tag:blogger.com,1999:blog-830495600033955541.post2758334408285448238..comments2024-02-07T21:47:19.639-08:00Comments on Adjacent Possible Medicine: 5 Rules for Medical Students to "Tweak" the systemAaronhttp://www.blogger.com/profile/06754718274193630654noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-830495600033955541.post-38459891472632190252010-11-09T17:48:14.228-08:002010-11-09T17:48:14.228-08:00So, if you happened to be sold on Family Medicine,...So, if you happened to be sold on Family Medicine, and you were me, how strongly would you look at the Dartmouth program?<br /><br />Can I get my hands on one of your control charts?<br /><br />Have you seen fitbit?<br /><br />Thanks for the comments!Aaronhttps://www.blogger.com/profile/06754718274193630654noreply@blogger.comtag:blogger.com,1999:blog-830495600033955541.post-25006983653822453332010-11-07T14:02:06.753-08:002010-11-07T14:02:06.753-08:00Nice post -- I have a frame with those 5 rules han...Nice post -- I have a frame with those 5 rules hanging on the wall next to my desk as a reminder. Working on consistently accomplishing #3, glad to see you're on #4-5. <br /><br />I think the notion of tweaking is key -- it's actionable, without being too esoteric and/or overwhelming. I think using data/outcomes can be a jumping off point to begin to find places to tweak, the key being experimenting with what works at your given practice location (FP, outpatient specialty clinic, etc) rather than just theorizing. Unfortunately, collecting data requires work/time/money, but hopefully the ease of doing so will be improved with EMR and some of the PHRs that you've shown. <br /><br />Control charts are an intriguing way that this can be accomplished by detecting special cause (new variable present in the system) and/or common cause variation (general variation), and then using the data as feedback to see if changes are beneficial (does common cause variation improve resulting in some special cause variation). This could be used by diabetic patients in following glucose levels, small practices for amount of time spent with patients/other "harder" outcomes, etc etc. I haven't used any of this out in rotations, but I learned a lot about it and used some of it doing my MPH. Dartmouth medical school/ Dartmouth-Hitchcock Medical Center implements a lot of this. Don Berwick (formerly of institute of healthcare improvement (IHI), now CMS Director) used a lot of these principles in conjunction with Paul Batalden (DMS/DHMC) for his work at IHI.Chrishttps://www.blogger.com/profile/08325890695329148180noreply@blogger.com