULTS: Of the 13,332 subjects in the analysis, 51.3% reported any disability and 28.2% severe disability. Subjects with any disability reported a 59.3% current colorectal cancer screening rate; those with severe disabilities, 58.8%. Both groups had higher screening rates than those without disabilities (52.1%). Those with disabilities did not have significantly different adjusted odds (OR 1.05; 95% CI 0.98,1.13) of current screening compared with those without disabilities. Statistically significant covariates were age, Asian race, Hispanic ethnicity, and seeing a PCP within the past year. The odds ratio for those with versus without severe disability was not statistically significant (OR 0.95; 95% CI 0.87,1.03). Odds ratios for health condition subgroups compared to those without that condition were statistically significant only for the groups with physical health conditions (OR 1.15; 95% CI 1.06,1.24) and chronic diseases (OR 0.89, 95% CI 0.80,0.99). CONCLUSIONS: Overall rates of colorectal cancer screening for people with and without disabilities were not significantly different, despite barriers to accessing care and disparities in other cancer screening rates. This may reflect an increased focus on health by people with disabilities compared to the nondisabled and/or fewer barriers to colorectal cancer screening than for other cancers. Policy initiatives aimed at decreasing health disparities for people with disabilities may be more productively focused on areas other than colorectal cancer screening. A DIFFERENCE-IN-DIFFERENCE ANALYSIS OF TRENDS IN UTILIZATION FOLLOWING A PRIMARY CARE REDESIGN INTERVENTION Kevin Nguyen1; Alyna T. Chien2, 4; David J. Meyers1, 3; Sara Singer1, 2; Meredith Rosenthal1. 1Harvard T.H. Chan School of Public Health, Boston, MA; 2Harvard Medical School, Boston, MA; 3Brown University School of Public Health, Providence, RI; 4Boston Children’s Hospital, Boston, MA. (Control ID #2699123) BACKGROUND: Many academic medical centers (AMCs) are seeking novel approaches to deliver higher quality care and lower costs for patients cared for in primary care practices. Beginning in mid-2012, 20 practices across 6 AMCs affiliated with Harvard Medical School launched a learning collaborative to establish team-based care at both hospital- and community-based practices. We describe trends and changes in utilization 3 years before and 1 year following this intervention. METHODS: The learning collaborative followed a sequenced change strategy, and relied on in-person learning sessions, monthly calls, and leadership training. We conducted difference-in-difference analyses using generalized linear models to compare changes in utilization between intervention practices and controls before and after the intervention using the Massachusetts AllPayer Claims Database (APCD) for 2009 to 2013. The APCD aggregates medical claims each year for private payers and Medicaid in the Massachusetts. The 20 intervention practices were identified by linking National Provider Identifier number to the Massachusetts Health Quality Partnership Physician database, which trackers physician hierarchy within practices and systems. We used propensity weights to identify controls that were of comparable size and affiliated with AMCs. Patients were attributed to intervention or control practices annually. Utilization measures included outpatient visits, emergency room (ER) visits, inpatient hospitalizations, ambulatory care sensitive inpatient (ACSIP) hospitalizations, and ambulatory care sensitive ER (ACSER) visits. We adjusted the utilization outcomes based on the number of months a patient was enrolled. We estimated percent change in intervention practices’ utilization relative to changes in controls’ utilization. RESULTS: One year following the beginning of the intervention, we found a statistically significant reduction in outpatient use in intervention sites compared to controls by 0.72 visits per patient per year, or approximately 7.3% (p < 0.01). From baseline, ER use decreased in intervention sites compared to controls by 0.06 visits per patient per year (8.3%, p < 0.01) and inpatient hospitalizations in intervention practices decreased by 0.1 admissions per patient per year (19.2%, p < 0.01). ACSIP admissions decreased by 0.02 per patient per year in intervention sites compared to controls (28.6%, p < 0.01) and ACS ER decreased by 0.01 visits per patient per year (9.1%, p < 0.01). CONCLUSIONS: We observed significantly larger reductions in utilization in intervention practices when compared to control practices. Our findings suggest that involvement in the learning collaborative was associated with significant reductions in healthcare utilization. A DI GI TAL LA NGU AGE DI VI DE? THE RELAT I ON SHI P B E T W E E N I N T E R N E T M E D I C AT I O N R E F I L L S A N D MEDICATION ADHERENCE AMONG LIMITED ENGLISH PROFICIENT PATIENTS Alejandra Casillas2; Leo Morales3; Jonathan Grotts2; Chi-Hong Tseng1; Gerardo Moreno1. 1UCLA, Los Angeles, CA; 2University of California Los Angeles, Los Angeles, CA; 3University of Washington, Seattle, WA. (Control ID #2703287) BACKGROUND: Use of an Internet portal to refill medicines positively affects medication adherence among English-speakers. However, no studies examine if Internet refills also affect medication adherence for patients with Limited English Proficiency (LEP). Our objectives were to 1) examine the relationship between use of an Internet medication refill system and medication adherence among linguistically diverse patients with chronic conditions and 2) compare this relationship between LEP and English Proficient (EP) patients. METHODS: We analyzed 2013–2014 data from 509 surveyed adults with hyperlipidemia, hypertension, and/or diabetes mellitus in the Group Health Cooperative. Data were merged from a multilingual phone survey, plan enrollment, claims data, and electronic medical records. The primary outcome, medication adherence rate (%), was calculated for patients with at least two pharmacy fills over a 12-month period by the “Continuous Measure of Medication Gaps” (CMG) method. For Internet refill system use, patients were asked, “Have you used the health systems Internet site to refill any medications in the last 12 months?”. LEP status was captured by patient self-identification with a non-English primary language, and/or a claims record of interpreter use. We used multivariate linear regression models to examine the adjusted effects of use of the Internet refill system on medication adherence, and compared this association between LEP and EP patients. We adjusted for age, gender, education, insurance, chronic conditions, and number of medications. RESULTS: 384 patients (75%) had a calculable CMG (to produce adherence rate): 134 EP and 250 LEP, included in the models. Patients who had calculable CMG’s were older, prescribed more medications, and more likely to have Medicare or Medicaid coverage, versus patients without a CMG. In unadjusted analyses, LEP patients had lower use of the Internet refill system (p < .001) and lower adherence versus the EP group (p < .001). In multivariate analyses, LEP status (b = −0.022, p = .047) was negatively associated with adherence. Use of the internet refill system (b = 0.030, p = .002), and Medicare or Medicaid insurance (b = 0.030, p = .007), were positively and independently associated with adherence. In stratified models, use of remote Internet refills was positively associated with adherence, even when examining EP (b = 0.029, p = .003) and LEP patients (b = 0.027, p = .049) separately. CONCLUSIONS: We found that the use of remote medication refills through an Internet portal was independently and significantly associated with higher medication adherence in both EP and LEP patients. These findings suggest that LEP patients could be under-utilizing a beneficial Internet tool. Should our health-care system fail to ensure that LEP patients can digitally manage their health care (such as refilling medications) through an Internet portal, we face the risk of widening the existing health care gaps via this digital divide. A LOOK AT WHO STILL NEEDS BREAST AND CERVICAL C A N C E R S C R E E N I N G S E RV I C E S F R O M S A F E T Y N E T P R O G R A M S F O L L O W I N G I M P L E M E N TAT I O N O F T H E AFFORDABLE CARE ACT Latonya Riddle-Jones; Julie George; Robert Burack. Wayne State University School of Medicine, Detroit, MI. (Control ID #2708275) BACKGROUND: The rate of uninsured adults in the United States has declined by nearly 40% since the Affordable Care Act in 2013, nevertheless, more than 20 million adults in the US remain uninsured. Safety net programs are necessary to help address the needs of those who remain uninsured, but to what degree? We have examined the enrollment of people in a safety net breast and cervical cancer screening program (BCCCP), serving uninsured and lowincome women in an area of Metro Detroit, Wayne County, MI, to better understand the magnitude and determinants of this need. METHODS: We examined patterns of enrollment by age, ethnicity, and income, in our community-based breast and cervical cancer control program for the period from 2013 through 2015. We used logistic regression to estimate adjusted odds ratios for enrollment according to race/ethnicity. RESULTS: Please see the attached graph depicting the number of breast and cervical cancer screenings of non-Hispanic and Hispanic women enrolled in our safety net program from January 2013 through October 2014. - The graph shows a decline in the number of nonHispanic women enrolled in our program from October 2013 through July 2014. - The graph also demonstrates that Hispanic enrollment in the program remained steady during this time, which correlates with the implementation of the ACA in Michigan (April 2014). - Our adjusted Odds Ratio for being Hispanic in 2015 compared to 2013 was 4.44. CONCLUSIONS: The ACA has reduced, but not eliminated the need for specific safety net programs in the United States. While enrollment in the BCCCP declined by 70% pre-post ACA, we have served over 15,000 women from 2013 through 2015 who, in the absence of this safety net program, would likely have remained unscreened. In particular, we note that the BCCCP has taken on increased importance for Hispanic women in our community, who remain disproportionately uninsured, here and elsewhere. A NARRATIVE REVIEW OF PHYSICIAN PERSPECTIVES R E G A R D I N G T H E S O C I A L A N D E N V I R O N M E N TA L DETERMINANTS OF OBESITY Feenalie Patel2; Ashley K. Haddad1; Debra A. Werner1; Monica E. Peek1. 1University of Chicago, Chicago, IL; 2University of Tennessee Health Sciences Center, Cordova, TN. (Control ID #2703874) BACKGROUND: Obesity is a multifactorial disease with influences from biology, behavior, social norms, physical environment, and the larger health system. However, current guidelines for managing obesity discuss only biologic and behavioral therapeutic options, without suggesting ways to address the social and/or environmental determinants of obesity. In this review, we evaluate the ways that physicians conceptualize and address the social and environmental determinants of obesity to better understand current practice. METHODS: We searched PubMed, Ovid, and PsycINFO databases and conducted hand searches of relevant bibliographies over the past 30 years. Search terms included variations on the following: obesity, attitude, perception, belief, knowledge, physician, adult, recommendation, treatment, cause, and etiology. Our final review included all articles that elicited physician perspectives on the causes or management strategies of obesity. We categorized causes and management strategies into the following domains, defined by the ecologic model of health: individual (i.e. biological, psychological, behavioral), social, environmental, and macro-level. RESULTS: We found 1144 total articles, 24 of which met inclusion criteria. Eleven articles (46%) assessed physician perspectives on obesity causes and 18 (75%) assessed physician perspectives on obesity management. Of the 11 articles that discussed obesity cause, all (100%) evaluated physician perspectives on at least one non-individual domain, but no paper evaluated physician perspectives across all domains. Of the 18 articles that discussed obesity management, 12 (66%) evaluated physician perspectives on at least one non-individual domain, and again, none evaluated physician perspectives across all domains. When asked to rank the causes of obesity across multiple domains, physicians ranked individual causes as more important than social or environmental causes in all except one study. Physicians also used individual management strategies more frequently (and believed individual management strategies were more successful) than social or environmental management strategies in all studies. CONCLUSIONS: No articles in our review allowed physicians to evaluate the causes or management strategies of obesity across all domains that might influence weight. However, within this limitation of available literature, our review suggests that clinicians rank individual characteristics as more important in the development and management of obesity than social or environmental factors. While clinicians may simply under-value the impact of social and environmental obesity determinants, this finding may also represent a lack of perceived ability or responsibility to address non-individual health determinants in clinical practice. As we move into the era of population health management, more research is needed to understand the most appropriate ways for physicians to address the social and environmental determinants of chronic diseases such as obesity. A NEEDS ASSESSMENT FOR EMPANELMENT IN A RESIDENT CONTINUITY CLINIC Jennifer Bracey; Alanna Stone; Sara Turbow. Emory University School of Medicine, Atlanta, GA. (Control ID #2704973) BACKGROUND: Empanelment is the act of assigning patients to a primary care provider (PCP). Improving empanelment could create greater satisfaction in clinic by increasing continuity and enabling closer relationships with patients, both of which could decrease resident clinic burnout and create interest in GIM careers. In this analysis, we sought to define the baseline accuracy of current PCP assignments for our resident continuity clinics, and we investigated if residents were engaging in empanelment by assigning themselves as PCP for patients without accurate PCP assignments. METHODS: This analysis was performed in three IM resident continuity clinics at a large urban hospital. We examined charts for all patients scheduled in clinic on two dates in December 2016. We recorded if the patient had a PCP assigned prior to the visit and, if they did, whether the listed PCP was the resident the patient was scheduled to see that day, a different current resident, a graduated resident, or another type of provider (ex. advanced practice provider, subspecialist, or community provider). We reviewed the same charts after clinic to determine if patients without a PCP or with an incorrect PCP had been reassigned to the resident they saw that day. Patients who did not show to clinic or who were added to the schedule after our initial pre-clinic chart review were excluded from the analysis. SAS Studio was used for data analysis. RESULTS: We reviewed 496 charts. Of those, 45.6% (n = 226) had the resident they were scheduled to see that day listed as their PCP. 13.1% (n = 65) had another current IM resident listed, 13.9% (n = 69) had a graduated resident listed, 10.5% (n = 52) had another type of provider listed, and 16.9% (n = 84) were unassigned. Of the 205 patients eligible to be assigned a new PCP at their visit, 44.4% (n = 91) came to the appointment. Five patients were assigned to PCPs other than the resident they saw that day. Of the remaining 86 patients, 45.4% (n = 39) had their PCP assignment changed to the resident they saw that day. CONCLUSIONS: We found that residents assign themselves to be the PCP at a low rate. There was no statistically significant difference in the percent of patients reassigned to a current resident between patients in each of the “inaccurate” PCP categories (p = 0.7314). This also does not appear to differ by PGY level. This analysis was limited by high no-show rates: 42.3 overall and 67.9% for patients without an assigned PCP. Overall, this project shows a need for increased focus on empanelment in our resident continuity clinic. Our next steps will focus on resident-level interventions to: 1) educate them on empanelment and why this process is important and 2) strategize ways for them to improve empanelment. By improving empanelment, we may see greater resident satisfaction with clinic, less clinic burnout and an increased interest in GIM careers. A NEW FRAMEWORK FOR STAKEHOLDER ENGAGEMENT IN EARLY STAGE TRANSLATIONAL SCIENCE Amy LeClair1; Thomas Concannon3; Virginia Kotzias3; Allison M. Cole2, 2; Simona Kwon4; Alexandra Lightfoot5. 1Tufts Medical Center, Boston, MA; 2University of Washington, Seattle, WA; 3RAND Corporation, Boston, MA; 4NYU School of Medicine, New York, NY; 5University of North Carolina at Chapel Hill, Chapel Hill, NC. (Control ID #2705519) BACKGROUND: Stakeholder and community engagement (SCE) is a national priority for the National Center for Advancing Translational Science (NCATS). There is an established framework for stakeholder engagement for the latter stages (T2-4) of translational science, but no such framework currently exists for early stage (T1) clinical researchers. Four Clinical Translational Science Award (CTSA) hubs launched a collaboration to develop a new framework for engaging communities and stakeholders in T1 research. METHODS: We led structured individual and group discussions with T1 investigators to learn about: (1) the health decisions they seek to inform with research evidence, (2) the actors who make those decisions, and (3) the individuals and organizations that are affected by those decisions. Focus groups lasted, on average, one hour. Interviews lasted approximately 30 min. Both were recorded. Audio recordings were transcribed and de-identified, and transcripts were coded using Dedoose™. We used a deductive-inductive procedure to develop the framework for stakeholder engagement in T1 research. A deductive codebook was development from the focus group & interview guides; emergent themes were added and the codebook was revised after preliminary inductive analysis. Two coders analyzed all transcripts using a constant comparison approach. Analysis included input from research participants to assure the framework could be used by T1 researchers. RESULTS: Eighteen individuals connected to four CTSA hubs participated in the discussions. Participants came from the fields ranging from basic chemistry and drug development to infectious disease and pediatrics and represented both methodological and topical experts. Preliminary analysis produced several findings. First, basic scientists can identify stakeholders, contrary to concerns that stakeholder engagement is not applicable at this stage. Second, stakeholders in early stage translational research (T1), as identified by the research participants, do not fit into the same framework as those further down the translational spectrum (T2-T4). A unique framework may therefore assist early stage researchers in the process of stakeholder engagement. Finally, participants indicated they would like more guidance on who, how, and when to engage them in their research. CONCLUSIONS: By showing T1 researchers how to identify and involve their stakeholders in (1) defining research questions, (2) carrying out research activities, and (3) disseminating research evidence, this work has the potential to improve the use of basic science evidence in latter stages of translation from bench to bedside. A NEW MODEL FOR EXPANDING AAMC MEDICAL EDUCATION RESEARCH CERTIFICATION Joshua T. Hanson; Jeffrey Jackson. University of Texas Health Science Center, San Antonio, San Antonio, TX. (Control ID #2702129) BACKGROUND: It is difficult to provide large-scale faculty development in medical education scholarship. This type of development frequently requires formal training and, in response, the Association of American Medical Colleges (AAMC) has created the Medical Education Research Certificate (MERC) program. MERC courses are offered at national meetings; however, this can be costly and time consuming to the individual faculty member. In an effort to provide this to faculty at the University of Texas School of Medicine (UTSOM), we engaged with AAMC to host the MERC program locally. Our goal was to create a sustainable faculty development program in medical education scholarship by increasing opportunity while reducing resource utilization. METHODS: MERC faculty traveled to the UTSOM campus where all the sessions were held. All workshop topics were offered in morning and afternoon sessions to accommodate clinical and administrative duties of the attendees. Attendees were recruited through the Division of General & Hospital Medicine, Office of Undergraduate Medical Education, and the Office of Graduate Medical Education. To measure impact of the program, ten-item pre and post surveys were administered and were constructed to measure increases in skills and knowledge of educational research. Individual paired comparisons were made between pre- and post- survey results by paired samples t-test and grouped according to certification completion. Survey data were compiled and analyzed using Microsoft Excel and Stata. RESULTS: The total number of registrants was 53 and the average number of workshops attended was 5. Twenty-nine registrants completed certification, for which the criterion is completion of six sessions. The total cost of the week of sessions was $16,179, which calculates to $305 per registrant or $558 per certificate. Complete pre- and post-survey data were available for 38 registrants (71.7%). All items had mean increases self-reported knowledge and skills. Among those that completed certification, comparisons demonstrated statistically significant improved knowledge and skills in 10/10 domains. Among those that did not complete certification, 4/10 domains had statistically significant improvements. CONCLUSIONS: Engaging with the AAMC to host the MERC program locally resulted in significant cost savings considering attendance and certification typically requires national meeting registration, travel costs, and is a multi-year endeavor. Certification was associated with increased knowledge and skills in all of the domains. Even partial attendance resulted in knowledge increases. This early success has led to the planning of a second annual MERC intensive program with recruitment of attendees from more departments. Future plans include measurement of sustained self-reported knowledge and measurement of increased scholarship after attendance and certification. A NOVEL APPROACH TO BLINDING IN A RANDOMIZED CLINICAL TRIAL (RCT) OF A COMPLEX BEHAVIORAL INTERVENTION : THE PREVENTING AMP UTATION BY TAILORED RISK-BASED INTERVENTION TO OPTIMIZE THERAPY (PATRIOT) STUDY Xiao Xiao1; Kimberly L. Stone1; Sarah Sullivan1; Yvonne Ye1; Madeline Russell1; Tova Bergsten1; Trina Wijangco1; Samantha M. Hill1; Sundar Natarajan2. 