Each approved NC MOC Project is integrated into the work physicians do every day in their office or in their clinical practice in an effort to improve the process of care and produce better patient outcomes.

If you are interested in enrolling and participating in one of the approved projects, please complete the NC MOC Enrollment Form.

Click here for the Mountain Area Health Education Center (MAHEC) projects. MAHEC is a Participating Organization which means they help their affiliated physicians earn MOC practice improvement credit for participating in initiatives approved by the NC MOC Advisory Board and the American Board of Medical Specialties.

 

Approved QI ProjectDescriptionPhysician Lead and Project Manager
Preventing Patient HarmPreventing Patient Harm is a program aimed at reducing hospital-acquired infections and patient safety indicators. Although much work has been done to prevent patient harm over the past decade, this work is gathering even more momentum, with tremendous efforts underway across the entire medical center.Tom Ivester and
Megan Miller,
Preventing Patient Harm Project Manager
Opioid StewardshipThe aim is to develop a system to standardize the education of prescribers and patients regarding the implications of unused medications and facilitate appropriate drug disposal. We hope to produce Standard Opiate Prescribing Schedules (SOPS) to guide responsible prescribing by our providers and minimizing unused pills in homes, while not limiting patients’ access to the medication when it is needed. Brooke Chidgey, Peggy McNaull and
Nathan Woody,
Patient Safety Quality Improvement (PSQI) Program Manager
Enhanced Recovery After Surgery (ERAS) - Adult and PediatricsThe Enhanced Recovery After Surgery (ERAS) pathways’ goal is to maintain physiologic function and to facilitate early post-operative recovery. The pathway serves to ultimately improve the quality of care delivered, improve patient experiences and accelerate recovery (via improvement in the use of pain medication, decreased costs, decreased length of stay and decreased readmissions).For a full list of physician leads for each ERAS project, click on the Enhanced Recovery After Surgery (ERAS) link in the first column of this table.
Lyla Hance,
Patient Safety Quality Improvement (PSQI) Program Manager
Improving Transitions of Care and Preventing ReadmissionsReducing readmissions is an ongoing organizational goal and strategic priority for UNC Medical Center.

Key elements of readmission prevention are: risk stratification & patient identification; comprehensive assessment by care manager; medication management; self-care training; timely, accurate discharge summary; post-hospitalization phone call; structured, patient-coordinated appointment with follow-up provider within 7 days; and ongoing care management.

The project’s goal is for the transitional care model to be standard practice for all high and moderate risk adult medicine and surgery inpatients admitted to UNC Hospitals.
David Hemsey and
Ayana Simon,
Quality and Organizational Excellence Leader, UNC HCS
Clean In, Clean Out: Hand Hygiene at UNCHospital Acquired Infections remain a priority of prevention in healthcare delivery especially in higher risk times of care such as during admission to an inpatient unit. Appropriate hand hygiene practices have been shown to decrease healthcare acquired infections and mortality as well as shorten length of stay in inpatient settings and decrease healthcare costs.

The program’s goal is that the UNC Hospitals inpatient care areas will have achieved a specific mean regarding hand hygiene compliance as detected on audits completed at the individual unit level.
Emily Sickbert-Bennett,
PhD, MS, CIC| Director
Hospital Epidemiology and Occupational Health Services
UNC Hospitals
Primary Care Improvement Collaborative (PCIC)UNC Health Care provides comprehensive primary care to a large population of North Carolinians through a variety of locations, both academic and community-based.

Primary care practice representatives from across the UNC Health Care System have joined together as a
Primary Care Improvement Collaborative (PCIC) to facilitate shared learning and accountability.

