Implementation of a Quality Metrics Competition to Improve Panel Management Among Internal Medicine Residents

Abstract

Background Panel management is essential for residents to learn, yet challenging to teach. To our knowledge, prior literature has not described curricula utilizing a financially incentivized competition to improve resident primary care metrics. Objective We developed a panel management curriculum, including a financially incentivized quality competition, to improve resident performance on quality metrics. Methods We developed a cancer screening and diabetes metric quality competition for internal medicine residents at Vanderbilt University Medical Center for their primary care clinics for the 2020-2021 (pilot) and 2021-2022 academic years. Residents received several educational tools, including a 1-hour introduction to the health maintenance dashboard within the electronic medical record (EMR) and instructions on how to access the quality dashboard outside the EMR, and were encouraged to discuss panel management with preceptors. Chief residents distributed measures to trainees 3 times annually, so residents were aware of their competition ranking. Residents’ composite metrics at year end were compared to baseline to determine top performers. The top 15 performers received $100 gift cards as incentives. We also assessed the curriculum’s impact on the residents’ metrics in aggregate. Results At curriculum completion, residents (n=100) demonstrated an average improvement of 1.9% from baseline composite metrics for the percent of patients receiving screening. In aggregate, residents improved in every measure except HbA1c testing. Breast cancer screening had the largest improvement from 69.5% (1518 of 2183) to 75.6% (1646 of 2178) of all patients receiving recommended screening. Conclusions The curriculum resulted in more patients receiving recommended cancer and diabetes screenings.