1Department of Veteran’s Affairs New York Harbor Health System, New York, NY; 2VA New York Harbor Healthcare System, New York City, NY. (Control ID #2705763) BACKGROUND: In order to generate valid results in RCTs, it is important to collect unbiased data. Behavioral intervention trials are more difficult to blind than pharmacologic trials. In our ongoing behavioral trial, PATRIOT, which aims to prevent foot complications in diabetes through improved self-care, we are intervening both face-to-face as well as remotely. Consequently blinding is more difficult. Here we illustrate the different blinding processes used. METHODS: In the PATRIOT trial, following randomization during the baseline visit, the intervention group receives computer-based education and demonstration on how to use a special foot thermometer. Following that, intervention participants receive a comprehensive intervention that includes regular telephone counseling and tailored mailings. The control group receives health prevention strategies not related to foot care. For this complex intervention, we needed to develop new strategies to maintain blinding at the participant, research assistant (RA), counselor, outcome adjudicator and data analyst levels. We created a “Blinding Tracker” to identify unblinded and blinded staff so that participants pass from unblinded to blinded staff so that only blinded staff collect data. The integrity of the study is maintained by careful monitoring of blinding with any break in blinding being contained. RESULTS: To date, we have enrolled 221 participants. While participants know the arm to which they are randomized, we needed to make sure that the staff collecting data are blinded. Participants are educated throughout the whole study process by the telephone counselors about the importance of blinding using non-scientific descriptions. Though the counselors know their participant’s treatment assignment, they do not know their foot photography results and other outcomes. The RA’s, who conduct study visits and collect data, are blinded to treatment assignment. To improve efficiency and preserve blinding, we have different RAs for different phases of a participant’s progress. Initially, RAs are initially blinded, but by the end of their involvement with a particular subject, when data collection is done, they become unblinded so they can show the educational videos and demonstrate foot thermometer use. However, RA’s can also become unblinded prematurely. To date, out of 96 six-month visits, there have been 26 such instances. RAs are subsequently transitioned off a particular subject to be replaced by a blinded RA. We will also control for RA blinding in the analysis. The adjudicators who read the foot photographs to determine outcomes and the statisticians are blinded to treatment assignment. CONCLUSIONS: Novel techniques have been used to achieve and maintain blinding, but it is resource intensive. While conducting complex trials, vigilance and responsiveness are needed. Finally, blinding information should be incorporated in the analysis in order to get the most valid results. A PALLIATIVE CARE (PC) ELECTIVE ROTATION FOR SENIOR INTERNAL MEDICINE RESIDENTS IMPROVES COMFORT LEVEL WITH PRIMARY PALLIATIVE CARE SKILLS Maie ElSourady; Mohana Karlekar; Sumathi Misra. Vanderbilt University, Mount Juliet, TN. (Control ID #2702217) BACKGROUND: Palliative Care (PC) specialists assist patients with serious illness, their families, and their clinicians with medical decision making, symptom management, advance care planning, and end of life care. As the population ages, the need for PC services will increase, and will exceed the supply of PC clinicians. Primary care physicians will need to feel comfortable in navigating many primary PC skills. METHODS: We describe a 2 week PC rotation for third year internal medicine (IM) residents at a large academic medical center. Between 2012 and 2016, 32 IM residents completed a PC elective rotation. The curricular components included didactic sessions and bedside teaching on a busy inpatient PC consult service and inpatient unit. All 32 residents completed a pre and post survey during the elective rotation in which they ranked their comfort level with primary PC topics using the RedCap survey tool (1 = Need further basic instruction, 2 = Competent to perform with close supervision, 3 = Competent to perform with minimal supervision, 4 = Competent to perform independently). They also ranked their overall comfort level in working with seriously ill and dying patients (1 = very uncomfortable to 10 = very comfortable).Surveyed topics included conducting a family conference, breaking bad news, discussing DNR orders, home hospice, shift in treatment to comfort care, treatment withdrawal and advance directives, performing a basic pain assessment, using oral and parenteral opioids, adjuvant analgesics, assessing and managing difficult symptoms, and assessing decision-making capacity. RESULTS: Prior to beginning the rotation, the IM resident average comfort level was 2.5 (range 2 to 3.5) for the above topics, indicating that their comfort was between “competent to perform with close supervision” and “competent to perform independently.” After completion of the rotation, the average comfort level was 3.3 (range 2.4 to 3.5), indicating they felt that they were competent to perform these tasks with minimal supervision. IM residents also indicated an increase in their comfort level in working with seriously ill and dying patients, from 6.7 prior to 8.6 after the rotation. CONCLUSIONS: We have shown that the self-reported comfort level of IM residents improves after a 2 week elective rotation with primary PC topics. At the end of the rotation, participants felt that they are able to perform these tasks with minimal supervision, which is reassuring as they complete residency. The limitations of this study are that it is an elective rotation, so we are unable to speak to the comfort level of IM residents who did not complete this rotation. This study raises questions as to the comfort level for PC topics of IM residents that have not participated in a PC rotation, and whether this improvement in resident comfort level translates to improved patient outcomes. A PERSONAL TOUCH TO DECREASE NO-SHOWS Jay L. Mathur2; Noor Khan1; Mehrshid Kiazand2. 1UPMC Mercy, Moon Township, PA; 2UPMC Mercy, Pittsburgh, PA. (Control ID #2699304) BACKGROUND: Outpatient non-attendance, or no-shows, produces major consequences for both patients and providers. A recent review of 42 studies found that telephone reminders, mostly automated, were the most effective system to reduce no-shows (9.4% reduction). Our Internal Medicine Clinic continues to have high no-show rates (27.1% annually) despite automated reminders. We sought to understand the impact personal phone reminders may have on noshow rates vs automated reminders. We were particularly interested in evaluating whether PGY1 no show rates were impacted at the beginning of their training. METHODS: Our teaching outpatient center is divided into two separate sections, Firms A and Z, each with its own resident panel, patient sets, and dedicated staff. All patients receive automated phone reminders 48 hours prior to their office visit. Only Firm A patients also received a personal phone reminder by a staff member during the first 4 months of the academic year. We analyzed the effect of this additional personal phone reminder versus automated reminders in improving no-show rates. RESULTS: 4,121 scheduled clinic visits from 6/29/15 - 10/31/15 were analyzed. 1,067 (25.9%) no-shows occurred over this period. The mean average scheduled visits per resident was 72.4 for A firm and 75.0 for Z firm (p = .7188). The cancellation rate per resident was similar in both firms (A = 22.0%, Z = 20.8% p = .3951). The average rate of no-shows per resident was significantly less for firm A (A =23.3%, Z = 28.7%, p < .0007). PGY1’s did have a lower no-show rate in firm A although the numbers were not statistically significant (A = 23.5%, Z = 29.2%, p = .0639) CONCLUSIONS: Personalized reminders may have resulted in significantly less no-shows in our study. We postulate that despite the cheaper and convenient alternative of automated telephone reminders, personalized reminders can reduce no-shows and lead to more efficient care and better outpatient training. Personalized reminders can also increase initial R1 clinic visits and subsequent continuity experience. Lack of statistical significance for R1 data from our review maybe from small sample size (firm A n = 10, Z n = 10). A POSITIVE DEVIANCE APPROACH FOR LARGE-SCALE DISSEMINATION OF AN EVIDENCE-BASED HYPERTENSION PROGRAM. Shari Bolen2; Thomas Love3, 2; Randall D. Cebul1. 1Case Western Reserve University, Chagrin Falls, OH; 2MetroHealth/Case Western Reserve University, Cleveland, OH; 3Case Western Reserve University, Cleveland, OH. (Control ID #2706516) BACKGROUND: Improvements in blood pressure (BP) control across diverse populations is challenging. Although evidence-based interventions for BP improvement have been successfully disseminated within large integrated health systems serving insured patients, less is known regarding successful largescale dissemination approaches of evidence-based interventions for hypertension management across multiple health systems serving diverse patients. Our objective was to compare BP control over time within diverse practices that participate in a large regional health improvement collaborative (called Better Health Partnership, BHP) which used a positive deviance approach to identify and disseminate a best practice for hypertension management across multiple health systems. METHODS: We compared cross-sectional results for the 116,042 patients seen in July 2015 - June 2016 to the 97,847 seen in July 2011 - June 2012 at all 33 practices who reported to BHP throughout that period. Using clinics’ electronic health records (EHR), patients are included in BHP’s biannual reports if they have a diagnosis of hypertension, are 18+ years of age, not pregnant, and have at least two primary care visits in the past 2 years and one in the last year at a participating clinic. BHP used the reported clinic-level EHR data to identify a best practice for hypertension management between 2009–2011 based on a protocol in one health system that showed dramatic improvement and high achievement of BP control. BHP disseminated this best practice using twice yearly public reports and regionwide learning collaboratives; practice coaching for sites with lower levels of good BP control; and EHR-catalyzed patient-centered care. RESULTS: In 2015–16, patients in the 33 practices were middle-aged (mean 62 years) and diverse (52% Female, 62% White, 32% Black and 3% Hispanic). Across seven Northeast Ohio counties, 28% lived in low-income neighborhoods (median income below $33,000). Patients in these practices showed similar characteristics across reporting periods except for insurance, which went from 5% Medicaid and 9% Uninsured in 2011–12 to 13.2% Medicaid and 3.2% Uninsured in 2015–16. Across all patients in the 33 practices, rates of good BP control (<140/ 90 mmHg) rose from 67 to 72% (a difference of 5.2 percentage points) from 2011– 12 to 2015–16, with increases of at least 4.8 percentage points in all insurance, race/ethnicity, sex, income and educational subgroups. Most improved were patients of Hispanic ethnicity (from 62 to 71%) and the uninsured (from 59 to 66%). CONCLUSIONS: A positive deviance approach substantially accelerated the dissemination and implementation of a best practice protocol for hypertension management across multiple health care systems with diverse patients in a regional health improvement collaborative. A specific focus on low income and minority populations may have led to the greater improvements seen in uninsured and Hispanic subgroups. A PRECISION MEDICINE APPROACH FOR PATIENT-REPORTED MENTAL HEALTH SCORES Anthony T. Fojo2; Katherine L. Musliner1, 3; Peter P. Zandi1; Scott L. Zeger1. 1Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; 2Johns Hopkins School of Medicine, Baltimore, MD; 3University of Aarhus, Aarhus, Denmark. (Control ID #2706653) BACKGROUND: In recent years, precision medicine approaches have been developed for a variety of diseases. Early successes have rested on genomic data and laboratory markers. Precision medicine techniques are underutilized in the field of mental health, partly because clinical management depends on patient symptoms and not genetic targets or biomarkers. The increasing use of the electronic medical record (EMR) and patient reported outcome (PRO) data offers an opportunity to develop algorithms to predict patient outcomes on an individual level. Our objective was to develop a precision medicine framework for mental health symptom scores, which we applied to data from a clinical trial of risperidone for schizophrenia. METHODS: We constructed a novel, multilevel prediction model that learns from serial symptom scores and predicts future symptom trajectories. We fit our model to the trial data - comprising scores on the Positive and Negative Syndrome Scale (PANSS) at weeks 0, 1, 2, 4, 6, and 8 - using Markov-Chain Monte-Carlo. We used 10-fold crossvalidation to evaluate predictive accuracy, and analyzed how many observations were necessary to accurately predict outcomes at study completion. RESULTS: Predictions were most accurate for the subsequent clinic visit, with diminishing accuracy farther into the future. Predictions of outcomes at study completion performed better after at two observations; additional observations yielded only marginal improvements. We present a sample of predictions for an individual based off of the first two clinic visits in the figure. Predictions of symptom scores at study completion based on the first two clinic visits deviated from the observed scores by a mean of 17.6 (interquartile range 6.8 to 23.0) on a scale from 30 to 210, and uncertainty intervals contained the true observation 98% of the time. CONCLUSIONS: We demonstrate how a rigorous statistical model can leverage repeated measurements to predict disease trajectory on an individual level. Our methodology could be extended to other diseases, such as depression, anxiety, or substance abuse, where PROs are measured serially to guide treatment. Our methods could also be extended to time frames beyond eight weeks, or used to predict outcomes such as suicidal behavior or hospitalization. The systematic use of repeated PROs offers the promise of precision medicine in the field of mental health. A QUALITATIVE ANALYSIS OF SYMPTOMATOLOGY IN OLDER HOMELESS ADULTS: RESULTS FROM THE HOPE HOME STUDY Adam Bazari1; Maria Y. Patanwala2; Colette Auerswald1; Margot Kushel3, 4. 1UC Berkeley-UCSF Joint Medical Program, Berkeley, CA; 2University of California, San Francisco, San Francisco, CA; 3UCSF/ZSFG, San Francisco, CA; 4UCSF, San Francisco, CA. (Control ID #2706528) BACKGROUND: The homeless population is aging. Older homeless adults experience the premature development of age-related conditions, but less is known about their symptom burden or experience. Somatic symptoms (physical symptoms) increase with age. Social (loneliness) and existential (guilt, regret, hopelessness) symptoms are distinct from but can overlap with mental health symptoms such as anxiety and sadness. We used qualitative methods to characterize the experience of somatic, social, existential and social symptoms in older homeless adults. METHODS: We conducted semi-structured interviews with participants from the HOPE HOME cohort, a longitudinal study of homeless adults age 50 and older. Inclusion criteria included: current homelessness and high somatic symptom burden, or at least one somatic symptom with high psychological, social, or existential symptom burden. Interviews covered participants’ views on symptom etiology, impact on daily activities, personal strengths and management strategies. We employed Grounded Theory to analyze our data, including open coding, selective coding, and writing theoretical memos. RESULTS: We interviewed 25 participants (60% men, 80% African American, ages 52–71). We found three emergent themes: 1) Existential and social symptoms cause as much distress as somatic symptoms. “My back pain actually is pretty real because I’m sleeping on cement but the thing that really gets me is the future. Sometimes there is a hopeless feeling that comes on.” “Right now [my feelings are] combined because the more mental, the more physical I go through…the only thing that is really destroying me now is I want to see my mother.” 2) There is a clear relationship between the experience of homelessness and symptoms. Participants describe how the experience of homelessness causes existential suffering that can manifest as somatic symptoms. “When I start thinking that I’m not gonna get off of this situation, my body starts to hurt, my stomach gets nauseated. It’s burning like it’s on fire.” 3) Participants manage symptoms with strategies from within and outside of biomedicine, including formal healthcare, religion, use of alternative medicines, and reliance on social supports. “[When I’m feeling angry], I just start praising God until He comes and allow his spirit to wrap his arm around me; put me in a nice sleep. When I wake up, I feel a lot better.” CONCLUSIONS: The traumatic experience of homelessness causes and exacerbates physical and psychological distress. Among older homeless adults, existential symptoms are intertwined with and as distressing as somatic symptoms. To provide optimal care for this population, health care providers should screen for and address a broad range of symptoms, including somatic, psychological, existential and social. A QUALITATIVE STUDY OF HOSPITALISTS’ PERCEPTIONS OF PATIENT SATISFACTION METRICS ON PAIN MANAGEMENT Susan L. Calcaterra1, 2; Anne Drabkin1, 2; Ingrid A. Binswanger2, 4; Joseph W. Frank2, 3; Jennifer Reich5; Stephen Koester5. 1Denver Health, Denver, CO; 2University of Colorado, Aurora, CO; 3Denver Veterans Affairs Eastern Colorado, Denver, CO; 4Kaiser Permanente Colorado, Denver, CO; 5University of Colorado, Denver, CO. (Control ID #2707048) BACKGROUND: Patient satisfaction metrics for pain management impacts federal incentive payments to hospitals. Hospitalists are key players in the delivery of high quality healthcare and are often financially compensated by their institutions for high satisfaction scores. Hospital-based initiatives to promote pain management may unintentionally contribute to excessive opioid prescribing. We aimed to understand hospitalists’ perceptions of the impact of satisfaction metrics on pain management in their clinical practice. METHODS: We conducted 25 open-ended, in-depth interviews with hospitalist physicians practicing in one of five hospitals (two university, one safety-net, one Veterans Affairs, and one private) located in Colorado or South Carolina. Four team members, two hospitalist physicians and two qualitative researchers, systematically analyzed transcribed interviews to identify emergent themes using a team-based, mixed inductive and deductive approach. RESULTS: Hospitalists felt institutional pressure to earn high satisfaction scores for pain management, which they believed led to increased opioid prescribing. One hospitalist stated: “I’m well aware that I’m being watched for my patient satisfaction scores. So at least consciously it does not affect my position on opioids, which is not to say unconsciously it doesn’t affect my decision.” Hospitalists expressed concern that tying physician compensation to satisfaction scores commoditized pain to the patients’ detriment. One physician recalled: “In my community practice, we were incentivized to keep people happy. It was expected that we keep up those scores. There is always pressure and you certainly don’t want your patients to not be satisfied, but I think when you are given individual incentives based on that, it does sometimes change your procedures.” Hospitalists believed that satisfaction scores would likely improve with more time spent at the patient’s bedside discussing pain management alternatives and options, but felt they lacked the time to do so. One hospitalist explained: “I think the patient’s satisfaction is mostly related to their relationship with the doctor rather than the pain. If you actually take the time to talk to the patient and they understand and they agree with you, then of course, the satisfaction scores are not going to be low.” Finally, hospitalist perceived that hospital administrators interpreted high satisfaction scores as representative of quality healthcare delivery. One physician stated: “I think patient satisfaction is one of the things in medicine where it is so far removed from what is actually happening clinically at the bedside. I don’t trust administrators who worry on a daily basis about patient satisfaction.” CONCLUSIONS: Patients should be educated about reasonable expectations for pain management in the hospital. Institutionally supported methods to improve physician-patient communication and engagement may promote both patient-centered, safe pain management and patient satisfaction. A RANDOMIZED COMPARATIVE EFFECTIVENESS TRIAL OF A TRANSITIONAL CARE CLINIC: 180-DAY EFFECTS David T. Liss1; Christine Schaeffer-Pettigrew1; Emily Finch1; Andrew J. Cooper1; Avani Sheth2; Ashanti D. Tejuosho1; Caroline Teter1; Ronald T. Ackermann1. 1Northwestern University, Chicago, IL; 2Cook County Health and Hospital System, Chicago, IL. (Control ID #2706621) BACKGROUND: Care transition interventions following hospital discharge can reduce subsequent rehospitalization. Early experimental evidence is mixed, particularly for vulnerable populations. This randomized trial examined a transitional care clinic for high-risk patients with no trusted medical home. METHODS: We conducted a pragmatic comparative effectiveness trial of the Northwestern Follow-up Clinic (NFC), a transitional care clinic where a multidisciplinary care team provided coaching and assistance navigating the post-discharge transition through clinic visits and phone outreach, medication management support, social service and behavioral health coordination and transitioning to a permanent medical home. Between September 2015 and February 2016, patients were randomized to either NFC referral or referral to a federally qualified health center (FQHC); we used a 3:1 allocation ratio to meet the NFC site’s capacity constraints. Following an emergency department (ED) visit, observation stay or inpatient admission, adults were eligible for inclusion if they had no medical home; were referred to the NFC by a hospital provider, or; expressed that they did not wish to return to their medical home or their medical home was insufficient to manage their needs. We examined differences in hospital care utilization during the 30 days after initial discharge (primary outcomes) and over 90-day and 180-day follow-up. Negative binomial regressions estimated differences in rates of: A) ED visits; B) observation stays; C) inpatient admissions, and; D) total hospital visits (i.e., A-C combined). Regressions adjusted for age, sex, insurance, race/ethnicity, driving distance, prior NFC use and type of initial hospital visit. RESULTS: A total of 654 eligible patients were randomized and included in analyses (490 NFC arm, 164 FQHC arm). The sample was balanced on all sociodemographic characteristics; most patients were uninsured (34.6%) or insured through Medicaid (49.7%). At 30 days, intent-to-treat analysis demonstrated non-significant differences in adjusted rates of ED visits (incidence rate ratio [IRR] 0.82, p = 0.46), observation stays (IRR 0.61, p = 0.19) and inpatient admissions (IRR 0.67, p = 0.16), but there were fewer total hospital visits in the NFC arm (IRR 0.65, p = 0.04). After 90 days, NFC patients had fewer adjusted inpatient admissions (IRR 0.60, p = 0.03) and total hospital visits (IRR 0.60, p = 0.01). Over 180 days, NFC patients had fewer adjusted ED visits (IRR 0.62, p = 0.04), observation stays (IRR 0.52, p = 0.02), inpatient admissions (IRR 0.51, p = 0.003) and total hospital visits (IRR 0.49, p < 0.001). CONCLUSIONS: Over 180-day follow-up, rates of all utilization outcomes under study were significantly lower in the NFC arm. These results demonstrate the potential of transitional care clinics to improve transitions and reduce hospital care use in high-need populations. A RANDOMIZED TRIAL OF DIFFERENT LEVELS OF INPATIENT MEDICAL ATTENDING SUPERVISION OF TRAINEES Kathleen M. Finn2; Christiana Iyasere2; Yuchiao Chang1; Joshua Metlay3. 