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The Hospital Medicine Reengineering Network (HOMERuN): A Learning Organization Focused on Improving Hospital Care

Auerbach, Andrew D. MD, MPH; Patel, Mitesh S. MD, MBA; Metlay, Joshua P. MD, PhD; Schnipper, Jeffrey L. MD, MPH; Williams, Mark V. MD; Robinson, Edmondo J. MD, MBA; Kripalani, Sunil MD, MSc; Lindenauer, Peter K. MD, MSc

Academic Medicine:
doi: 10.1097/ACM.0000000000000139
Articles
Abstract

Converting the health care delivery system into a learning organization is a key strategy for improving health outcomes. Although the collaborative learning organization approach has been successful in neonatal intensive care units and disease-specific collaboratives, there are few examples in general medicine and none in adult medicine that have leveraged the role of hospitalists nationally across multiple institutions to implement improvements. The authors describe the rationale for and early work of the Hospital Medicine Reengineering Network (HOMERuN), a collaborative of hospitals, hospitalists, and multidisciplinary care teams founded in 2011 that seeks to measure, benchmark, and improve the efficiency, quality, and outcomes of care in the hospital and afterwards. Robust and timely evaluation, with learning and refinement of approaches across institutions, should accelerate improvement efforts. The authors review HOMERuN’s collaborative model, which focuses on a community-based participatory approach modified to include hospital-based staff as well as the larger community. HOMERuN’s initial project is described, focusing on care transition measurement using perspectives from the patient, caregiver, and providers. Next steps and sustainability of the organization are discussed, including benchmarking, collaboration, and effective dissemination of best practices to stakeholders.

Author Information

Dr. Auerbach is professor of medicine, University of California, San Francisco Division of Hospital Medicine, San Francisco, California.

Dr. Patel is resident physician, Perelman School of Medicine, University of Pennsylvania, Section of Hospital Medicine, Philadelphia, Pennsylvania.

Dr. Metlay is professor of medicine, Perelman School of Medicine, University of Pennsylvania, Section of Hospital Medicine, Philadelphia, Pennsylvania.

Dr. Schnipper is associate professor of medicine, Division of General Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts.

Dr. Williams is professor of medicine, Northwestern University Feinberg School of Medicine, Division of Hospital Medicine, Chicago, Illinois.

Dr. Robinson is physician in chief and associate chief medical officer, Christiana Care Health System, Wilmington, Delaware.

Dr. Kripalani is associate professor, Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, Tennessee.

Dr. Lindenauer is associate professor of medicine, Tufts University School of Medicine, Boston, Massachusetts, and director, Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts.

Funding/Support: Dr. Auerbach was supported by a K24 grant from the National Heart, Lung, and Blood Institute (K24HL098372) during the development of this manuscript. Dr. Metlay was supported by K24AI073957 during the development of this manuscript. The HOMERuN network received funding from the Association of American Medical Colleges.

Other disclosures: Dr. Auerbach reports receiving honoraria for work with the American Board of Internal Medicine, as well as honoraria from the Society of Hospital Medicine for his position as editor-in-chief, Journal of Hospital Medicine. Dr. Schnipper reports being a consultant to QuantiaMD for the creation of educational material regarding medication safety, grant funding from Sanofi aventis for an investigator-initiated study of transitional interventions in patients with diabetes, and honoraria from the Society of Hospital Medicine for the Glycemic Control Mentored Implementation project. Dr. Williams reports honoraria for multiple presentations on care transitions at grand rounds and conferences. Royalties from Elsevier for Comprehensive Hospital Medicine. Grant funding from the Society of Hospital Medicine to Northwestern University Feinberg School of Medicine for Project BOOST (Better Outcomes by Optimizing Safe Transitions) and honoraria from the Society of Hospital Medicine for BOOST. Dr. Kripalani reports honoraria from the American Board of Internal Medicine for question-writing work, consultancy, and equity in PictureRx, LLC, a company that makes patient education tools for medication management, and consultancy with Pfizer, Inc. as a content expert for their health literacy Web site.

Ethical approval: This program was approved by institutional review boards at all participating sites.

Correspondence should be addressed to Dr. Auerbach, Division of Hospital Medicine, UCSF Box 0131, 505 Parnassus Ave., San Francisco, CA 94143-0131; telephone: (415) 502-1412; fax: (415) 514-2094; e-mail: ada@medicine.ucsf.edu.

© 2014 by the Association of American Medical Colleges