Explore Quality & Safety

Housestaff Incentive Program

2009-10

The Housestaff Incentive Program (HIP) is an innovative partnership between UCSF Medical Center and the Department of Graduate Medical Education, whereby residents and fellows receive financial incentives tied to achievement of medical center quality goals. Beginning in the 2009-10 academic year, each department set one quality goal (in addition to 3 common goals across all residency programs). The Internal Medicine Residency Program focused our initial quality goal on improving inpatient resident teams' communication with primary care physicians, and developed a multifaceted quality improvement program (PDF) to target this goal. We developed this program recognizing the importance of communication between inpatient and outpatient providers in ensuring safe care transitions, and recognizing this communication as a key component of the core competencies of systems-based practice, professionalism, and communication. We created a multifaceted quality improvement program that used education about the importance of care transitions, audit and feedback, and public reporting of data in addition to the financial incentive to promote the importance of PCP communication. At the beginning of the project in July 2009, communication with PCP's was documented in only 55% of discharges from the medical service. We increased this proportion to the target rate of 80% within six weeks; this rate was sustained for the rest of the academic year, and exceeded 90% for the final three months of the year. All residents received a $300 financial incentive as a result of achieving this quality goal. We also conducted surveys of referring physicians before and after the program was implemented; these surveys found a significant improvement in referring PCP's satisfaction with the communication they received when their patients were hospitalized.

2010-11

Kara Bischoff, MD presents the 2010-2011 residency program's quality improvement poster (PDF)

For 2010-2011, the residency program has continued to build on the success of the PCP communication project by targeting communication with primary physicians at the time of hospital discharge. The quality goal for this academic year is to complete 75% of discharge summaries on the day of discharge. We developed this goal in conjunction with the Division of Hospital Medicine's effort to implement an electronic discharge summary (PDF), which was launched in the fall of 2010. By completing discharge summaries on the day of discharge, communication between inpatient and outpatient physicians should become more timely and accurate, ensuring patient safety after hospital discharge. This project has also been successful, with the target rate of completion of discharge summaries being reached within the first month of the project. The program has also resulted in a significant improvement in the quality of discharge summaries, as documentation of medication reconciliation and tests pending at discharge has also improved markedly since implementation of the electronic discharge summary.

See the links below for additional information:

For additional information or questions please contact:

Sumant Ranji, MD
Associate Professor of Clinical Medicine
Associate Program Director for Residency Program
(415) 514-9256
sumantr@medicine.ucsf.edu