1Harvard Medical School, Boston, MA; 2MGH, Boston, MA; 3Massachusetts General Hospital, Boston, MA. (Control ID #2703602) BACKGROUND: While the relationship between resident work hours and patient safety has been extensively studied, there is limited data on the impact of different levels of inpatient attending supervision of internal medicine residents on patient safety or resident education. METHODS: We conducted a 9-month clustered randomized trial on an academic inpatient medicine teaching service where 22 experienced faculty were asked to provide two different types of resident supervision: “routine oversight” (joining morning rounds to review new admissions only) and “responsive oversight” (joining morning rounds to review both new admissions and established patients). Each faculty served as their own control and the order of routine vs. responsive oversight was randomized for different 2-week blocks on service. The primary outcome was the rate of potential medical errors using an established algorithm based on medical record review. Secondary outcomes included number of orders written, consultations and radiology studies. Resident education was evaluated with a time motion study to assess resident participation on rounds and surveys to assess both resident and attending perceived educational value of the two models. RESULTS: A total of 1503 patients (5,691 patient-days) were included in the analysis. While the medical-error rate decreased by 9% from the routine oversight to the responsive oversight rounding models, this was not statistically significant (109.0 vs. 93.7 per 1000 patient days, P = 0.26). There was no difference in mean orders written in the morning (7 am–12 pm) or afternoon (12 pm–5 pm) in either routine vs. responsive models (63.8 vs. 81.3 total orders per day - morning, P = 0.12), in consultation notes (11.3 vs. 13.2 total consults notes per day, P = 0.31) or radiology studies (5.7 vs. 6.2 studies done per day, P = 0.89). A time motion analysis of 161 work rounds, found no difference in mean length of total time spent discussing established patients in the two models (202 +/− 46 min-routine vs. 202 +/− 57 min responsive, P = 0.99). The time a supervising resident spoke on work rounds did not change (58 +/− 20 min vs. 57 +/− 20 min, P = 0.58) but the time interns spoke did decrease when the attending joined rounds (64 +/− 19 min vs. 55 +/23 min, P = 0.008). In surveys both residents and interns reported that when an attending joined rounds they were less efficient, had decreased autonomy and had more fear of being judged. Attendings believed that the team knew their plan of care better though residents did not perceive this. CONCLUSIONS: In an academic inpatient medical service, increased attending supervision did not significantly reduce medical errors or affect number of orders written, consultations or radiology studies. Residents perceived less autonomy and efficiency, though a time motion analysis found no difference in length of rounds or level of supervising resident participation. A RANDOMIZED TRIAL OF INPATIENT LABORATORY TEST PRICE TRANSPARENCY IN THE ELECTRONIC HEALTH RECORD: THE PRICE TRIAL Mina Sedrak3; Jennifer S. Myers4, 1; Dylan Small1; Irving Nachamkin4; Justin B. Ziemba5; Dana Murray4; Gregory Kurtzman1, 4; Jingsan Zhu1; Wenli Wang1; Deborah Mincarelli4; Daniel Danoski4; Brian Wells4; Jeffrey S. Berns4; Patrick Brennan4; Bill Hanson4; C J. Dine1, 4; Mitesh Patel1, 2. 1University of Pennsylvania, Philadelphia, PA; 2Crescenz VA Medical Center, Philadelphia, PA; 3City of Hope Comprehensive Cancer Center, Duarte, CA; 4University of Pennsylvania Health System, Philadelphia, PA; 5Johns Hopkins School of Medicine, Baltimore, MD. (Control ID #2700021) BACKGROUND: While many health systems are considering increasing price transparency at the time of order entry, the evidence of its longer-term impact on clinician ordering behavior is unclear. Few randomized trials exist and among those conducted, they are single site, of limited duration (<6 months) and outcomes are not adjusted for patient characteristics or comorbidities. METHODS: The Pragmatic, Randomized Introduction of Cost Data in the Electronic health record (PRICE) trial was a randomized, controlled trial conducted at three hospitals to evaluate the effect of displaying Medicare allowable fees for inpatient laboratory tests on clinician ordering behavior comparing changes during a one-year pre- and one-year post-intervention period. Test groups were randomly assigned to display fee data (intervention, n = 30) or not (control, n = 30) in the electronic health record. The main outcome measure was change in number of tests ordered per patient-day. Secondary outcome measures were change in number of tests performed per patient-day and associated fees per patient-day for tests ordered and performed. Multivariate adjusted models were fit to outcome measures adjusting for time trends and patient demographics, insurance, disposition, and comorbidity severity. RESULTS: The sample included 98529 patients comprising 142921 admissions. Pre-intervention trends of order rates among the intervention and control groups were similar. In adjusted analyses of the intervention group compared to the control group over time, there were no significant changes in overall test ordering behavior (0.05 tests ordered per patient-day; 95% CI, −0.002, 0.09; P = 0.06) or associated fees (0.24 US dollars per patient-day; 95% CI, −0.42, 0.91; P = 0.47). Subset analyses found small but significant differences in tests ordered per patient-day based on patient intensive care unit (ICU) stay [(Patients with ICU stay: −0.16, 95% CI: −0.31, −0.01, P = 0.04)(Patient without ICU stay: 0.13, 95% CI, 0.08, 0.17; P <0.001)] and the magnitude of associated fees [(top quartile of tests based on fee value: −0.01, 95% CI, −0.02, −0.01; P = 0.04)(bottom quartile: 0.03, 95% CI, 0.002, 0.06; P = 0.04)]. Adjusted analyses of tests that were performed found a small but significant overall increase in the intervention group relative to the control group over time (0.08 tests performed per patient day, 95% CI, 0.03, 0.12; P < 0.001). CONCLUSIONS: Displaying Medicare allowable fees for inpatient laboratory tests in the electronic health record did not lead to any meaningful or consistent changes in overall clinician ordering behavior. To our knowledge, this is one of the largest and longest evaluations of a randomized introduction of price transparency in a health care setting. A RANDOMIZED TRIAL OF USING LOSS AVERSION AND ENHANCING GROUP-BASED INCENTIVES IN A PHYSICIAN PAY-FOR-PERFORMANCE PROGRAM Amol S. Navathe1; Andrea B. Troxel2; Amanda Hodlofski1; Kristen Caldarella1; Amelia Bond1; Qian Huang1; Shireen E. Matloubieh1; Lee Sacks3; Pankaj Patel3; Kevin G. Volpp1; Ezekiel J. Emanuel1. 1University of Pennsylvania, Philadelphia, PA; 2New York University, New York, NY; 3Advocate Physician Partners, Chicago, IL. (Control ID #2706589) BACKGROUND: Pay-for-performance (P4P) is the most pervasive valuebased payment scheme despite little evidence of positive effects on patient outcomes. Yet, Medicare’s upcoming Merit-based Incentive Payment System (MIPS) will expand traditional P4P even further. In this study, we examine whether two principles from behavioral economics, loss aversion and social pressure, can improve the effectiveness of physician financial incentives. METHODS: We conducted a cluster randomized 3-arm clinical trial among 43 primary care and specialist practices at Advocate Physician Partners (APP), Chicago, IL. The active phase of the trial was January 1, 2016 to December 31, 2016, with follow-up through March 31, 2017. The control arm (Arm 1) was compromised of 21 physicians enrolled in the existing physician incentive payment design with quarterly performance feedback and a one-time bonus check (to be distributed April 1, 2017). Arm 2 tested the use of loss aversion among 26 physicians, in which incentive accounts were pre-funded with the total incentive dollars available over the 2016 program year. Arm 3 evaluated the performance of 24 physicians in an enhanced social pressure design that increased the group portion of the bonus to 50 percent. We performed an intention-to-treat analysis of treatment assignment on quality measure performance, including wellness (e.g. body mass index (BMI) screening), chronic care (e.g., appropriate beta blocker prescription), and mental health (e.g. depression screening) measures. Pairwise comparisons were evaluated with the Tukey range test. NOTE: Because the trial is still in follow-up period we present blinded results below - at the SGIM conference we will present final unblinded results. RESULTS: There were 16,375 attributed patients with conditions related to APP P4P quality measures in the 2016 program year. Significant differences in performance were observed between the trial arms for 7 measures across 3 categories, though this tended to be true only in the greater than 65 age population. For example, for the ‘beta blockers for chronic heart failure’ measure in the chronic care category, we observed scores of 73% in Arm Y, 67% in Arm X, and 68% in Arm Z, differences of 5 and 6% (P = 0.033), however there was no significance for patients less than 65 years (P = 0.75). Similarly, for blood pressure measurement among cardiovascular disease patients over 65, we observed a score of 90% in Arm Y, 59% in Arm X, and 49% in Arm Z, differences of 31 and 41 percentage points (P = 0.028), while there was no significance for patients less than 65 years (P = 0.66). We observed similar trends for other measures such as ‘depression screening and follow-up’ and ‘BMI assessment.’ CONCLUSIONS: The trial results suggest that the intervention in Arm Y may be a useful technique to make physician P4P incentives more effective. The performance improvements for patients over 65 may in part be explained by applicability of the quality measures. A SAFE SPACE FOR SOLIDARITY, CONVERSATION, AND FINDING MEANING IN MEDICINE: REFLECTIVE WRITING WORKSHOPS LED BY NEAR-PEERS DURING THIRD-YEAR CLERKSHIPS Lorenzo R. Sewanan2; Kayleigh Herrick-Reynolds2; Priscilla Wang1; Andi Shahu1; Daniel Zheng2; John Encandela2; Anna Reisman1. 1Yale School of Medicine, New Haven, CT; 2Yale University, New Haven, CT. (Control ID #2704999) BACKGROUND: Third-year medical students (MS3s) routinely experience mentally and emotionally challenging situations. They often lack the opportunity to debrief about these experiences due to time constraints, clinical hierarchy, and peer isolation during clerkships. Medical schools are increasingly incorporating reflective writing into curricula. A growing body of literature demonstrates the positive impact of reflective writing for medical students, including increased empathy and improved learning. These sessions are usually conducted by faculty facilitators, whose presence may prevent truly open discussion. We proposed that reflective writing workshops led by near-peers built into the third-year curriculum would provide a more effective model for honest reflection. METHODS: Students and facilitators were medical students at Yale School of Medicine. The study occurred over a one-year period as MS3s rotated through four core clerkships. Facilitators were trained upperclassmen volunteers. MS3s were split into groups of 10–15 and required to attend a workshop at the end of each rotation. Rules of engagement were reviewed (confidentiality, title IX, commitment to active, judgment-free participation and listening). Workshops followed a structured but flexible series of questions progressing from warm-up questions to more challenging prompts. Evaluations were voluntary and anonymous, including (1) a paper survey of open-ended questions at the end of the session and (2) a longer, online end-of-year survey. We used a randomized iterative consensus process within a phenomenological framework to analyze the qualitative data. Major themes arising from this formal categorization process were used, along with representative quotes. RESULTS: 266 session questionnaires were collected across 28 sessions, and 82/102 possible participants filled out the end-of-year survey. Most respondents (62%) indicated that they would attend the workshops even if not required. Our qualitative analysis revealed that the workshop provided a safe space for reflection and sharing. Many students were surprised to learn how willing peers were to share experiences. Students valued having protected time and found the prompt-based format beneficial. Common themes included challenges of patient care, medical hierarchy, interprofessional tension, and burnout. Students found that the format of writing and sharing provided solidarity within the class. Many stated that the workshops helped them process experiences not discussed before and encouraged them to focus more on emotions in clinical care. Most indicated that they would rather share negative experiences in a group led by near-peers than by faculty. Many described a desire to write and engage in active reflection in the future as a result of workshop participation. CONCLUSIONS: The near-peer reflective writing workshops provided protected space to process difficult clerkship experiences, increased solidarity and support within the class, and encouraged MS3s to actively reflect. A SIMULATED NIGHT ON CALL (NOC): ASSESSING THE ENTRUSTMENT OF NEAR GRADUATING MEDICAL STUDENTS FROM MULTIPLE PERSPECTIVES. Adina Kalet1, 1; Tavinder Ark2; Kinga L. Eliasz1, 1; Mike Nick1, 1; Grace Ng1, 1; Demian Szyld3, 1; Sondra Zabar1, 1; Martin V. Pusic1, 1; Thomas S. Riles1, 1. 1New York University School of Medicine, New York, NY; 2University of British Columbia, School of Population Health, Vancouver, BC, Canada; 3Harvard Medical School, Boston, MA. (Control ID #2705395) BACKGROUND: The AAMC has identified 13 Entrustable Professional Activities (EPAs) that all entering residents should be expected to perform on day 1 of residency without direct supervision regardless of specialty choice. We developed an immersive, Night on call (NOC) simulation to understand the measure of entrustment of all 13 Core EPAs from the perspective of patients, nurses, attendings, and peers. METHODS: NOC is a 4-hour simulation, during which a medical student rotates through a series of authentic clinical coverage scenarios including: 4 standardized patient (SP) cases with varying degrees of complexity, each of which require first answering a call from a standardized nurse, (SN), then evaluating a SP with the SN in the room, making immediate management decisions and writing a coverage note; a phone call to an attending (Attn, an experienced clinician) to orally present (OP), and discuss the case, formulation of a clinical question and finding a best answer using digital library resources (EBM), a test of ability to recognize a pre-entrustable peer, and a handoff of 4 cases to a peer (HOff, portrayed by an senior medical student). Competency assessments were based on validated tools where available. Each rater provided an entrustment judgment. This included 9 raters providing a total of 16 entrustment judgments: 4 SPs and 3 SNs (1 rating competency and 1 rating communication each), 1 Attn based on OP, 1 peer rating based on the HOff (1 item each). Raters were trained in both case portrayal and rating reliability. This study is IRB approved. After exploring the relationships among competency measures and entrustment judgements, to test the hypothesis that NOC measures trustworthiness of our near graduates, we conducted a one-factor (entrustment) confirmatory factor analysis (CFA) with the 16-entrustment items allowing the ratings from the same raters and between raters on the same case to correlate. The CFA was conducted with a means and variance adjusted weighted-least squares estimation (WLSMV) to take the ordinal distributions of the entrustment items into account. RESULTS: 73 medical students (39 women; Age 26.5 (+2.6) years) completed NOC. The one-factor CFA model fit the data (χ2 = 155.27, df = 112, p < .001, CFI = 0.97, TLI = 0.97, RMSEA = 0.07, p > 0.05). All but 2 of the 16 factor loadings were greater than 0.3, (Attn factor loading = 0.23 and the SP ratings from the first clinical case of NOC sequence (0.21)). diabetes, psychiatric conditions, chronic pain, asthma and obesity. While up to 75% of individuals utilize relatively little healthcare during any given year of the data, there are several smaller unique clusters of patients including a consistently sized cohort of “outliers” (approximately 3% of the population) who utilize significantly more care and who exhibit complex multimorbidity profiles. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): The methodology of our project may serve as a blueprint, readily adapted to a variety of practice settings. While some of the patient patterns detected are particular to the community in which our practice is located, the goals of dissemination include the hope that other practices will be able to in turn examine their own community-specific patterns and further inform practice-level changes and institution-level care coordination. POTENTIAL SOLUTION TO SHORTAGE OF GENERAL INTERNAL MEDICINE PHYSICIANS IN JAPANESE HOSPITALS Urara Nakagawa1; Toshiaki Wakai1; Masaji Saijo2; yasushi tanabe1; Dongkyung Seo1. 1Sapporo Tokushu-kai Hospital, Sapporo-shi, Japan; 2Sapporo Tokushukai Hospital, Sapporo, Japan. (Control ID #2701286) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Shortage of general internal medicine (GIM) physicians in Japanese hospitals OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): The need of GIM physicians has been multiplied because of this extremely aging society in Japan. However, comparing the number of GIM physicians per 10,000 population in the USA to the one in Japan, USA has 4.75 times more GIM physicians than Japan. (8.71 in the USA vs 1.83 in Japan, per 10,000) Therefore, the workload for each GIM physician has increased lately, which potentially cause burnout of GIM physicians. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): Sapporo Tokushu-kai Hospital, a community hospital with 300-bed in Japan, opened GIM department in 2008 as “Primary Department”, which was responsible for urgent and emergent care, as well as inpatient care in the hospital. However, most of those physicians had retired over 5 years because they switched their specialties. A remained physician hired 2 medical records clerks, which was not a common occupational category in Japan, to support the physician to maintain the department in 2012. They were assigned to document onto electronic medical record (EMR) and writing referral letters based on dictations by the physician, and to take over the physician’s chores including, e.g. physicians’ scheduling, the other paper works, and preparations for presentations. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): We used two quantitative metrics to measure the outcome of the intervention; 1) Number of total discharged patients per year from the department, 2) As a quality of patient-care, the rates of sending referral letters to psychiatrists of drug overdose patients on their discharge from the hospital; this hospital was 9th best hospital in Japan which accepts drug overdose patients (2010), and letters for psychiatrists deemed crucial on discharge since the hospital has no psychiatric department, 3) Proportions of time spent on EMR and paper works by the physician. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): Majority of inpatients who were discharged from the department were older than 70 years old. (69.2%, 2014) Comparing preintervention (2011) to post-intervention (from 2012 to 2014), the findings includes; 1) The number of discharged patients per year from the department was 861 in pre-intervention, and 1003 on average in post-intervention, 2) The rate of sending referral letters was 40% in pre-intervention, and 78% on average in post-intervention, 3) The proportion of time spent on EMR and paper works by the physician was 59% in pre-intervention and 23% in postintervention. In addition, academic activities including presentations in conferences and recruiting activities were vitalized regardless of increased numbers of patients per the physician. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): GIM physicians’ workload can be decreased by medical records clerks, which may lead efficient inpatients care and potentially maintain quality of patient-care, despite of shortage of GIM physicians. PRESERVING THE RIGHT TO VOTE IN SICKNESS AND IN HEALTH Carine Davila1; Irina Kryzhanovskaya2; Rachel J. Stern2; Jeffrey Critchfield2; Arla Escontrias3; Alon Unger1. 1University of California, San Francisco, San Francisco, CA; 2University of California, San Francisco at Zuckerberg San Francisco General Hospital, San Francisco, CA; 3San Francisco Department of Public Health, Zuckerberg San Francisco General Hospital, San Francisco, CA. (Control ID #2703262) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Hospitalized patients lack information on absentee voting during a medical emergency. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): To design and implement a program to assist hospitalized registered voters to submit an absentee ballot for the 2016 US general election. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): We recruited a multi-disciplinary team including hospitalists, nurses, social workers and hospital personnel, in the inpatient setting of a 418-bed urban safety-net hospital. The program leader, an internal medicine resident, educated team members on absentee ballot procurement, dissemination of ballots, and submission of completed ballots. Key steps to enacting a patient voting program include: − Identify program lead for voting initiative - Research local or state-specific policy on absentee voting in setting of medical emergency - Identify liaison to work with local voting officials - Early outreach to hospitalists, nursing leadership, and staff on absentee voting procedure Multidisciplinary effort to advertise absentee voting to all eligible patients Define clear roles and workflow for absentee ballot requests, completion and submission MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): We measure success on multiple levels: level of awareness among patients and staff about the absentee voting process during a medical illness; multidisciplinary support for voter participation; and ballot completion among hospitalized patients. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): Ballot authorization forms in 4 languages were distributed to hospital units on Nov. 8, 2016. There were 194 eligible patients: those in surgery or immediately post-operative, critically-ill, in skilled-nursing units, in research trials, or inpatient on the psychiatry ward were excluded. Bedside nurses asked all patients about their interest in voting, distributed forms and collected completed ones. Nurses did not verify voting eligibility. Patients did not participate for the following reasons: not registered, registered in another county, non-citizens, too ill, did not like candidates/issues, or declined without explanation. A hospital representative delivered 27 completed forms to the voting center. Election officials verified 11 (41%) applications and rejected 16 (59%) because applicants were not registered or registered in another county. Of the 11 absentee ballots, 8 (73%) were delivered; 3 patients were already discharged. All 8 ballots were completed and submitted to a polling location on Election Day. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): We describe a successful resident-led patient advocacy initiative to help hospitalized eligible voters submit a ballot despite acute illness. In 2016, US voter participation was only 58.6 and recent elections have been decided by small margins. Poor health is an important barrier to voter participation, particularly among elderly and low-income voters. This program serves as a roadmap for healthcare leaders and voter advocates. Ongoing effort to advertise broadly and galvanize regional leadership is needed to ensure hospitalized eligible voters, despite poor health, can participate in future elections. PREVENTING AVOIDABLE ED VISITS AND INPATIENT ADMISSIONS IN HIGH RISK PATIENTS Eleanor Weinstein1, 2; Dana Mallano1; Leora Botnick1; Carey Hamblin1; Marie Delgado1. 1Jacobi Medical Center, Bronx, NY; 2Albert Einstein College of Medicine, Bronx, NY. (Control ID #2698213) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Health care costs are concentrated in small populations of high risk and specifically concentrated in avoidable inpatient admissions and emergency department visits at H+H (Health + Hospitals - the public safety net system in NYC). OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): To assist clinicians burdened by providing care for a medically and socially complex population. To use a collaborative care model to better understand the needs of the patient and to plan interventions. To decrease cost and improve outcomes for this high risk group. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): The team consisting of nurses, social workers, population health experts, clinicians and data managers worked with a population of 200 high -risk patients (100 Medicare patients and 100 Medicaid patients). Patients were considered high risk based on a risk stratification predictive model used by the H+H Accountable Care Organization for the Medicare group. For the Medicaid group, the patient was considered high risk if they had > 4 ED visits or > 3 hospitalizations in the previous 12 month period. The approach was to review the case in detail looking for red flags including high utilization of inpatient or ED services and low utilization of primary care services; risk score for hospitalization; and total cost of care in the previous 12 months. Patients were grouped according to what was felt to be the driver of the inappropriate utilization. The team met weekly to discuss each patient and plan the intervention. The goal was to engage the patient in appropriate primary care services as well as to deploy care management programs or other interventions addressing gaps in care according to the patient’s need. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): The outcome measures included a comparison of inpatient admissions, emergency room visits, and primary care visits to the ambulatory practice from baseline to the completion of the intervention period. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): The Medicare population was largely one with multiple medical co-morbidities. There was a large number of patients with ESRD in this group. The Medicaid population had many patients with behavioral health issues, substance abuse and social barriers to optimal health. Through the intervention period, we were able to show a decrease in inpatient admissions from 1.79 per patient per year to .66 as well as an increase in primary care utilization from 1.37 to 1.68 visits per patient per year for the overall group. The Medicaid subgroup of this population was difficult to engage in care. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): Busy clinicians are unable to optimally care for a high risk population in the standard manner often leading to frustration and burnout. A collaborative model of care utilizing nursing, social work, clinicians and population health experts is key to have an impact on health outcomes in high risk populations. Additionally, we need to explore enhanced coordination and collaboration with the ED and CBO’s to provide an alternative model that would support the homeless substance abusing population - addressing the gap in care within the ED - this group’s most frequent site of care. PRIMARY CARE BEHAVIORAL HEALTH INTEGRATION: IMPROVING PRIMARY CARE PROVIDER OUTCOMES? Liza Hoffman1; Jillian Burley2; Emily Benedetto1; Robert Joseph2; Collen O’Brien2; Ellie Grossman1. 1Cambridge Health Alliance, Somerville, MA; 2Cambridge Health Alliance, Cambridge, MA. (Control ID #2705709) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): While research indicates that behavioral health (BH) integration can improve the patient experience of care, less is known about how this intervention affects Primary Care Providers (PCPs). OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): 1. To improve care for patients with BH needs in a primary care setting. 2. To understand the functions of BH staff integrated into primary care. 3. To understand how BH integration affects PCPs. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): Our internal medicine practice serves 7700 patients and is part of a large, safety net health system in the greater Boston area. The clinic performs annual screening for depression and unhealthy alcohol and drug use in all patients. Integrated BH staff members are available onsite to provide clinical services and to partner with PCPs. The BH team’s Mental Health Care Partner (MHCP, 1.0FTE) often serves as the first point of contact; the MHCP provides assistance with triage, care coordination, brief interventions related to behavior change (e.g. sleep hygiene, risky drinking, smoking cessation), and population management for patients with depression. Integrated Therapists (1.5FTE) are available for informal consults and crisis intervention, and provide short-term psychotherapy for individuals and groups. The clinic’s integrated Psychiatrist (.35FTE) provides medication consultation and short-term care (1–2 visits) to assist PCPs. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): Evaluation of the program is ongoing, and will include: 1. PCP surveys to explore use of integrated BH services, confidence in providing care for patients with BH needs, work-life stress, and perception of patient outcomes. 2. Structured PCP interviews to explore themes from survey data. 3. Provider referral counts to BH services. 4. Timestudy data for MHCPs. 5. Electronic medical record (EMR) data for screening rates, disease prevalence, care utilization, and clinical outcomes. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): PCP survey data show that 79% reported utilizing BH staff weekly or more than once per week for reasons that included consultation, referral for treatment, and crisis intervention. 100% of PCPs agreed or strongly agreed that clinical outcomes for patients with BH needs improved post-intervention, 92% agreed or strongly agreed that having onsite integrated BH staff decreased personal stress, and 100% of PCPs reported enhanced confidence in caring for patients with BH needs. Over 53% of MHCP time was spent in direct patient care or PCP discussions (not including documentation), and 74% of these direct patient contacts came from PCP referrals. Most patients had mild/moderate symptoms, and the most common condition addressed by the MHCP was anxiety. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): In implementing BH integration programs, primary care practices can anticipate improvement in PCP confidence and decreased stress. Focused attention on building relationships between PCPs and BH team members may help to optimize these programs. Anxiety management may be a symptom particularly amenable to integrated BH team care. PROMOTING WELLNESS IN PRIMARY CARE PROVIDERS: THE EFFECT OF A WELLNESS COMMITTEE ON PROVIDER SATISFACTION Katherine Small1; David Skovran2; Trang Vu1; Jonathan Ripp1; Shanna Levine1; Alex Federman1; Lauren Peccoralo3. 1Icahn School of Medicine at Mount Sinai, New York, NY; 2Mount Sinai, New York, NY; 3Mount Sinai School of Medicine, New York, NY. (Control ID #2704101) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Physician burnout is common and can lead to poor morale, depression, reduced provider retention, decreased productivity and the perception of decrements in care quality. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): To assess work satisfaction and burnout in faculty physician (MD) and nurse practitioner (NP) primary care providers (PCPs) at a resident continuity clinic with the goals of identifying areas needing improvement, implementing appropriate interventions and reassessing satisfaction metrics. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): Based on the American Medical Association’s STEPS Forward program, we formed a committee that composed an anonymous survey (modified Mini-Z, 16 questions, quantitative and qualitative) of faculty at Mount Sinai’s Internal Medicine Associates (IMA) to assess satisfaction and gather suggestions for improvement. We then presented survey findings to leadership and devised interventions to address the most relevant issues. We plan to distribute a follow-up survey after the changes to the practice have been implemented. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): The baseline data is presented in our findings to date. The quantitative assessment of satisfaction and burnout is presented as descriptive data. The qualitative assessment of the areas needing improvement and suggestions for change is assessed using a grounded theory approach and the main themes are presented. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): Overall, 31 PCPs (24 MD, 7 NP) responded to the survey (response rate 77%). On a 1–5 scale (1 = poor, 5 = optimal), the average score in response to the question “my control over my workload” was 3.2. In response to the question “I am satisfied with my current job” 58% (18) PCPs reported that they agree and 19% (6) reported that they strongly agree. In response to what level of burnout is felt, 16% (5) of PCPs reported no burnout, 45% (14) reported stress but no burnout, and 35% (11) reported at least one symptom of burnout. The qualitative answers to identify sources of burnout centered around five main themes: clarification of roles of support staff, improved teamwork, reciprocal feedback between leadership and providers, functional facility infrastructure, and acknowledgement of work not reflected by productivity and patient satisfaction metrics. Since presenting this feedback to leadership, we have begun discussions to address role clarity, helped secure funding for additional administrative support, added computers to teaching areas and added praise boxes to acknowledge colleagues. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): The leadership and wellness committee have partnered to implement changes for faculty and staff wellness that are appropriate for our practice. The interventions are limited by funding and resources as well as survey anonymity precluding a paired pre/post analysis. The next steps will be to assess the impact of the interventions on PCP wellness and satisfaction. PROPP: PATIENT RECALL OF PRIMARY PROVIDER Chirag R. Patel1; Daniel Bercik2; Austin Brown2; Karen L. Mendieta2. 1The Ohio State University Wexner Medical Center, Columbus, OH; 2The Ohio State University College of Medicine, Columbus, OH. (Control ID #2688242) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Physicians have found marginal success in effectively conveying to their patients that most basic of identifiers, their name. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): Improve the hospitalized patient’s ability to accurately recall members of their primary inpatient care team. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): IRB approval was sought and received in order to measure and improve inpatient General Medicine teaching service patients’ accurate recall rate of their primary provider. Several exclusions were incorporated to ensure the validity of our data. Ultimately, we found results much lower than expected; as such causal determination was sought. A root cause analysis was undertaken and led to two major initiatives: photo roster card distribution and effective white board use. These initiatives were rolled out and data was collected regarding the primary team members’ ability to effectively convey their respective name to the patient. The photo roster card included: team name; physician team member photo, name and role with description; medical student, case manager and social worker name and role with description. Effective white board use was described as listing of primary team member names and their role. The roster cards were distributed and white boards populated during the time of attending physician initial bedside encounter. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): On hospital day 3, the study team visited with patients. Three objectives existed during this encounter, to determine: 1) if white board was used effectively, 2) if a patient received a photo card, 3) the patient’s ability to accurately recall members of the primary team. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): Our end point was determining accurate provider recall of any member of the primary team. We found a strong statistically significant difference between the group of patients who received a photo card independent of white board use (63%) and those who did not (29%). Additionally, a medium strength statistically significant difference was determined between the group of patients with white board use independent of photo card receipt (79%) and those without use (34%). Lastly, sub-group measurement was done to better understand the impact of both white board use and photo roster card distribution. Although we found a significant difference in recall between the two groups, 87 and 23% respectively, the statistical strength was limited. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): Care of an ill patient requires several skills that are not only limited to one’s clinical acumen but also include the personal connection developed with the patient. Doctor-Patient communication is a skill that many have developed over their years of training and then practice. At the heart of establishing a connection and developing rapport is the introduction. Our team determined that use of a photo roster card and/ or white board use improves a patient’s ability to recall a member of their primary team. Additionally, our data supports future determination of the efficacy on patient recall with utilization of both modalities concurrently. PROTON PUMP INHIBITOR OVERUSE: LEVERAGING TECHNOLOGY TO DEPRESCRIBE Colin T. Iberti; Clare Whipple; Katherine Small. Mount Sinai Hospital, New York, NY. (Control ID #2674233) OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): To reduce PPI overuse via systematic deprescribing aided by an electronic medical record tool. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): Starting with our first Plan-Do-Study-Act (PDSA) cycle, we educated a team of two internal medicine attendings and 15 residents at the general internal medicine residency clinic of an urban tertiary care hospital regarding the harms of PPI overuse. Clinicians then received automatically generated electronic medical record messages with targeted patients on PPIs, triggering an in-visit prompt designed to quickly and easily assess indications, medical necessity of PPI, and potential to deprescribe. After clinician feedback, the second PDSA cycle refined the required response to the prompt and provided monthly report cards giving feedback on the PPI patients per clinician. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): The primary outcome is the percentage of the team’s patients on PPIs. The secondary outcomes include tracking the indication for PPI prescriptions to examine what proportion of our PPI use is appropriate. Process measures will include the frequency of use of the invisit dotphrase prompt out of number of total visits with PPI patients, as well as the number of residents receiving PPI education. Balance measures include utility and ease as measured by team survey and follow-up phone calls with patients regarding symptoms, antacid requirements, or requiring restart of PPIs. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): The electronic medical record tool identified 332 panel patients chronically on PPIs; 103 were scheduled for office visits and eligible for the intervention during the six-month study period. Providers used the prompt in 70 of those visits, or 68% of the time. 36 (35%) of the 103 patients scheduled had their PPI discontinued as a result of the intervention. Of the 103 patients chronically on PPIs who were seen during the study period, the prevalence of PPI use decreased from 100% (103 patients) to 65% (67 patients). The most commonly encountered indications for chronic PPI use prior to the intervention were GERD (41.6%), dyspepsia (19.8%), and continued in-hospital GI prophylaxis (13.9%). KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): An electronic medical record intervention was successful in identifying PPI overuse, reducing patients on non-indicated chronic PPI therapy, and improved our ability to provide high-value care and prevent potential medication related adverse events. PUTTING VETERANS F.I.R.S.T. FAILURE INTERVENTION RISK STRATIFICATION TOOL TO REDUCE 30 DAY READMISSION FOR PATIENTS WITH CONGESTIVE HEART FAILURE Serena M. Ogunwole1, 2; Jason Phillips2; Patricia Wathen2. 1University of Texas Health Science Center San Antonio, San Antonio, TX; 2Ut health science center at San antonio, San Antonio, TX. (Control ID #2707659) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Proton pump inhibitor (PPI) overuse is associated with significant adverse events including increased risk of Clostridium difficile infection, community acquired pneumonia, and hip and spine fractures. STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Over a million patients are hospitalized for heart failure each year. As many as 25% 1of these patients are readmitted within 30 days of discharge, making CHF exacerbations the most common cause of 30-day hospital readmission.From a financial standpoint, treatment of CHF is extremely costly: with direct and indirect costs totaling more than 37billion dollars and Medicare spending exceeding 17 billion dollars. Additionally, the shift toward 30-day admission rates as a quality measure has led to increased financial penalties for institutions with the highest readmission rates. Several studies have linked the reduction of 30 day readmission with early (within 7 days) physician follow up after discharge OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): Primary aim :increase the number of completed 7 day follow up appointments to 50% for all patients discharged from the internal medicine service with the diagnosis of acute decompensated heart failure by implementing a new discharge order template Secondray aim: reduce readmission rates CHF exacerbations by 20% at our hospital DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): This project was done at an inpatient facility at the Veterans Administration hospital Proposed interventions: 1. Through literature review and consultation with a heart failure specialist we determined criteria for a high risk heart failure patient. Once these patients were identified, targeted interventions were given to them; including follow up with a CHF specialist. 2. We created a mandatory order set that populates upon discharge of a patient with a primary diagnosis of CHF: the order set has criteria that will enable internal medicine residents to risk stratify patients at high risk for CHF readmission. Patients identified as high risk for readmission will have follow up in the CHF clinic with a heart failure specialist. Patients who are not deemed high risk by the criteria will have follow up with a provider who can change medications. Regardless of who the patients follow up with, ALL follow up appointments will be placed within 7 days of discharge. This order set will auto-populate a clerk order to make an appointment with the appropriate clinic thus streamlining and standardizing the process for follow-up appointments for CHF patients. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): 7 day follow up appointment percentage Absolute reduction in annual admission rates FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): We decreased the average time to follow up from 17.7 days (October 2014) when the project was implemented to 8.7 days (January 2015) Percentage of patients readmitted within 30 days postdischarge at baseline, and following intervention one(creation of heart failure work group) and two (intensive follow up post discharge) were 25%, 22%, and 21%, respectively. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): Identifying high risk patients is a cost effective strategy for utilizing limited resources. Using an electronic medical record as a strategy for enforcing adherence to a protocol is an extremely effective intervention QUALITY IMPROVEMENT INTERVENTION ON HIGH UTILIZER INPATIENTS ADMITTED TO INTERNAL MEDICINE SERVICES Samuel O. Schumann2; Marc Heincelman2; Patrick D. Mauldin2; Jingwen Zhang1; Justin Marsden2; Don Rockey1; William P. Moran2. 1MUSC, Charleston, SC; 2Medical University of South Carolina, Charleston, SC. (Control ID #2706729) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): The top 10% high cost patients, labeled high utilizers (HU), disproportionately consume an exceedingly large amount of acute care resources and the value of this care is questionable. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): 1. Identify patients at risk for a HU admission in real time using predictive modeling. 2. Implement a quality improvement guideline intervention directed at patients identified as high risk for a HU admission to reduce low value inpatient care, primarily focusing on reducing length of stay. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): A quality improvement guideline intervention study was performed on all patients > 18 years old admitted to internal medicine services from October 1st, 2015 April 11th, 2016. An established predictive model (AUROC = 0.80) was used to analyze admission variables and identify patients at risk for a HU admission in real time. A predictive model estimator score of ≥ 0.15 was used to define patients at risk for a high utilizer admission, giving the model a sensitivity of 55 and specificity of 84%. An estimator score of ≥ 0.15 was also projected to identify 2 patients per day at risk for a HU admission, which was a patient volume appropriate for the scope of the intervention. Certain patients meeting pre-specified criteria were excluded from the study, such as new solid organ or bone marrow transplant recipients. Patients with a HU estimator score ≥ 0.15 and not excluded were enrolled in the study and received intervention in three areas: early palliative care consultation, early pharmD medication reconciliation, and recommendations to follow Choosing Wisely guidelines for lab tests, chest x-rays and blood transfusions. The top 10% high cost patients admitted to internal medicine services from July 1st, 2013 - June 30th, 2014 were used as the comparison group. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): Primary outcome was a reduction in length of stay. Secondary outcomes included pharmaceutical charges, laboratory charges, total hospital costs and discharge disposition. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): 373 patients were identified by the predictive model as being at risk for a HU admission (1.92 patients were identified per day). 130 patients were enrolled in the quality improvement guideline intervention and received all 3 areas of intervention (early palliative care, pharmD medication reconciliation and choosing wisely education). 243 patients were excluded. In the comparison group 7,571 patients were admitted to internal medicine services and 757 were the top 10% high cost patients. The mean LOS for HU patients enrolled in the guideline intervention was 10.3 days compared to a historical mean LOS of 25.4 days (P value 0.0183). The median LOS for HU patients enrolled in the guideline intervention was 6.1 ± 13.2 days, compared to a historical median LOS of 19.5 ± 32.5 days. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): Patients at risk for a high utilizer admission can be identified in real-time based on admission variables. Guideline based interventions can then be deployed early in an admission to improve the value of care and decrease length of stay utilization. An intervention using a portable ultrasound and standard IV equipment was also found by nurses to be acceptable and beneficial to patients. REDUCING CENTRAL VENOUS CATHETER RATES USING AN ULTRASOUND-GUIDED PERIPHERAL INTRAVENOUS CATHETER SERVICE Benjamin T. Galen; William Southern. Albert Einstein College of Medicine, Bronx, NY. (Control ID #2692713) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Central venous catheters (CVC) may be used in patients with difficult venous access on medical wards, but carry risk of complications including infection, thrombosis, pneumothorax, or arterial injury. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): 1) To assess the impact of an ultrasound-guided peripheral IV (USGPIV) service on the rate of newly-placed CVC on an inpatient unit 2) To assess the acceptability and perceived benefit of this service by nurses DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): The traditional technique (using manual palpation) of placing a peripheral IV is successful in most cases. However, when the traditional method fails, a central venous catheter may be placed to maintain intravenous access. Because CVCs are associated with complications, we tested the effectiveness of an ultrasound guided peripheral IV service to reduce the number of newly placed CVCs on an inpatient ward. We hypothesized that an USGPIV service would reduce the incident CVC rate on an intervention unit compared to a similar unit without this service. In this quality improvement initiative on an inpatient ward, providers activated the USGPIV service bundle when their patient’s IV access was lost, insufficient, or expired and IV placement by the traditional technique (typically 3 attempts) was unsuccessful. The procedure team then placed at least one USGPIV in an upper extremity using a portable ultrasound device (GE V-Scan Dual Probe) and standard sized IV catheters. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): The primary outcome measure was the number of newly placed CVCs on the intervention vs. control unit. Additional measures included a survey of the patients’ nurse (at the time of IV placement) examining the intervention’s acceptability and benefit to patient care. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): We found a significant reduction in the rate of newly placed CVC on the intervention unit compared to the control unit at 90 days: mean 0.47 vs. 0.67 newly-placed CVC/day (p = 0.048) We also found that 93% of nurses surveyed reported that the USGPIV service prevented delays in patient care. In addition, 73% of nurses reported that if an USGPIV service was not available, that a CVC would have been required for their patient. Furthermore, 80% of nurses felt that their patient preferred an USGPIV to the traditional technique and 100% agreed that an USGPIV service should be made permanently available on their unit. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): An ultrasound-guided peripheral IV service appears to be an effective tool for the inpatient medical ward to reduce central venous catheter REDUCING THE BURDEN OF QUALITY IMPROVEMENT THROUGH THE ABMS MAINTENANCE OF CERTIFICATION PORTFOLIO SPONSOR PROGRAM Sandhya K. Rao2; Suzanne M. Turner3; Timothy G. Ferris1. 1MGH, Boston, MA; 2Massachusetts General Hospital, Boston, MA; 3Massachusetts General Physicians Organization, Boston, MA. (Control ID #2705621) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Many different stakeholders, including Center for Medicare Services (CMS), commercial payers, Joint Commission, state licensure boards, and the American Board of Medical Specialties (ABMS) require physicians to engage in separate practice improvement activities which contributes to administrative burden among physicians. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): 1. Enable physicians to meet multiple requirements through their on-going institutional and departmental quality improvement projects. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): The ABMS Multispecialty Portfolio Sponsor program enables instutions to approve local quality improvement efforts for MOC Part IV credit. The Mass General Physicians Organization enrolled in the Portfolio Sponsor Program in 2012. We established a quality review committee to review projects to ensure they were designed and executed according to the requirements of the program. In 2014, we enhanced the value of the program by obtaining Continuing Medical Education credit for physicians who earned MOC credits. Each participating physician is now eligible to earn up to 20 CME credits for their partcipation in a project in addition to MOC part IV credits. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): 1. Number of projects submitted 2. Number of physicians earning CME and MOC Part IV credits 3. Estimated hours saved for physicians through alignment of requirements. (Assumes 10 hours per physician per MOC Part IV effort if completed on his or her own) FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): Approved QI projects: 2012: 18 2013: 24 2015: 31 Physicians earning credit 2012: 117 2013: 192 2014: 507 2015: 705 Esimated Hours Saved: 2012: 1170 2013: 1920 2014: 5070 2015: 7050 KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): 1. It is possible to earn MOC through local QI work. 2. Aligning projects to multiple requirements reduces physician administrative burden and saves time 3. Physicians need support in crafting projects to meet requirements, a MD champion with knowledge of their board requirements and administrative support to design and organize projects accordingly. 4. Leadership should design QI projects to support multiple requirements to allow for the largest number of physicians to earn credits and meet institutional requirements. REDUCING THE NUMBER OF LABORATORY ORDERS IN A TERTIARY ACADEMIC FACILITY: A QUALITY IMPROVEMENT STUDY Rachna Rawal2; Oluwasayo Adeyemo2; Jennifer Schmidt1. 1Saint Louis University, Saint Louis, MO; 2St. Louis University, St. Louis, MO. (Control ID #2706336) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): High prevalence of over-testing in academic medical centers due to lack of cost awareness and discussion among resident teams. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): 1. Reduce unnecessary daily labs among resident housestaff 2. Raise resident awareness of lab costs 3. Encourage discussion of cost-conscious lab testing DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): The cost of health care is significant. Reducing unnecessary lab testing would decrease cost. In this study, we focused on residents rotating on the inpatient medicine service at an academic hospital servicing a large, urban population. Interventions targeted knowledge of daily lab ordering practices, including ordering rational. Resident experience discussing daily labs with their team and their global perspective on the physician’s role in cost conscious medicine were addressed. The first intervention included educational presentations at resident conferences, team room posters, weekly informational emails, and monthly emails to alert attending physicians about the project. Future interventions include modification of conference presentations and Epic SmartSet changes. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): We collected data on the number of basic metabolic panels (BMPs), comprehensive metabolic panels (CMPs), complete blood count with and without differential (CBC w/diff, CBC w/o diff) over the course of a four-week period (both at baseline and after each intervention). Additionally residents completed a survey before and after the intervention with multiple choice, free response and Likert scale questions (anchors 1 = never, 5 = always). FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): After the initial intervention, we saw a nonsignificant decrease in CBCs w/diff and an increase in CBCs w/o diff. BMPs and CMPs ordered did not change. Baseline survey showed 88% of residents feel unnecessary lab ordering occurs at our institution. While 82% of residents feel it is their responsibility to consider lab cost, only 67% of residents actually do. 50% of residents never or rarely wait for admission lab results prior to placing additional lab orders. While these values did not change significantly after the intervention, significantly fewer residents stated they ordered daily CBCs if a patient had a normal admission CBC (p = 0.019). Post intervention results showed a significant increase in residents discussing lab ordering with their team, 50% to 100% (p = 0.028). KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): Our study confirms that residents are aware of unnecessary lab testing and feel they should consider testing cost; it also confirms that while residents feel this way, their actions do not consistently follow suit. We believe that the majority of our effect came through increasing awareness of testing costs and practices; we also believe this will be the most sustainable result moving forward. Anecdotally, some residents were unaware that a CBC could be ordered without a differential or that it was possible to order only a specific electrolyte rather than a full BMP. Basic education on lab cost as well as encouraged discussion within the resident team require relatively minimal labor but show significant results. SBOT: A SHELTER-BASED OPIOID TREATMENT PROGRAM Avik Chatterjee1, 2; Aura Obando2, 3; Erica Strickland2, 5; Ariana Nestler2, 6; Terri LaCoursiere-Zucchero2, 4. 1Harvard Medical School, Cambridge, MA; 2Boston Health Care for the Homeless Program, Boston, MA; 3Harvard Medical School, Boston, MA; 4University of Massachusetts-Worcester, Worcester, MA; 5Northeastern University, Boston, MA; 6Tufts University School of Medicine, Boston, MA. (Control ID #2698947) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): The opioid epidemic has brought significant morbidity and mortality, particularly among homeless individuals, but to our knowledge no shelter-based treatment for opioid addiction exists. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): To evaluate the successes and challenges of a novel family shelter-based opioid treatment (SBOT) program in its first year. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): A family outreach team at our Community Health Center has treated patients facing homelessness in diverse settings since 1985. Between 6/2015-6/2016, the team took care of 669 adults and 405 children. Prevalence of OUD in our patients during that time was 6%. Office-Based Opioid Therapy (OBOT) works for homeless adults as well as it does for housed adults. But homeless adults in families have unique barriers to OBOT including transportation and childcare needs. Our team of a physician, a nurse, case managers, and a therapist works in a twice-a-week outreach clinic at a 120-room family motel-shelter and regularly encounters patients with opioid use disorder. In 2015, our team developed SBOT. Features of SBOT include on-site induction, weekly group or individual therapy, regular urine drug testing and medication counts, intranasal naloxone training, medication lockboxes, and employment, housing and family support. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): We reviewed the charts of patients who started SBOT from 8/2015 to 8/2016. We reported patient demographics and co-morbidities. We used Chi-squared tests to compare overdose history, urine drug test results, and employment at the beginning of and during treatment. We also reported reason for leaving the program. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): We started 10 patients on SBOT in our first year. Six were women and 6 reported white race. Mean age was 35 (range 32–40) and median number of children was 2 (range 1–5). Thirty percent had a history of illicit oral opioid use only, 20% had a history of heroin use only, and 50% had a history of both. Half tested positive for hepatitis C and none for HIV. All had anxiety and 70% had depression or bipolar disorder. Mean time in SBOT was 7.4 months (range 3–12 months). Four patients had experienced overdose before SBOT, but none did during SBOT (P < 0.01). In the first month of treatment, 77% of urine drug tests showed controlled substances, compared to 51% in the third month (P < 0.01). In their final month of treatment, 3 patients reported being employed, compared to 1 at the beginning (P = 0.04). After the review period, 4 continued SBOT, 5 moved out of the shelter and transferred care elsewhere, and 1 left the motel and did not continue agonist therapy. Two patients relapsed after leaving the shelter and lost custody of their children. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): Shelter-based opioid treatment—SBOT—helped a diverse group of vulnerable adults access treatment. An inter-professional team and the ability to send labs contributed to our success. A significant challenge was transitioning care once patients left the shelter—access to OBOT in the community is limited, and requires solving transportation, childcare and other issues SBOT helped patients overcome. SCREENING FOR DIABETIC RETINOPATHY IN PRIMARY CARE USING A HAND-HELD RETINAL CAMERA Carolyn F. Pedley1; Ramon Velez1; Claudia L. Campos2; James L. Wofford2; Darius Wilson2; Angela Smoak2; Dobson Latanya2; Delois Samuels2. 1Wake Forest, WinstonSalem, NC; 2Wake Forest University, WInston-Salem, NC. (Control ID #2706773) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Diabetes is the leading cause of acquired blindness in adults. Diabetics with limited access to health care are not properly screened for eye disease. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): 1. To provide effective screening for diabetic retinopathy in a population with limited accesss to health care 2. To screen for retinopathy during routine provider visits 3. To coordinate retinal screening with specialists able to provide eye care DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): A safety net clinic staffed by an academic institution employed a hand-held Zeiss Visuscout 100 Retinal Imager camera to take retinal images of diabetics’ eyes over a 3 1/2 month period. Pictures were taken in a procedure room in the clinic by nurses after the patients’ clinic visits. Each eye was photographed without dilation and the images were transmitted by a TreVia portable tablet device to be read by Ophthalmology in the medical center. Picture quality could be assessed on a camera monitor before transmission and photographs could be retaken if necessary. Patients and providers received paper and electronic reports and recommendations based on the readings. The patients to be photographed were highlighted in the clinic schedule as they came in for regular visits. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): 1. Number of diabetics screened 2. Clarity of images for reading 3. Nursing time involved 4. Effective communication among patients, providers and ophthalmologists FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): 51 diabetic patients received retinal photographs in the 3 1/2 month period. 95% of the photographs were interpreted as being adequate for reading although 21% had to be repeated. 18% of the photographs recommended that the patients see an Ophthalmologist for further evaluation and treatment. Nurses required 20–40 min per patient depending on the ease of taking the images. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): A hand-held retinal camera employed in a busy medical clinic is an effective tool for improving diabetic eye screening rates. The hand-held camera is easy to operate and training is not very difficult. Not dilating pupils adds to the comfort and safety of patients. The TreVia tablet system also proved to be effective in transmitting images and sending results and recommendations to providers and patients. The main barriers to increasing the screening numbers was the time needed by the nurses to take and transmit the images. In a busy practice individuals taking such images would have to have dedicated time. SERVICE-LEARNING PROJECT IMPROVES HEALTH LITERACY VIA STEM CURRICULUM IN BRONX NY ELEMENTARY STUDENTS Andrew Johnston; Kim Ohaegbulam; Rohan Biswas; Kevin Shieh; Alicia Philippou; David Liao; Tonya Aaron; Liane Hunter; Aldemar Guzman; Elizabeth Fruchter; Maria Marzan; Christopher Phang; Judith Wylie-Rosett. Albert Einstein College of Medicine, Bronx, NY. (Control ID #2708035) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): By engaging in health and STEM education awareness, can healthier lifestyle habits of Bronx youth be obtained through a medical student driven servicelearning program? OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): 1. Evaluate attitudes, habits, beliefs, and familial influences of youth that impact scientific curiosity and health awareness 2. Identify factors that demonstrate a relationship between STEM education/ interest and health literacy 3. Quantify the impact of the intervention on improving health literacy and STEM interest. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): Through a partnership with the South Bronx Police Athletic League after-school program, volunteers from Hoops for Health, a community based service learning program of the Albert Einstein College of Medicine, administered its innovative curriculum, mentored fourth and fifth grade students, and assessed the relationship between STEM education and health literacy. On a monthly basis during the 2015–2016 academic year, Hoops for Health volunteers conducted one fortyfive minute session dedicated to modules in STEM education and health promotion and another forty-five minute session devoted to physical fitness and nutrition counseling. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): A survey was given to the students at the start and end of the program to identify significant factors relevant to health and science promotion, along with a nine-item feedback survey to evaluate the program. Using this data, we examined the objectives of our program. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): We found that students, who identified as having math or science as their favorite subject, not only liked science more, but also participated in physical activity more frequently during the week. Furthermore, we show that students in our program with parents in a STEM-related field practiced healthier lifestyle habits and displayed more health awareness. Students rated our program highly, noted that they learned new concepts in health and science, and favored our hands-on modules. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): Since household background is a critical component in fostering lasting healthy lifestyles, creating events and programs aimed at promoting health education to both parents and children should be prioritized. Also, creating strong relationships between after-school programs (Police Athletic League, Boys and Girls club, YMCA, etc.) and local medical/graduate schools is an easily accessible avenue to disseminate health and STEM awareness information as well as establish a forum with the community to better assess their needs. Furthermore, we make our curriculum available to facilitate the establishment of other positive learning environments. SHARING THE LOAD: THE EFFECTIVENESS OF INVOLVING A NON-CLINICAL TEAM MEMBER IN DIABETES GROUP EDUCATION AND SUPPORT Melanie Martin1; Feben Girma2. 1Wake Forest, Greensboro, NC; 2Wake Forest Baptist, Winston-Salem, NC. (Control ID #2706371) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Patient engagement is crucial for improved outcomes in diabetes and can be enhanced by use of a non -clinical team member to provide disease education and support, even in a challenging patient population. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): 1.Describe a diabetes education/support course that can be led by a trained non-clinical team member. 2.Provide evidence of improvement in glycemic control via measurement of participants’ Hemoglobin A1c through this program. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): Care Plus is a multidisciplinary outpatient program that provides primary care and care coordination to frequently admitted patients from safety net practices at Wake Forest Baptist Health. Fifty percent of the patients enrolled in Care Plus have diabetes, and most have multiple other comorbid conditions along with significant psychosocial challenges. Effective treatment of Type 2 Diabetes Mellitus requires lifestyle changes along with medication adherence. Adequate instruction on the causes, consequences and treatment of diabetes can be challenging in a resource limited practice. We explore the benefits of training a non-clinical patient navigator as a peer diabetes educator. This educator was trained in the Diabetes Empowerment Education Program under Alliant Quality, a Quality Improvement Organization under Centers for Medicare and Medicaid. Weekly diabetes education support groups are conducted following the Alliant Quality 6–8 week curriculum. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): We compare individual pre and post participation HgbA1c results during the program. Patient satisfaction survey regarding the program is forthcoming. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): Fifteen Care Plus patients with DM II attended at least half of the curriculum and are included in this study. Seven of these patients chose to attend the program multiple times as they found it to be engaging and helpful. For patients that chose to participate repeatedly, we compared their results prior to enrollment of their first session to their results after completion of their last session. The group average HgbA1c prior to enrollment was 10.1 (range 7.1- 13.7) and the group average HgbA1c after completion was 9.0 (range 7.1- 12.2). The average improvement in HgbA1c was 1.1. Individual results ranged from worsening by 0.5 to improvement by 3.4. Although the changes cannot be attributed to this intervention alone, the group education and support enhanced patient engagement. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): Effective diabetes education is time consuming and can be especially challenging for clinics with limited resources serving uninsured and under insured patients. The lifestyle changes and importance of medication adherence are paramount to improving glycemic control. Training a nonclinical team member as a Peer Educator in the Diabetes Empowerment Education Program has proven to be an effective way to engage patients and provide diabetes education, resulting in HgbA1c improvement. SLEEP IS VITAL: IMPROVING SLEEP BY REDUCING NOCTURNAL VITAL SIGNS Elaine C. Khoong2; Hana Lim2; Timothy Judson2; Kelly Johnson2; Nicole Kim2; Karen Bieragual2; Jin Ge2; Priya A. Prasad1; Kyle Tillinghast3; Catherine Lau3; Michelle Mourad3. 1UCSF, San Francisco, CA; 2University of California - San Francisco, San Francisco, CA; 3University of California, San Francisco, San Francisco, CA. (Control ID #2705849) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Hospitalized patients get fewer than five hours of sleep a night, and poor sleep leads to increased rates of delirium, falls and hypertension as well as decreased patient satisfaction. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): 1. To improve sleep among hospitalized patients by minimizing nighttime disruptions and increasing housestaff awareness of their role in promoting sleep. 2. To ensure the intervention does not compromise patient safety DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): This project was conducted at a tertiary care academic hospital. We included patients on the hospital medicine service who were discharged from an acute or step-down unit. In our baseline needs assessment, hospitalized patients reported nighttime disruptions, including vital signs, were a common cause of sleep disturbance. At baseline, 15% of patients at our hospital were discharged on sleep promotion vital signs (VS), defined as any VS less frequent than every four hours. Our goal was to increase the rate of patients with sleep promotion VS 24 hours prior to discharge to 45%. To ensure continued patient safety, we tracked rapid response calls and intensive care unit (ICU) transfers for the hospital medicine teaching service. Housestaff led a yearlong project that included interventions including provider and nursing education, audit and feedback, and electronic medical record (EMR) changes - aimed at decreasing nocturnal VS checks for stable patients. We provided education at monthly resident orientations and encouraged housestaff to order sleep promotion VS on patients with stable VS for 24 hours and no anticipated medical changes. We provided real-time feedback to each medicine team by emailing a performance dashboard every two weeks, fostering healthy competition. High and low performing teams were given a brief survey regarding barriers to sleep promotion VS. We created easily accessible “Sleep Promotion Vitals” orders and embedded them into the hospital medicine admission order set and the standard order entry tool. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): Our outcome measures were: a) the rate of patients discharged from the hospital medicine teaching service on sleep promotion vitals at least 24 hours prior to discharge; b) the rate of rapid response calls and ICU transfers for our patients; and c) validated measures of sleep quality from patients on sleep promotion versus standard (every 4 hours) VS. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): Early results demonstrated an increase in sleep promotion VS from 15 to 55% within six months. We have met our goal (45 + %) for each of the last four months (08-12/2016). There were no recorded adverse outcomes (rapid response calls or ICU transfers) related to decreased nocturnal VS. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): Through a multifaceted, resident-driven approach including provider and nursing education, feedback, and EMR changes, we can successfully and safely decrease nocturnal vital signs in hospitalized patients. STANFORD’S PRIMARY CARE 2.0: INTENTIONAL LEAN DESIGN OF A QUADRUPLE-AIM-BASED PRIMARY CARE TRANSFORMATION ALTERNATIVE TO THE PATIENT-CENTERED MEDICAL HOME Garrett Chan1; Rumana Hussain3; Marcy Winget1; Cati BrownJohnson1; Jonathan G. Shaw2; J A. Glaseroff1; Megan Mahoney1. 1Stanford School of Medicine, Stanford, CA; 2Stanford School of Medicine, S, CA; 3Stanford Health Care, Stanford, CA. (Control ID #2699102) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Systematic reviews of patient satisfaction, utilization, cost, and provider outcomes associated with the Patient Centered Medical Home (PCMH) have been inconclusive, showing only modest improvements across all the domains; as an alternative, an intentional “Lean” (continuous improvement) design approach could lead to more profound improvements. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): In 2016, Stanford Healthcare undertook the goal to develop a new model of primary care specifically directed at meeting the Quadruple Aim. Facility and care models were designed using Integrated Facility Design, ie. Lean 3P Design. This design approach was an adaptation of Toyota 3P (Production, Preparation, Process) employing a team-based process design with representation from all relevant stakeholder groups to achieve a design that promoted high quality care, reduction of waste, and patient and employee satisfaction. