Missing the mark: inaccuracy of administrative data in identification of hospitalized patients with pneumonia and results of a systematic clinical reclassification process on readmission rates

I am a hospital medicine physician interested in quality improvement, patient safety, and medical education across the UME, GME, and CME environments. My current QI and research projects include work on readmissions, inpatient ORYX and patient experience measures, clinical documentation improvement, medication reconciliation, and appropriate utilization of inpatient resources. Alongside this work, I serve as the lead mentor for our Durham VA Chief Resident in Quality and Safety within the Department of Medicine and the Program Director for the Duke University Hospital CRQS.

As Associate Program Director for Quality Improvement and Patient Safety in the Duke Internal Medicine Residency Program, I oversee QI and safety education and projects for our residents and help co-lead our Residency Patient Safety and Quality Council. Additionally, I supervise housestaff and students on our general medicine wards, precept housestaff evidence-based medicine resident reports, and serve as a small group leader for our second-year medical student Clinical Skills Course. Finally, I lead our Innovation Sciences committee as part of the ongoing School of Medicine Curriculum Innovation Initiative.

I am trying to focus my research efforts in two specific areas, the medical intensive care unit, and clinical lung cancer research. Within the intensive care unit I am specifically interested in clinical trials and outcome evaluation. My interest in lung cancer centers on the clinical and cost effectiveness of various diagnostic procedures.

In the intensive care unit I am specifically involved in clinical trials for the adult respiratory distress syndrome (ARDS). At the present time I am on the steering committee for the NIH ARDS clinical trial network. We are currently enrolling patients in clinical protocols studying the effects of ventilator strategies, as well as novel therapeutic agents in the outcome of ARDS. I am also interested in ICU outcome research including statistical modeling of ICU outcomes.

My interest in lung cancer research centers on evaluating the efficacy of diagnostic tests in the diagnosis of pulmonary malignancy. I have retrospectively and prospectively evaluated bronchoscopic procedures, comparing the sensitivity and specificity of various techniques as well as their cost-effectiveness. I am also currently analyzing the clinical utility and cost-effectiveness of positron emission tomography in the diagnosis of lung cancer.

Key words: clinical trials, medical intensive care, lung cancer diagnostic testing

Patient safety and quality improvement, hospital based performance improvement, care transitions and hospital readmissions, general internal medicine hospital care, resident and medical student education.