Our goal is to improve the health and outcomes of the patients we treat. The collaborative will target measures that balance the needs of our providers, priorities of the organization, and the impact to our patients.
Lynne Fiscus and
Crystal Hoffman,
MHA
HealthCare System Program Manager, Improvement Collaboratives
Practice Quality, Innovation and Population Health Services
Improving the Implementation of Lung Cancer Screening GuidelinesThis project aims to improve the delivery of appropriate lung cancer screening by: increasing collection of accurate, detailed smoking histories; increasing use of clinical reminders for lung cancer screening; conducting and documenting Shared Decision Making (SDM) for lung cancer screening; and increasing the use of Lung-RADS classification in CT screening scan reports.Daniel Reuland and
Laura Cubillos Starrett, MPH,
Research Associate/Project Manager, Lineberger Comprehensive Cancer Center, University of North Carolina
Code SepsisPrompt recognition and treatment of sepsis have been identified as a means of improving sepsis survivorship. Many of the interventions aimed at early recognition of sepsis also increase the likelihood of earlier recognition of complications included in the definition of Failure to Rescue. The main indicators of survival from sepsis are timely administration of initial antibiotics and fluids, making recognition a key component of treating patients with sepsis. Code Sepsis aims to implement a standardized pathway for adult and pediatric sepsis patients including recognition, activation, and treatment in UNC Hospitals. Karen Gupton,
Quality Organizational Excellence Leader,
UNC Hospitals
Integrating Palliative and Oncology CareCancer patients who receive palliative care have better advanced care planning, reduced ICU admissions, and earlier Hospice referral providing a better quality of life for the patient and reduced cost savings for everyone.

This project will review the census on a daily basis to identify patients with metastatic cancer who could benefit from a Palliative Care consultation. In addition, the project will provide monthly feedback of palliative care metrics and provide training in Palliative Care skills to the Hematology/Oncology fellows, residents, and NP/PA staff.
Laura C. Hanson,
MD, MPH
Professor, Geriatric Medicine
Director, UNC Palliative Care Program
Antibiotic Stewardship in the Pediatric ED: Standardizing UTI Testing and TreatmentUrinary Tract Infections (UTIs) is one of the most common pediatric infections and effective management requires appropriate diagnostic methods and treatment. Antibiotic resistance is an increasing threat in healthcare, which is principally driven by the misuse of antibiotics. Therefore, it is critical to follow clinical practice guidelines and provide the most appropriate antibiotics, only to patients who truly have a bacterial infection. The Pediatric Antimicrobial Stewardship Program at UNC is tasked with implementing programs that enhance the appropriate use of antibiotics in both inpatient and outpatient areas. Zach Willis and
Elizabeth Walters,
Doctor of Nursing Practice Student, School of Nursing, UNC-Chapel Hill
Cystic Fibrosis Transition: Graduating from Pediatric to Adult CareWith >50% of US CF patients currently 18 or older, CF can no longer be considered a pediatric disease. Yet compared to age-matched peers, young adults who grow up with a chronic health condition achieve milestones later in life or not at all. This may be an unintended consequence of the family-focused care provided in pediatrics that can limit education, independence, and attainment of self-management skills.
Our aim is to improve the CF transition process by creating a streamlined approach to transition for patients beginning early in adolescence and extending to the handoff to adult clinic (age >=18).
Jen Goralski,
MD, Assistant Professor, Pulmonary/Critical Care Medicine/Pediatric Pulmonology
Clinical Pathway for the Outpatient Education of Pediatric Patients with Newly Diagnosed Type 1 Diabetes MellitusType 1 Diabetes Mellitus (T1DM) is one of the most common chronic illnesses in childhood. At the time of diagnosis, a significant amount of education is needed to equip children and their parents with the knowledge and skills necessary for managing diabetes. Historically pediatric patients with newly diagnosed T1DM have been hospitalized to receive this education, and prior to discharge, the family was required to demonstrate the ability to check blood sugars, give insulin, and know what to do in the case of hypoglycemia or hyperglycemia.

Our goal is to develop, implement, and refine an effective and safe outpatient diabetes management pathway
Elizabeth Sandberg,
MD, Fellow,
Division of Pediatric Endocrinology, School of Medicine at UNC-Chapel Hill

Reducing Exposure Vancomycin-Related Nephrotoxicity
Some cases of nephrotoxicity are likely preventable. Recent evidence has demonstrated that the combination of vancomycin and piperacillin-tazobactam confers an increased risk of nephrotoxicity compared to vancomycin plus a different beta-lactam antibiotic. We identified patient populations in whom vancomycin target troughs could be safely lowered, which we predicted would result in a decreased incidence of supratherapeutic troughs and nephrotoxicity.

We aim to decrease the incidence of vancomycin-related nephrotoxicity in our children’s hospital by 50% by the completion of our project.
Zach Willis, MD

Post-Partum Depression Screening
10-25% of new mothers have post-partum depression. It is a common medical condition that can significantly affect the health and well-being of mothers, infants and family units. Post-partum depression is the most common underdiagnosed obstetric complication. Pediatricians have the greatest opportunity of encountering infants and caregivers.