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): Design activities spanned 18 months and included local consumer research (22 interviews); site visits (9 sites, 33 participating stakeholders); and visioning sessions. Notable features of the core Primary Care 2.0 model included: (1) three Physician (MD) and Advanced Practice Provider (APP) pairs, caring for 10,000 patients; (2) 3,330 patients empaneled to an MD-APP pair and four care coordinators (CCs) in each team; (3) embedded extended care team relevant to primary care, namely clinical pharmacist, dietitian, behavioral health specialist, nurse, and physical therapist. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): 1. Survey sent to SHC stakeholders who had any involvement in the design process, assessing feasibility and acceptability of the design process. 2. Survey sent specifically to Design Team members. This open-ended survey focused on group composition and dynamic on the creation of a multidisciplinary team-based model. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): Lean Integrated Facility Design was appropriate and acceptable to stakeholders, who created a full care model based on the Quadruple Aim. 77% of respondents reported that they strongly believed the design process was valuable. Notably, no respondent selected neutral or negative rankings for questions related to the design process. In the comment sections, respondents described an effective team, leadership, and collaborative experience. Themes from the second survey included the importance of team building activities in promoting a psychologically safe and effective group process and the role of the multidisciplinary composition of the design team in creating a multidisciplinary care model for PC 2.0. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): Lean Integrated Facility Design can be adapted to primary care redesign by focusing multidisciplinary teams on sequential design processes. Diverse stakeholders’ perspectives promote a final blueprint that reflects diverse constituents and promote overall buy-in. Time spent in “soft-skill” teambuilding is valuable for promoting group efficacy in designing new primary care models. SYRIAN CRISIS: AN INNOVATIVE SANITARY RESPONSE IN SWITZERLAND Jeremie Blaser1; Ioana Hincu1; Brigitte Pahud-Vermeulen1; Mario Gehri2; Joan Carles Suris Granell2; Patrick Bodenmann1. 1Vulnerable Population Center, Lausanne, Switzerland; 2Children’s Hospital, Lausanne, Switzerland. (Control ID #2701429) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): The Swiss government started a resettlement program, in collaboration with the United Nation High Commission on Refugees (UNHCR) to facilitate the arrival of particularly vulnerable refugees from Syria, which brings the need of a dedicated healthcare program. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): 1) To provide the necessary healthcare for this particularly vulnerable population. 2) To gather information about this population, in terms of medical conditions, but also from a more holistic view of the families, as we know they are selected on vulnerability criteria. This can be used as a feedback to the health authorities about the specific needs of this population. 3) To offer a protection to the medical staff against compassion fatigue through an interdisciplinary consultation, as repeated exposition to the traumatic history of most of these families can be difficult to bear. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): Around 1800 persons are expected to arrive in Switzerland between 2016 and 2017 from the resettlement program. In the canton of Vaud (10% of the general population), an interdisciplinary family consultation was set up for those families, staffed with a pediatrician, a general practitioner, an interpreter, as well as a nurse practitioner. At the first consultation, a health assessment is provided to the whole family at the same time. Vaccinations are proposed and screening for tuberculosis is planned for children systematically. Patients can then be oriented toward different medical specialties as needed. A second consultation is planned two months later for a clinical follow-up, to pursue the vaccination plan, and to discuss the results if tests were performed. A shared meeting with the whole medical team concludes the assessment. After this 2nd consultation, a follow-up with a private general practitioner and/or pediatrician is organized. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): 1) Feasibility will be assessed by the number of consultations provided. Medical conditions of the patients will be reported as the number of chapters from the ICPC-2 classification (classification of symptoms and medical conditions for primary care) concerned by the complaints of the patients 2) Vulnerability will be assessed with a validated vulnerability scale. 3) Protection against compassion fatigue will be reported as the absence of compassion fatigue in the medical team. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): 1) Between July and December 2016, 60 persons have been seen for a first medical evaluation, including 32 adults and 28 children. The adults had on average complaints concerning 3.1 chapters of the ICPC-2 classification, and children 1.3. 2) With the use of the vulnerability scale: 2 adults were identified with 4 axes of vulnerability and 3 with 3 axes. One child was identified with 3 axes. 3) No compassion fatigue has been reported so far. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): The interprofessional model of a consultation for Syrian migrant families is feasible. The complementarities of the actors are a good protection against compassion fatigue that may threaten the staff. TEACHING WHEN YOU CAN’T SPEAK: LEADING SHARED MEDICAL APPOINTMENTS (SMAS) FOR LINGUISTIC MINORITIES Cynthia Schoettler; McShane Michael; Nihan K. Cannon; Kelly Pereira; Yamini Saravanan. Cambridge Health Alliance, Cambridge, MA. (Control ID #2698752) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Shared Medical Appointments (SMAs) have been shown to be an effective way to teach self-management, improve measures of control and increase patient self-efficacy for chronic illnesses using a less hierarchical, culturally focused context; however non-English speakers are often excluded from this intervention due to limited provider linguistic capabilities, despite evidence showing medical interpreters can help overcome language barriers. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): The objectives of this Quality Improvement (QI) project were to 1) Pilot SMAs for non-English speakers when providers do not share the same language, 2) To understand if SMAs using medical interpreters could be successful and effective for this population, and 3) Establish bestpractices for this type of SMA. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): The Primary Care Center (PCC) of Cambridge Health Alliance is an urban safety-net, Harvard Medical School-affiliated community outpatient clinic that serves a culturally and linguistically diverse patient population, including a large Portuguese-speaking population. A monthly series of 10 SMAs for Portuguese speakers with Diabetes Mellitus was created. SMAs are led by a multidisciplinary team including (non-Portuguese speaking) resident and attending physicians, 2 Portuguese interpreters, and 1 Portuguese-speaking medical assistant. SMAs follows the same format: Pre-visit team huddle to discuss flow, content/plan, methods of interpreting; 30 min of 1:1 brief diabetes-focused patient visits for focused exam and individualized management (1 physician:1 interpreter); 60 min for group discussion (led by physicians and facilitated by both interpreters); End-of-visit team de-brief reviewing all elements of the SMA. This roughly follows the traditional QI format of continuous Plan, Do, Study, Act (PDSA) cycles. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): To understand the impact of using medical interpreters in groups, effects will be followed in 3 main areas: traditional measures of diabetes control (i.e. A1c), patient perceptions (via focus groups), and provider (especially interpreter and medical assistant) feedback to identify successful elements and best practices. Focus groups will take place midway (early 2017) and after completion of the series. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): Thus far, patients have demonstrated good attendance and are very involved in asking questions. Facilitators focus on interactive group dynamic that encourages peer teaching. Interpreters use “simultaneous” translation method to reduce the need to pause for interpretation, which allowed for lively conversations and education, and ability to address cultural perceptions of diabetes such as, “diabetes is caused by stress”. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): It is possible to develop and lead effective SMAs in languages other than English, if group leaders partner with strong in-person interpreting services. TEAM FACECARDS IMPROVE PATIENT IDENTIFICATION OF PHYSICIANS BUT HAS LITTLE IMPACT ON PATIENT SATISFACTION Ernie L. Esquivel2; Michael Ding2; Nancy Tray2; Laura F. Gingras1; Arthur Evans2. 1New York Presbyterian Hospital - Weill Cornell Medical Center, New York, NY; 2Weill Cornell Medical College, New York, NY. (Control ID #2703724) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Caring for patients in the hospital requires the efforts of many health care providers, but several studies have highlighted that most inpatients are unable to identify the physician(s) responsible for their daily management. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): We evaluated the effect of a healthcare team identification tool, team facecards, on provider identification, patient perceptions of physician communication, and patient satisfaction. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): A prospective study was conducted to evaluate the efficacy of team facecards among patients admitted to inpatient teams at NewYork-Presbyterian Hospital. Team facecards were designed to include a photo of each physician member of the primary care team and descriptions of their roles. Patients in the intervention group were provided a team facecard at the beginning of their hospital stay by a non-physician research assistant, and a second team facecard was posted in the room. Patients in the control group did not receive the team facecards. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): After one to two days, patients were asked to identify one of their providers and to answer dichotomized questions adapted from the ABIM-PSQ, addressing the provider’s communication skills including use of non-medical jargon, honesty in answering questions, investment in patient well-being and recovery, explanations of diagnosis, treatment, and listening skills. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): During an eight-week study period, a total of 328 team facecards were distributed. Of these, 231 patients could be surveyed since 97 patients were either discharged or transferred to the ICU. A total of 166 (71.9%) agreed to be surveyed while 202/243 controls (83.1%) participated in the survey. Patients who received team facecards could correctly name one of the physicians in 41/166 (24.7%) cases, while another 62 (37.3%) pointed to the card when asked to identify their team. In the control group, only 57/202 (28.2%) could identify a member of the team. The majority of patients in the intervention group 142/166 (85.5%) found the facecard helpful, while 175/202 (86.6%) control patients thought that it might have been useful to receive a team facecard. Patients in the intervention group were significantly more likely to state that their doctors explained their diagnosis and treatment in an understandable way 94.6% vs. 88.1% (P = 0.03). Trends toward significant difference (P = 0.09) were also noted in patient’s perception that their doctors used language that was easy to understand, were honest in answering questions, and communicated better during the physical examination if they had received a team facecard. No significant differences were noted in six other questions of patient satisfaction, with favorable responses obtained in more than 80% of cases. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): Team facecards helped patients identify a member of their physician care team, and were perceived positively by patients who received them. However, responses to patient satisfaction questions in both groups were generally favorable and team facecards had only minimal impact on improving these responses. TELE MONITORING OF PATIENTS WITH UNCONTROLLED HYPERTENSION- A PROPOSAL FOR POPULATION HEALTH MANAGEMENT Charles Choi1; Matthew Wilson1; Jason Hopper1; Elizabeth Tysinger1; Kristy Marvin1; Deanna Jones2; Claudia L. Campos1. 1Wake Forest University, WInston-Salem, NC; 2Wake Forest Baptist Health, Winston Salem, NC. (Control ID #2706363) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Acces to care is another barrier to achieving blood pressure control in under represented minorities. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): The objectives of this pilot intervention are to determine (1) the feasibility (medication side effects, acceptability, recruitment, retention, adherence to protocol) and (2) the effect on BP at 3 months of home BP telemonitoring and use of protocols lead by a nurse practitioner in patients with uncontrolled hypertension of the internal medicine clinic. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): We propose to implement a tele monitoring system using home blood pressure measurements via phone transmission. It differs from clinic-based care through the systematic use of home BP tele monitoring and telehealth care coordinated by a nurse practitioner.BP protocols will be used for medication titration.. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): The outcomes are (1) treatment side effects, acceptability, self-monitoring rates, medication and protocol adherence. The secondary outcomes are (1) BP control to <140/90 at 3 months and (2) change SBP and DBP at 3 months. Side effects will be elicited during phone visits (Appendix B), self -monitoring rates will be recorded on HBPM device and compared to paper recordings. Medication adherence will be assessed using the medication adherence (Morisky Medication Adherence) Scale during the initial and final visits. We will measure patient acceptability of HBPM using the questionnaire by Lindroos during the final visit. Protocol adherence will be monitored by assessing if patients do comply with measurement times (4 measurements per week for 3 months) and if phone communicated measurements are consistent with recorded numbers. Patient drop outs before the end of the study will be monitored. We will define “out-of-window” visits when more than 7 days from originally scheduled visit have elapsed. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): A cross sectional study through an EHR query between 04/17/2016 and 10/17/2016 revealed that among 1833 patients seen at OPD, a third (691/1833) have suboptimal BP control (SBP > 140 or DBP >90). One investigator (C Choi) randomly selected 30 charts during that time period of patients scheduled for a BP check with a nurse for uncontrolled hypertension and performed a chart review. Patients were 12 Male and 18 Female, ages ranging from 26 to 74 years old (mean 57) and predominantly AA (20/30). Initial office mean BP was 172/90 and subsequent nurse visit mean BP was 158/82. 5 patients had private insurance, 9 patients were uninsured, 13 Medicare and 3 Medicaid recipients. Nurse follow up visit no show rate was 27% (8/30). The average number of BP medications per patient was 2.5 and the average number of total medications was 9.2 (range 1 to 22). KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): Changing our practice patterns towards patient centered and population management interventiosn are imperatives in achieving better healthcare outcomes THE 4:2 ON/OFF SERVICE MODEL FOR AMBULATORY PRECEPTING: AN INNOVATIVE SOLUTION TO MAINTAINING RESIDENT-ATTENDING-PATIENT CONTINUITY Melissa S. Lee1, 2; Andrew A. Chang1, 2; Moses Lee1, 2; David Stevens1, 2. 1Kings County Hospital, Brooklyn, NY; 2SUNY Downstate, Brooklyn, NY. (Control ID #2707561) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): The shift to an X + Y system risks disruption of continuity between residents and their patients/preceptors because residents will be precepted by multiple attendings. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): To test a scheduling system where ambulatory faculty preceptors “follow” their residents in a 4:2 On/Off Service model. To preserve the resident-patient-preceptor relationship. To avoid faculty burnout as a result of the intervention. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): Kings County is a large, urban, academic safety-net institution located in Central Brooklyn. We are the primary care continuity practice site for 36 SUNY Downstate Internal Medicine residents. Firms of 12 residents attend clinic during the 2 week Y block. Preceptors supervise 4 residents. Rather than maintaining the traditional preceptor schedule in which each attending precepts the same half-day each week, preceptors are now “on service” with their residents for 6/8 continuity sessions during the Y block. A swing preceptor covers 2 sessions. Faculty do not precept during the 4 “off service” weeks while their residents are on the inpatient wards. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): Maintenance of resident continuity with preceptors and patients, improved resident and faculty satisfaction. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): Continuity with a primary care provider is widely accepted as a cornerstone of quality and patient experience. In the 4:2 model where attendings have the same precepting schedule every week, resident continuity with preceptors and patients is limited. Residents have a different preceptor for each continuity session. Had we chosen to maintain current attending preceptor schedules in which each attending precepts once per week, residents would have 25% continuity with their preceptors instead of 75% in our On/Off Service model. This was achieved without increasing the total number of attending precepting sessions. The On/Off Service model did not result in attending burnout due to the loss of balance in their work week as was feared. 83% felt they did not lose a sense of balance in their work week, and felt this model was better than the traditional once weekly paradigm. All faculty reported that the 4:2 On/Off Service model kept them excited about working at Kings County. An unexpected finding disclosed during an informal evaluation process was strengthened relationships and improved resident-preceptor communication around patient care. Continuous conversations with a preceptor over 2 weeks improved patient safety and care as laboratory and imaging results were reviewed and discussed promptly. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): When transitioning to an X + Y system, give strong consideration to an On/Off Service Ambulatory Precepting Model to preserve resident continuity with patients and preceptors and improve resident-preceptor relationships and satisfaction. THE COMPLEX HIGH ADMISSION MANAGEMENT PROGRAM (CHAMP): DEVELOPMENT AND PRELIMINARY IMPACT ON HOSPITAL UTILIZATION Bruce L. Henschen2; Margaret Chapman1; Abby Toms1; Mckay Barra1; Luke O. Hansen3. 1Northwestern Memorial Hospital, Chicago, IL; 2Northwestern University, Chicago, IL; 3Amita Health, Chicago, IL. (Control ID #2673887) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Patients who are high-utilizers of hospital-based resources pose unique challenges to medical and psychosocial support networks that our current fragmented health care delivery model is unable to manage. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): 1. Reduce hospital utilization and improve clinical outcomes among medical high-utilizer patients. 2. Use intensive case management and care coordination to create a system of care that meets the complex needs of high-utilizers. 3. Partner with patients to develop individualized care plans, promote continuity, and rebuild trusting relationships. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): The Complex High Admission Management Program (CHAMP) is a longitudinal, relationshipbased care model that consists of two social workers (comprised of 1.5 FTE total), two physicians (0.5 FTE), and a program administrator (0.1 FTE). The EMR alerts providers to CHAMP patients; the CHAMP team provides consistency in care services across the continuum through creation of individualized care plans in collaboration with the patient, acts as a hospital consultation service for their patients when admitted, and provides primary care and care coordination when discharged. Intensive case management and trust building, both with patients and providers, play key roles in identifying and targeting the root causes of high utilization. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): We have examined rates of hospital admission among patients enrolled in CHAMP compared to retrospective data prior to enrollment. Through a randomized, controlled trial, we plan to prospectively gather utilization, patient satisfaction and quality of life, and other clinical endpoints. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): As of Fall 2016, 53 patients have been enrolled in CHAMP. Their mean age is 56; 17 (32%) carry a diagnosis of sickle cell disease, although the spectrum of medical and social issues is diverse. In a 6month follow-up period, patients enrolled in CHAMP experienced a 30.0% decrease in hospital 30-day unplanned inpatient readmissions as defined by Medicare (p = 0.04), compared with 6 months prior to each patient’s enrollment. There was also a 29.3% decrease in total hospital admissions and an 11.7% decrease in total number of inpatient bed-days during the study period. Patients self-identified with the CHAMP intervention, and providers from varied settings anecdotally reported improvements in care coordination. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): CHAMP, designed to improve care for high-utilizing patients, is associated with a significant decrease in inpatient hospital readmissions, total admissions, and days in the hospital in a retrospective pre-post analysis. Key drivers of success have been re-establishing trust and strengthening engagement in both patients and providers. The program is feasible with institutional support and has been promoted by clinicians and other members of health care teams, administrators, and hospital executives. Ongoing and future investigations assessing a broader range of outcomes and looking at long-term outcomes are necessary to demonstrate program effectiveness and sustainability. THE ED-PACT TOOL: COMMUNICATING VETERANS’ CARE NEEDS AFTER EMERGENCY DEPARTMENT VISITS VIA ELECTRONIC MESSAGES Kristina M. Cordasco1, 2; Hemen Saifu1; Lisa V. Rubenstein1, 2; Mana Khafaf1, 2; Brian Doyle1, 1; Jonie Hsiao1; Greg Orshansky1, 2; David Ganz1, 2. 1VA Greater Los Angeles Healthcare System, Los Angeles, CA; 2UCLA, Los Angeles, CA. (Control ID #2702251) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Communication failures between providers are a threat to patient safety. Despite the importance of timely receipt of recommended post-emergency department (ED) care, up to two-thirds of patients discharged from EDs do not receive recommended post-ED care. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): We developed, piloted, and formatively evaluated a tool (The ED-PACT Tool) facilitating post-ED communication for patients in six primary care clinics in VA’s Greater Los Angeles Healthcare System (VAGLAHS). DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): The ED-PACT Tool uses the electronic health record to send messages from Veterans Health Administration (VA) ED providers to patients’ VA Patient-aligned Care Teams (PACT) nurses, when patients are discharged home from the ED with urgent or specific follow-up needs. