Jeremy

That’s a great takeoff point, and I’ll just reiterate some things that resonated with me from one of the articles you sent about the I-3 program. You emphasized that social engagement was super important, the numbers, and it could be electronic. There were a fair number of webinars integrated into the model. I think this is intriguing to think about, because that lowers the cost in many ways. Expenses can be prohibitive sometimes for in-person meetings. A real sense of shared mission, shared resources, and shared experiences grew out of this experience. You mentioned the exponential impacts, which I think is a powerful way to say your program multiplies impact.

It’s not just additive, it’s multiplicative. You’ve also mentioned that it creates innovation beyond the residency. You draw on that with your reference to the numbers of patients who likely were impacted. Hundreds of thousands of patients were impacted. I think sometimes program directors get overly narrow in thinking about impact. We mention the class of residents we’re trying to graduate this year, not realizing the lifetime impact those graduates will have. If you multiply that exponentially over a 20-, 30-, 40-year career, it’s pretty profound.

Other folks. Do you have feedback or thoughts about the concept around regional learning collaboratives for spreading innovation?

Bill G

I had the privilege of participating in two programs, one at Northern Ohio University and then the UC Davis Network with which Jeremy is familiar. I also did some consulting for WWAMI, so I have had hands-on experience with regional collaboratives. There used to be grant money to fund the collaboratives. I remember at both Davis and in Northeast Ohio, we had quite a bit of HRSA money to support getting together at what is now called Northeastern Ohio College of Medicine. We actually had three different tracks, and we could run it over a three-year period. This was very impressive, but resource-intensive.

Warren

We learned how to do it much more cheaply as we went on. This is one of those areas where the clinical and grounding in the clinical outcomes, we were able to, and we didn’t go with HRSA for any of this. It was our local large foundations who had a quality agenda. After the first finding that there was a 47% reduction in hospitalization for a sizable percentage of CHF, there was a willingness to pay for the next extension. I don’t think you have that kind of enthusiasm around an educational agenda. That wasn’t intentional on our part, but it is one of the things that there’s a lot of money out there, particularly nowadays. It was just a matter of talking with possible funders—saying, all right, what might interest you?  It’s a little bit of contrast with some of the work that Colorado has done with PCMH and residencies. A two to three-year segment was probably the right length of time. It gave people enough time to say I’m in, but it wasn’t such a long period of time that they got tired of it, or there’s still a lot of change going on. It impressed me by the end that there were a number of our people who had not just one, but two EHR changeovers in the period of time. That’s the comment I’d have about the money.