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): Before implementation, we assessed readiness to participate in the innovation with ED and PACT leadership interviews and PACT nurse questionnaires. During deployment, we used audit and feedback to monitor adherence with correct use of the tool. We logged all user feedback, tracked all failures (i.e., PACT nurse not acting on a message) and their causes, and used run charts to assess for weekly variations in failures. We audited a random sample of 150 messages to capture types of care needs for which messages were sent. We interviewed leaders in the ED and three PACT clinics about perceptions of the ED-PACT Tool’s usability and value, as well as implementation facilitators and barriers. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): In pre-implementation interviews, ED and PACT clinic leadership endorsed improving post-ED care communication as being a priority issue. Nurse care manager pre-implementation questionnaires showed that 23 of 29 nurses were “confident” or “extremely confident” in their ability to use the ED-PACT Tool. Between November 1, 2015 and November 30th, 2016, the ED-PACT Tool was used to send 1630 messages from the VAGLAHS ED to nurses in 48 PACT teams. Care needs included: symptom recheck (55%); care coordination (16%); wound care (5%); medication adjustment (5%); laboratory recheck (5%); radiology follow-up (3%); and blood pressure recheck (3%). On average, nurses successfully acted on 88% of messages (weekly range, 72% - 100%). Reasons for failure included human error, staffing shortages and technical errors. Interviews with ED and PACT clinic leaders revealed that the ED-PACT Tool is perceived to provide substantial benefit for coordinating post-ED care by effectively communicating with patients’ PACT nurses. PACT leaders also reported nurse training and “buy-in” facilitated implementation, while insufficient staff posed a barrier. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): The ED-PACT Tool facilitates communication between providers during a vulnerable care transition. Primary care nurses can fill an important role in receiving and triaging post-ED care coordination messages. Deployment of similar tools should include attention to the organizational, human and technical factors revealed by our evaluation. THE HEART OF THE TEAM IN TEAM-BASED CARE: IMPROVING PROVIDER-MEDICAL ASSISTANT PAIRING IN PRIMARY CARE Braden K. Mogler2; David Lee1; Claire K. Horton1. 1UCSF, San Francisco, CA; 2University of California San Francisco, San Francisco, CA. (Control ID #2706810) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): While stable pairings of primary care providers (PCPs) and medical assistants (MAs) is a core component of team-based care and can decrease burnout and improve team functioning, achieving stable pairings is a particular challenge in a residency based clinic with many part-time providers. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): 1. Assess baseline rate of MA-PCP pairings 2. Identify root causes of pairing discontinuity 3. Implement interventions to improve rate of stable pairings DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): Over the past 5 years, our clinic has made major efforts to improve team-based care and create a high-functioning medical home model. Key stakeholders identified discontinuity with MAs (ie, rarely working with their assigned MA) as a core area of dissatisfaction. This low rate of stable MA-PCP pairings was a frequent complaint among providers, and other clinics have described an inverse relationship between rate of stable pairings and burnout. To increase our rate we measured stable pairing rates over time, identified factors contributing to missed pairings, chose a staff champion to oversee scheduling, changed staff scheduling protocols to favor stable pairings, and focused efforts on clinic sessions with greatest opportunity for improvement. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): We defined our primary measure of success as a 10% relative increase in stable MA-PCP pairing rates over one year. We also monitored qualitative satisfaction among staff and providers via regular clinic feedback sessions. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): Our baseline rate of MAs and PCPs working together in their assigned pairing was 50%. Our first intervention was to identify a senior MA with a high degree of peer leadership skills as staff champion in charge of MA scheduling and to make teamlet pairing top prioritiy in MA scheduling. With this intervention alone our stable pairing rate improved to 70%. In our second intervention we identified root causes of discontinuity of pairing. These factors included sick calls, difficulty in scheduling MAs for evening clinic sessions, and a cultural bias toward prioritizing attending-MA pairs over resident-MA pairs. We explicitly re-prioritized MAresident pairings, improved full staffing rates overall, and our current work focuses on improving evening clinic assignments. Provider feedback indicates a high degree of satisfaction with the improved pairing rates, with many providers indicating that this change has improved their clinic experience significantly; MAs express more satisfaction as well. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): 1. Stable MA-PCP pairings in primary care clinic can decrease provider and staff burnout. 2. While achieving high rates of stable pairings in a residency based clinic is challenging due to the large number of part-time providers, monitoring pairing rates and data transparency can give insight into modifiable factors to increase stability. 3. Identifying a staff champion and prioritizing stable pairings in scheduling can greatly increase rates as well as staff and provider satisfaction. THE HOMELESS RESPONSE TEAM: PROVIDING CONTINUITY OF CARE FOR HOMELESS PATIENTS Meghan R. Rochester1; Erik Rueckmann2. 1University of Rochester School of Medicine and Dentistry, Rochester, NY; 2University of Rochester Medical Center, Rochester, NY. (Control ID #2702415) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Homeless patients have higher readmission rates and healthcare costs with worse health outcomes. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): Improve continuity of care from inpatient to outpatient. Enhance medical student competence in caring for homeless individuals. Reduce healthcare costs associated with the care of homeless individuals. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): The Homeless Response Team is a pilot program comprised of an interdisciplinary team working with homeless patients accessing care at Strong Memorial Hospital in Rochester, NY. Self-identified homeless individuals admitted to the hospital were screened by social work to determine eligibility. Inclusion criteria included: the patient’s status as homeless, no history of violence, not acutely psychotic. If appropriate, a response team was dispatched to enroll the patient. Student teams evaluated the patient’s willingness to participate, reason for hospitalization, discharge plan, and response plan. Post discharge, teams scheduled weekly follow-up to assess current needs and barriers to compliance with the treatment plan, providing support as able. The intervention period is six months but is ended if patients are lost to follow-up or wish to withdrawal. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): Measures of success include impact on patient care and barriers to care, student learning, and health care costs. These measures will be assessed by administering the Health Care Climate Questionnaire, Patient Activation Measures and Patient Activation Assessment at the start and end of the intervention and by qualitative analysis of student notes. Impact on care will be monitored by assessing the number of patients who are newly connected with a PCP, outpatient social work or housing. We will administer the Health Professionals’ Attitudes Towards the Homeless Inventory to medical students pre and post-intervention to assess for changes in bias. We will analyze the readmission rates and hospital-associated health costs of the patients prior to, during, and after the intervention period. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): Since April 2016, the Homeless Response Team has been referred fourteen patients, assessed twelve, and enrolled ten patients. One completed the intervention, five were lost to follow-up, two entered inpatient substance abuse treatment, two voluntarily ended their participation. The patients were racially diverse; the majority were chronically homeless middle-aged men with substance abuse problems living in emergency shelters, had insurance and a PCP, and identified transportation and cost as barriers. Students noted motivation as a barrier. Assistance given included establishing care with PCPs and social work, arranging transportation, accompanying patients to appointments, obtaining eyeglasses, insurance, and substance abuse treatment. Students worked with patients on reconciling concerns regarding treatment plans and the health care system. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): Active post-hospitalization follow-up by medical students shows promise in connecting homeless patients with appropriate services and bridging the gap between inpatient and outpatient care. THE MAGIC CLINIC: AN INTERDISCIPLINARY GERIATRIC CONSULT CLINIC EMBEDDED IN A PATIENT-CENTERED MEDICAL HOME Mark J. Simone2, 1; Lisa Padgett2, 3. 1Harvard Medical School, Boston, MA; 2Mount Auburn Hospital, Cambridge, MA; 3Massachusetts College of Pharmacy and Health Sciences, Boston, MA. (Control ID #2693535) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Chronically ill older adults in the primary care setting often require an interdisciplinary team to address their health care needs; we therefore studied the impact of the creation of a geriatric consult service in a patient-centered medical home. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): 1. Optimize the medication regimens for older adults 2. Reduce health care utilization (ED visits, hospitalizations, readmissions) 3. Improve health outcomes and perform appropriate geriatric assessments for chronically ill older patients DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): The MAGIC (Mount Auburn Geriatric Interdisciplinary Consultation) Clinic was created to provide an interdisciplinary geriatric consultative service to older adults in the Primary Care Center (PCC) at Mount Auburn Hospital (MAH). The MAGIC Clinic is staffed by a geriatrician, clinical pharmacist, and geriatric social worker. The MAGIC Team also includes interdisciplinary members from the PCC and MAH community who meet monthly to review recent cases and coordinate ongoing care. Geriatric patients are referred by their PCPs often for reasons of dementia evaluation and management, medication optimization, functional decline, and complicated psychosocial issues. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): We will measure health care utilization and other patient outcomes 6 months before and after enrollment in the MAGIC Clinic. We will also survey patients and providers. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): The MAGIC Clinic opened March 2015, and during its first year, saw 27 patients during 61 encounters. The mean age is 79.3, range 65–92 years old. The majority of patients live alone (59%), 1/3 are dependent in ADLs, 2/3 are dependent in IADLs, with a mean of 12.6 chronic active conditions (range 7–23). One third have a high-school education or less, and about 15% are non-English speaking and racial minorities. Our pilot data for patients with at least 6 months of follow-up in the MAGIC Clinic (n = 15) show reductions in ED visits (70%, n = 7), hospitalizations (66%, n = 6), and readmissions (100%, n = 3). 10 patients were newly diagnosed with dementia. Vaccination rates increased significantly (n = 27) from 33 to 96% (p < .0001), and documentation of health care proxy increased from 41 to 62% (p = .0143). Our efforts to optimize medications show a decrease in anticholinergic risk score, total number of medications, daily dose burden, and reductions in potentially inappropriate medications. Our patient and provider surveys show high levels of satisfaction. Pre and post patient/caregiver surveys show improvements in all domains, with most feeling that the visits have improved their overall care and that they would recommend the service to others. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): We created an innovative and much needed geriatric consultative service embedded in a patient-centered medical home. This new clinical service is highly valued by patients and providers. Our team focuses on areas of great importance to the care of older adults. Patients and providers from practices outside of the PCC have asked for referrals to the MAGIC Clinic, so in the future we hope to expand our services beyond the PCC. THE SHINGLES VACCINATION INITIATIVE- INCREASING RATE OF IMMUNIZATION AGAINST HERPES ZOSTER IN AN ELIGIBLE OUTPATIENT POPULATION. Irina Kushnir2; Ibrahim Ali2; Frank Cacace1, 2. 1Hofstra North Shore LIJ, Great Neck, NY; 2Northwell Health, Manhasset, NY. (Control ID #2707026) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): How to improve the quality of preventive care at the Long Island Jewish Ambulatory Care Unit (LIJ ACU) by increasing the rate of Shingles vaccination. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): The primary objective of our initiative was to increase the number of patients at LIJ ACU who received a vaccine against Herpes Zoster. Our secondary objectives were to increase provider and patient awareness of the shingles vaccine, and to identify the barriers to administration of the vaccine which was being underutilized at our clinic. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): Our initiative was implemented at a resident run clinic with a predominantly socioeconomically underprivileged and elderly patient population. We first identified and educated all health care personnel and patients about the benefits, harms, and indications for the Zoster vaccine. All patients over the age of 60 who do not have specific contraindications are eligible for the vaccine; we identified our population of interest with the help of a database provided by IT. We also identified barriers to administration of the vaccine, in particular lack of financial coverage by certain insurance companies, and collaborated with pharmacists to address these barriers. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): We used quantitative metrics to measure the success of our initiative by comparing the number of individuals vaccinated with Zoster in the ACU clinic prior to initiation of our quality improvement project, and then at its completion. We also measured the amount of individuals vaccinated for Zoster each year, and analyzed the trend over the years, with particular attention to the trend from 2014 to 2016, from before the initiation to after the conclusion of our project. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): We found that after implementation of our intervention, the rate of shingles immunizations rose drastically at our clinic. We began to implement our intervention after the advent of the 2015 academic year, and watched the rate of vaccinations practically quadruple from 14 vaccinated individuals in 2014 to 42 patients in 2015. We had completed our quality improvement project by the end of the academic year in 2016, and by July 2016, there were already 28 vaccinated patients in 2016. When simply comparing vaccination rates prior to and after implementation of our project, our findings were even more remarkable. A total of only 35 eligible patients received the Zoster vaccine between 2012 and 2015, compared to 91 patients that were vaccinated between July 2015 and 2016, the rate of vaccinations had nearly tripled in 1/3 the studied time after implementation of the zoster vaccination initiative. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): Our takeaway point from our quality improvement project is that a multidisciplinary approach should be employed, and that the benefits, harms, degree of efficacy and monetary cost of an intervention must always be addressed prior to its implementation. THE SUBSTANCE USE WARMLINE: A NEW RESOURCE FOR PRIMARY CARE Rebecca Sedillo2; carolyn chu2; James Gasper2; Erin Lutes2; Benjamin R. Smith2; Jacqueline P. Tulsky2; Scott Steiger1. 1University of California, San Francisco, San Francisco, CA; 2University of California-San Francisco, San Francisco, CA. (Control ID #2702571) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Many primary care clinicians lack confidence and/or experience in substance use management, leading to significant stress, frustration, and burnout. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): In 2015, the Clinician Consultation Center (CCC) and Bureau of Primary Health Care launched a Substance Use Warmline (SUW), 855-300-3595, to increase access to timely, evidence-informed addiction medicine consultation for community health providers. The SUW aims to increase provider knowledge and skill through the delivery of tailored, expert clinical decision-support. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): A multidisciplinary team of expert nurses, Addiction Medicine-certified physicians, and clinical pharmacists provides free, on-demand telephone consultation for clinicians. The SUW offers advice on all aspects of substance use evaluation and management, including complex patients with cooccurring chronic pain, behavioral health issues, HIV, and other chronic conditions. The team logs case details in the CCC’s secure standardized database. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): Callers are emailed a 5-item Likert survey after each consultation to assess satisfaction with the service. Respondents also have an option to submit free-text comments. The SUW also monitors monthly call volume and repeat callers. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): 63.7% of calls over the first year were from MDs/ DOs, and the number of calls increased by an average of 28% per month. >25% were internists and 30% of physician callers had DATA2000 waivers to prescribe buprenorphine. Prescription opioids were discussed in 64.2% of cases, followed by stimulants (31.1%), alcohol (28.3%), non-prescription opioids (17.9%), sedative/hypnotics (13.2%), and other substances (13.2%). 43.4% of cases involved polysubstance use. Consultants discussed a broad range of clinical topics: SUD screening and diagnosis, MAT options, opioid safety/dosing/tapering, urine toxicology use, behavioral interventions for SUD, and withdrawal management. Almost 60% of cases involved documented psychiatric co-morbidities, and over a third involved patients with chronic pain. Callers consistently rated the SUW highly: the vast majority indicated questions were answered thoroughly with useful, up to date information. All survey respondents said they would both utilize the SUW again and recommend it to colleagues. One caller noted: “This was a great resource. I was at my wits’ end trying different techniques and getting nowhere. I felt supported and I received new information to use.” Almost a third of all callers contacted the SUW more than once. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): The SUW appears to be a useful tool for primary care practitioners who have called to request on-demand, telephone-based substance use consultation.Early results suggest this service may help reduce or prevent burnout among providers managing complex patients who use drugs and/or are prescribed high-doses of opioids. TIME CONSTRAINTS TRUMP ENTHUSIASM IN MEDICATION RECONCILIATION Carmen L. Lewis; Laurence Williams; Mary W. McCord; Hillary Chrastil; Lauren Drake; Huong M. Lam. University of Colorado, Denver, CO. (Control ID #2698925) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): General Internal Medicine practices increasingly face unrealistic work expectations and are challenged to re-distribute work from physicians to other team members. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): 1.) Determine the practicality of full medication reconciliation by medical assistants (MAs) during the rooming process. 2.) Assess the fidelity and time required for full medication reconciliation. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): Initially, our practices agreed across our three clinical teams to train MAs to reconcile up to six medications, deferring patients with more than six medications to physicians. Subsequently, a system wide initiative for medication reconciliation training was required. After this training, MAs on two of three teams organically expanded to full medication reconciliation. To standardize our work, the nurse coordinator required the third team expand to full medication reconciliation. MAs on the third team voiced concerns about their ability to complete full medication reconciliation, in addition to other rooming requirements within the currently allotted 5 to 7 min traditional rooming time. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): Several weeks after the clinic-wide implementation, the third team’s providers indicated that not only was medication reconciliation not being done reliably, but other rooming requirements were also suffering. This outcome seemed to be isolated only to the third team, as the other two teams reported strong compliance with the new medication reconciliation procedure and high quality rooming. We performed a Root Cause Analysis (RCA) exercise to: 1) Define the timeline that led to the current state. 2) Identify the contributing factors and root causes. MA observations were conducted to determine fidelity and time required for full medication reconciliation. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): The RCA exercise concluded with two possible root causes: 1) Workload distribution within the clinic was not consistent, causing challenges for the third MA team. 2) The concern about time constraints were not adequately addressed on the two teams who adopted full medication reconciliation. We found that individual MA rooming workload was unequally distributed across teams (15.3, 13.7, and 11.5 patients roomed/ MA) indicating that volume was not the cause of the third team’s performance, as it was the team with the lowest volume. We also conducted a series of 13 observations, which showed an additional five to eight min were required to complete full medication reconciliation. We found only members of the third team correctly completed full medication reconciliation. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): 1.) System training can impact local environments and disrupt existing workflows. 2.) Enthusiasm for expanded work among MAs, encouraged spread without adequate evaluation of time and fidelity. 3.) RCA analysis can be a helpful tool to examine performance. TO CHOOSE WISELY: REDUCING THE OVERUSE OF LABS IN HOSPITALIZED PATIENTS - A HIGH VALUE CARE ENDEAVOR Ana I. Velazquez2; Mariana Mercader2; Krystle Hernandez2; Rifat Mamun2; Daniel I. Steinberg1; Alfred Burger3. 1Beth Israel Medical Center, New York, NY; 2Mount Sinai Beth Israel, New York, NY; 3Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY. (Control ID #2706220) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Routine daily labs are often performed without clear clinical indication on stable hospitalized patients. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): 1. To reduce the ordering of unnecessary daily labs 2. To educate providers on appropriate ordering of labs on the hospitalized patient DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): The Society of Hospital Medicine Choosing Wisely recommendations state providers should avoid performing repetitive CBC and chemistry testing in the face of clinical and lab stability. Our institution removed the “daily labs” order capability from our EMR in June 2014. An audit of lab use 1-year later showed no change in lab volume. Discussion with providers revealed labs were being ordered several days in a row, by creating individual orders timed to occur each day. A survey of our housestaff showed a majority were in favor of change reducing “daily labs” use. The HVC committee devised a multipronged approach to reduce lab overuse via provider education, peer champion advocacy, and team based feedback on lab ordering patterns. We reviewed CBC and chemistry labs performed from March- July 2016 on3 of our general medicine teaching floors to establish our baseline ordering practices. The percentage of basic labs ordered >24 h in advance of being done was found to be 20%. An educational presentation based on the Choosing Wisely campaign and our baseline lab ordering pattern was given to IM residents and hospitalists. This intervention was performed at the start of each 4-week block beginning in August. IM service lab ordering data was reported bi-weekly to team members, reviewing the percentage of labs ordered >24 hours in advance for their block period. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): At the end of each 4 week block the percentage of labs ordered >24 hours in advance was measured. This percentage was compared to our baseline percentage. An absolute and relative change was calculated for each block rotation. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): In the first 4 week block of our intervention we saw no change. In the second block with an increased focus on peer championing and feedback to each team member we saw a slight decrease in unnecessary lab ordering to a total rate 18.4%. In the 3rd and 4th 4 week blocks of the intervention we respectively saw decreases to 12.5 and 13.8% in labs ordered >24 hours advance of being drawn. This was a relative decrease by 37.5 and 31% of labs ordered in the absence of current clinical data. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): Our project shows that while the best solutions generally are system based, the culture around overuse and the ability of physicians to create solutions to problems may require a more manual process of monitoring clinical behaviors and providing feedback. We have seen significant changes in physician behavior during our intervention. While culture change may take a longer period and regression to the mean errors can be made based on early and limited data, we look to sustain this success and change the culture at our institution around daily lab use. STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Can a primary care based interprofessional transition of care clinic reduce 30 day hospital readmission, ED utilization 30 days post-discharge, and improve timely primary care follow-up? OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): 1. Reduce hospital readmission at 30 days 2. Reduce ED utilization 30 days post hospital discharge 3. Improve timely follow-up in the primary care clinic post discharge (defined as less than or equal to 14 days) DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): We developed an outpatient interprofessional transition of care clinic in a university based academic internal medicine clinic. The clinic is staffed by an attending physician, medical resident, medical student, social worker, psychologist, pharmacist, pharmacy resident, pharmacy student, registered nurse and home health representative and operates one half-day a week. Our clinic is notified of hospital discharge for those patients seen at our affiliated hospital. Within 48 hours after discharge all patients followed by our clinic are contacted by phone by a registered nurse or pharmacist. This call focuses on ensuring appropriate follow up in clinic, medication reconciliation, and addressing any issues since discharge. The primary goal for follow up is with the patient’s primary care provider, when that isn’t possible in an appropriate time frame the patient is scheduled in the transition clinic. The first 30 min of the transition clinic schedule is protected for an interdisciplinary team huddle which focuses on follow up from the prior week and review of the patients that will be seen in clinic each day. The resident or attending will present the medical history followed by group discussion of medical, psychosocial and logistical issues which could contribute to readmission. During the huddle we determine which team members will see the patient and when. The note from the visit is forwarded to the primary care provider for review. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): Through chart review we will measure the transition clinics impact on 30-day readmission rate, ED utilization 30 days post discharge, and the number days until follow-up in primary care when compared to standard follow-up in our clinic. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): Data from the project is currently under review. Preliminary data to date shows a statistically significant reduction in 30-day readmission rate in those patient’s seen in the transition clinic when compared to those with standard follow-up. Complete results will be available at the time of the conference. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): Our project demonstrates that an interprofessional outpatient transition clinic can reduce 30 day hospital readmission. Our transition clinic leverages many already existing resources and focuses them in a collaborative fashion on patients during this high risk transition in care. Through interprofessional teamwork many of the psychosocial and logisitical issues that lead to readmission can be addressed. TO THE HOSPITAL AND BACK: AN INTERPROFESSIONAL TRANSITION OF CARE CLINIC TO REDUCE HOSPITAL READMISSION Ryan Nall. University of Florida, Gainseville, FL. (Control ID #2706341) TRANSFORMING A LARGE URBAN HEALTH SYSTEM TO PROVIDE COMPREHENSIVE TRANSGENDER CARE Jules ChytenBrennan1; Zoe Ginsburg2; Mollie B. Nisen2; Madeleine Lipshie-Williams2; Elliot Goodenough3; Patel V. Viraj1; Robert Beil1. 1Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY; 2Albert Einstein College of Medicine, Bronx, NY; 3Montefiore Medical Center, Bronx, NY. (Control ID #2703567) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Transgender (trans) people are highly marginalized, have pervasively poor health outcomes, and limited access to healthcare. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): We describe efforts to integrate trans healthcare throughout a large integrated health system with primary through quaternary care, with the goals of: 1. Increasing access to comprehensive healthcare for trans people in an urban, underserved area. 2. Increasing competence in caring for trans patients at every level of care. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): In 2014, five Montefiore providers formed the Trans Health Working Group with initial goals of attracting key department champions, and improving care for trans people within existing services. Senior administration expressed support, and provided the services of a learning specialist. The new goal of a comprehensive transgender health program emerged. Program focus areas include: best practices for medical, surgical and mental health care; institutional policies; information systems; development and implementation of educational curricula; and mechanisms for community accountability. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): Process and outcome based metrics are being used in the following areas: −Representation in the Trans Health Working Group -Number of departments and employees trained -Utilization of internal referrals systems -Trans inclusion in institutional policies -Qualitative feedback from trans community members -Number of available trans-specific medical, surgical, and mental health services FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): The Trans Health Working Group now has over 50 members from 14 departments, including residents and medical students. We have created an intensive trans competency curriculum for higher volume sites, and an online course is being implemented for all new employees. We have completed focus groups among current and potential trans patients as a step toward an ongoing community advisory board. Institutional non-discrimination, and bed assignment policies have been modified. Primary and hormonal care are available at one third of clinical sites. Numerous transgender surgeries are available, with more planned. Trans appropriate electronic health records will be piloted in 2017. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): Heathcare for trans people has been historically limited to LGBT specific clinics or individual providers with few health systems taking steps to care for transgender communities. However, with newly expanded access to health insurance, decreasing exclusions for trans care, and growing social support, the movement of trans communities into mainstream health settings will likely continue. Examining the successes and challenges of integrating trans healthcare into our large, urban health system offers a model for other institutions. TRIANGLE INTERPROFESSIONAL PARTNERS FOR PREVENTION (TIPP): STUDENTS COLLABORATING TO IMPROVE CARE FOR SUPERUTILIZER PATIENTS Trudy Li3; Rob Broadhurst3; Meg Zomorodi3; Jamie A. Jarmul2; Anne Jones3; Sara Skavroneck3; Meredith Park4; Amy Weil1. 1UNC Chapel Hill School of Medicine, Chapel Hill NC, NC; 2UNC-Chapel Hill, Durham, NC; 3University of North Carolina at Chapel Hill, Chapel Hill, NC; 4University of North Carolina at Chapel Hill, Greensboro, NC. (Control ID #2704227) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Superutilizers (SUs) of the healthcare system experience frequent hospitalizations and emergency department (ED) use as well as fragmented care, leading to high costs and low quality care. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): 1. Develop sustainable processes to engage IP students in improving quality of care for SUs by identifying and addressing root causes of hospitalizations. 2. Decrease hospitalizations and ED visits for SUs, lowering total hospital charges. 3. Increase IP students’ mutual understanding and respect for each other’s skill set. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): Using an algorithm to identify SUs at our institution (>3 hospitalizations in 12 months), IP teams of students (social work, nursing, public health, and medicine) conducted home visits to identify root causes of hospitalizations and improve care coordination. Student teams of 2 or 3 worked closely with SUs to address risk factors for readmission. Each week, students met with IP faculty to discuss SU needs and progress. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): 1. Pre/post-intervention hospitalization and rates and monthly charges were compared. 2. Pre/post surveys of readiness to work in IP teams were performed. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): Recruitment is ongoing, but preliminary results are available. Of the seven enrolled patients, pre-intervention average monthly inpatient charges ranged from $2,235 to $19,662 monthly. Pre-intervention average monthly outpatient charges ranged from $0 to $6,457. Postintervention, average monthly inpatient cost decreased in five of seven patients. For these patients, average monthly inpatient charges ranged from $0 to $50,267 and outpatient charges ranged from $85 to $5,290. Three of seven patients have not had any additional hospitalizations post-intervention. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): Identifying and connecting with patients 1. Custom-built Electronic Medical Record reports identified patients with high hospitalization and/or ED use. 2. Initially only currently admitted patients were enrolled. However, inclusion criteria were broadened to include patients identified from the outpatient setting. 3. Exclusion criteria were key for facilitating student participation (e.g. exclusion of patients with unsafe home conditions/ongoing psychological issues after communication with PCPs as well as patients who lived too far away from campus) IP Education: Logistical difficulties 1. Scheduling meetings and patient visits was difficult due to differences in curricular schedules among schools. 2. Differences in students’ EMR access denoted an implicit hierarchy as in many cases only medical students had access. Students as significant contributors to care To improve quality and efficiency of care for SUs, many of whose needs are contextual rather than purely medical, students are an untapped resource for academic medical centers. Working with SUs also increases students’ commitment to care for vulnerable populations. URINE TOXICOLOGY SCREENING IN PATIENTS WITH CHRONIC OPIATE USE: AN ATTEMPT TO CURB OPIATE ABUSE IN A PRIMARY CARE PRACTICE Kaitlin E. Crowley1; Amy L. Bilodeau1; Alev Atalay2; Rose M. Kakoza1. 1Brigham and Women’s Hospital, Boston, MA; 2Brigham and Women’s Hospital, Jamaica Plain, MA. (Control ID #2706768) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): With the rapid increase in rates of opioid addiction and opioid-related deaths, it is important for primary care clinics to monitor opioid use utilizing urine toxicology screens and appropriately act on those results to improve the safety of opioid prescribing. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): To analyze urine toxicology results at our large academic primary care practice for discrepancies and assess rates of primary care provider follow up. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): Retrospective chart review at a large outpatient primary care practice within a tertiary academic medical center. Using a new chronic opioid registry, the practice implemented workflows to facilitate routine urine toxicology screening. Patients analyzed were those screened between 7/1/2016 to 10/30/2016. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): Urine toxicology screen results were assessed for discrepancies based on the opioid medications patients were prescribed. Following assessment of these results, further chart review was conducted to determine actions taken by primary care providers based on those results, specifically: documentation of discrepancies and adjustments to medication regimens. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): A total of 62 urine toxicology screens were reviewed for this analysis. Of the 62 screens, 37 (59.7%) were found to be appropriate, 15 (24.1%) were inappropriate, and 10 (16.1%) had results with unclear interpretation. Of the 15 cases determined to be inappropriate, 6 (40.0%) were suspect for patient tampering, 7 (46.7%) were positive for drugs not prescribed to the patient, and 2 (13.3%) yielded negative results when they should have been positive. Documented acknowledgement (“review”) of the urine toxicology screen by the ordering provider in the electronic medical record was noted for 49 (79%) of the screens. However, further documentation or discussion of the results with a note in the medical record chart was found for only 14 (23%) of the screens. Of the 25 potentially discrepant results, 20 (80.0%) were not addressed in the electronic health record and only 1 (4%) had a change to their medication regimen in response to the discrepancy found on urine toxicology screening. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): With the current opioid epidemic primary care practices need to implement effective monitoring systems to proactively screen patients on chronic opioids to ensure safe prescribing. In our experience, despite implementation of an effective screening process, a minority of patients identified with discrepant urine toxicology results had any documented follow up or change to their opioid medication regimen. Potential factors for poor follow up include lack of provider education on interpretation of urine toxicology screens and provider time and skill in addressing discrepant results with patients. Provider education and training in these areas will be an important next step for the practice as we seek to improve our ability to not only screen our patients on chronic opioids but to also adequately treat those for whom a potential problem is identified. USE OF A MACHINE-LEARNING ELECTRONIC EARLY WARNING SCORE SYSTEM REDUCES TIME TO THERAPY IN ACUTE DETERIORATION. Santiago Romero Brufau; Kim Gaines; Jordan Kautz; Matthew G. Johnson; Joel A. Hickman; Curt Storlie; Jill Nagel; Jeanne M. Huddleston. Mayo Clinic, Rochester, MN. (Control ID #2707223) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Delayed detection and intervention to acute deterioration of inpatients is prevalent and increases mortality risk. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): − Reduce time to response after acute deterioration of inpatients (sepsis, shock, acute respiratory insufficiency, etc.). - Reduce time to therapy (antibiotics, other medication, oxygen, fluids, etc.) in instances of acute deterioration of inpatients. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): Setting: two tertiary hospitals in southeastern Minnesota. Intervention: a system that automatically pulls data from the electronic medical record, calculates risk score for acute deterioration, and send an automatic alert to the physician, resident or NPPA on call. After receiving an automatic alert, the recipient is expected to go to the bedside to assess the potentially deteriorating patient. The system rechecks two and three hours after that point, sending additional automatic alerts if the patient’s risk score is still unusually high. At the three-hour mark, the attending physician is also automatically alerted. The risk score was developed using machine learning methods, and a nursing assessment using their pattern recognition. After the initial alert, the system guides a time-limited escalation of expertise to the bedside. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): − Main measures of success are: Reduction in the time to any order (laboratory tests, image tests, medication, etc.), measuring time to physician action or assessment. Reduction in the time to a therapy order (medication, oxygen, fluids). FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): − The intervention reduced the time to any order from 63 min to 41 min (a 40% reduction), and the time to a therapy order from 106 min to 56 min (a 47% reduction). - As counterbalance measures, rates of ICU transfer and mortality were not significantly changed. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): − Automatic alerts using accurate early warning scores can help with detection of instances of acute deterioration of inpatients. - A timelimited escalation of expertise can help with timely intervention and prioritization of acute events in the hospital, and can reduce time to intervention. USING AN OUTPATIENT POST-MORTEM SURVEY TO IDENTIFY QUALITY IMPROVEMENT STRATEGIES Jessica Kaltman; Anne M. Walling; Neil Wenger. UCLA, Los Angeles, CA. (Control ID #2706554) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Significant deficiencies exist in quality of end-of-life care received by cancer patients in symptom management, communication, emotional and spiritual support, advance care planning and coordination of care. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): A post-mortem survey is an emerging strategy to inform end of life quality improvement efforts. We describe the process of developing and implementing a post-mortem survey in the outpatient setting at an academic health system, and the barriers and facilitators of implementation in this setting. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): We developed a 24-item post-mortem survey consisting of 14 items from the National Quality Forum-endorsed Bereaved Family Survey, seven validated items from the After Death Bereaved Family Interview, Family Evaluation of Hospice Care, and the National Health and Aging Trends Study, and three created items to reflect the ambulatory care setting. Eligible decedents were > 18 years of age and spoke English, had > 2 visits to the oncologist in the last 6 months of life, received chemotherapy or radiation therapy in the last 2 years of life, and had chart documentation of metastatic disease. Death was verified in the chart or by obituary found via internet search. Caregivers surveyed were the appointed healthcare surrogate in an advance directive or the first listed contact. The list of eligible decedents was reviewed by the Offices of Risk Management and Patient Relations to identify individuals who may experience harm by receiving a survey. An introduction letter and survey were sent 12 weeks after the decedent’s death to the identified caregiver. Respondents could opt out by telephone or mail. A post-card reminder was sent two weeks after initial mailing if no response received and telephone follow up after four weeks. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): We tracked response rate, percentage of post-card reminders sent and follow-up phone calls required to evaluate mechanisms to improve response rate. Challenges faced during implementation were tracked. We evaluated time required for administrative departments to review decedent list and time required to prepare survey mailings. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): Of 111 eligible decedents, 94 surveys were mailed to caregivers and 30 surveys (32%) were completed. Of the total eligible decedents, 21% had an advance directive. Death could not be verified for 12% of decedents, addresses for 15% of caregivers could not be found and only 5% of caregivers called to find their address returned the call. 4% of caregivers opted out. Of the surveys returned, over 80% of respondents answered all items on the survey and 83% responded to the open-ended item. Responses to the open-ended question addressed caregiver training, quality of hospice care, and communication amongst physicians and between the physician and patient. Follow-up phone calls to non-responders did not improve response rate. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): A post-mortem survey can be implemented in the outpatient setting to assess quality of end of life care, but additional efforts are needed to enhance response rate. VIDEO VISITS IN PRIMARY CARE: A NATIONWIDE PILOT STUDY AT THE VETERANS HEALTH ADMINISTRATION Leonie Heyworth2; Kathryn Corrigan3; Gordon Schectman1. 1Veterans Affairs Central Office, Milwaukee, WI; 2VA San Diego, San Diego, CA; 3VA Central Office, Washington, WA. (Control ID #2710674) STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Does the addition of video visits among Veterans receiving traditional primary care improve clinical outcomes, satisfaction and reduce cost of care? OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): To examine the impact of video visits, in addition to traditional primary care, on outpatient quality measures, healthcare utilization, cost and satisfaction among Veterans at 4 sites. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): The Veterans Health Administration’s (VHA) Patient-Aligned Care Team (PACT), is a team-based approach to delivering patient-centered primary care with the aim of enhanced access and coordinated care management. Core PACT team members include the primary care provider, the registered nurse care manager, the clinical assistant and the clerical assistant. To date, PACT has successfully increased reliance on non-traditional means of accessing care, such as use of secure messaging and teleprimary care into a rural clinic setting. The “Video PACT” offers video encounters through clinical video technology (CVT) and web-based real time communication via mobile platform. Four sites were invite to participate. Each site identified two physicians as Video PACT providers. Veterans are selected for participation in the pilot by their PACT based on several criteria, including willingness to participate, ability to use a computer or tablet, and likelihood to benefit from the pilot (e.g. difficulty accessing care, frequent ER/hospital use, multiple comorbidities). Veterans are trained to use the tablet or computer software for the video visit and issued a tablet if needed. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): The first phase of this pilot assessed Veteran and provider experience of video visits by survey as well as clinical quality metrics, such as blood pressure; utilization of health services; and process measures like diabetes screening and receipt of vaccinations, obtained via chart review. The direct cost of video encounters was compared to face-toface encounters. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): In the first phase of this pilot, 15 video encounters took place across 2 medical centers. Survey response rate was 71%. The mean age of participants was 65. The majority were white males. 71% had a KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): Implementing video encounters presents a novel opportunity to enhance patient-centered care for organizations interested in leveraging technology to expand access in primary care. The findings to date from this pilot study suggest high levels of patient satisfaction for video visits and a lower cost of video visits compared to face-to-face visits.

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Abstracts from the 2017 Society of General Internal Medicine Annual Meeting, Journal of General Internal Medicine, 2017, 83-808, DOI: 10.1007/s11606-017-4028-8