Our aim is to implement a post-partum depression screening program, track the number of post-partum depression screenings (at 1, 2, 4, and 6 months well-child visits) in our new mother population, and increase the number of appropriate referrals, while increasing our post-partum depression screening rate from 0% to 75% over a 6-month period.
Sarah Ryan, MD
Faculty Education and Supervision of Medical Student Quality Improvement ActivitiesThe CBLC faculty will be engaged in their own Quality Improvement development as they train and supervise medical students through the implementation of various Quality Improvement projects.

The aim is to improve the individual Quality Improvement competence and skill level of the Community-Based Longitudinal Care course faculty.
Amy Shaheen, MD

Improving Provider Adherence to Turner Syndrome Care
Guidelines
Turner Syndrome is a complex medical condition which requires medical providers to evaluate numerous comorbidities. It can be difficult for both the providers and the patients to keep up to date on the recommended screenings. This project aims to increase the percentage of patients who are up to date on the recommended screening evaluations.Jennifer Law, MD, MSCR

Neurodevelopmental Disabilities and the Transition from Pediatric to Adult Health Care
The transition from pediatric to adult healthcare systems is a complex process requiring cooperation from primary care physicians, pediatric and adult specialists, families, and patients alike. Transitioning can be difficult for youth with any kind of special healthcare need: this seems to be even more complicated for youth with neurodevelopmental disabilities. This project aims to increase the percentage of adolescent patients (ages 12 to 26 years) who receive transition related services (transition planning, resources, etc.) at the Carolina Institute for Developmental Disabilities (CIDD).Diana Cejas, MD, MPH

LGBTQuality Improvement: Strengthening Care in Outpatient Pediatrics
LGBTQ young people have higher rates of obesity, depression and suicidal ideation, substance abuse, eating disorders, unsafe sex, and HIV.

The pediatrician can be a key figure in promoting a lifetime of health to LGBTQ youth; yet, many key interventions to enhance this unique ability have yet to be implemented in pediatric practice. Leading medical organizations recommend that pediatric practices provide visual and verbal cues of being friendly to LGBTQ populations, confidentially document sexual orientation and gender identity (SO/GI) data, appropriately screen for psychosocial and medical illness in LGBTQ populations, and refer to appropriate resources.

Our aim is to improve patient satisfaction, increase staff knowledge about LGBTQ related issues, increase LGBTQ electronic health record documentation and increase the number of screenings completed in the greater than 13 years old pediatric patient population.
Emily Vander Schaaf, MD

Implementation of Antibiotic Time Outs at Hillsborough Hospital
When patients are admitted to the hospital with a suspected acute infection, they often receive broad-spectrum antibiotics. Often, the initial empiric regimen is not revisited in light of new data, such as diagnostic test results and evolution of the patient’s clinical condition. Patients may then be needlessly exposed to an antibiotic regimen that is more toxic, broader in spectrum, and/or more expensive than a targeted regimen.

This project aims to increase Antibiotic Time Outs to 80% across all Hillsborough Medical Services and across 2 General Medicine/1 ICU Medical Center Teams.
Zach Willis, MD, MPH

Malnutrition in Hospitalized Family Medicine Patients
North Carolina is third in the nation for senior hunger yet participation in community nutrition resources throughout the counties are underutilized according to the NC Division of Aging and Adult Services. The prevalence of malnutrition at UNC Hospital is between 15% and 25% for all patients and for patients >65 years of age respectively. Hunger and chronic disease are the context of malnutrition, which is an independent predictor of adverse patient outcomes including severity of illness, length of hospital stay, preventable readmissions and hospitalization costs.
This project aims to implement community based quality improvement interventions around malnutrition and food insecurity in the hospital at discharge that will carry through to the patient’s community and to the patient’s primary care provider.
Amir Barzin, DO, MS

Reducing Fall-Related Fractures in Older Adults-Ambulatory and Primary Care
Fragility fractures result from the confluence of osteoporosis (low bone mineral density) and falling. In the United States, nearly 50% of white women and 20% of white men and black women will suffer a fragility related fracture in his or her lifetime. The annual cost of treating fragility fractures in the United States is estimated to exceed $25 billion by 2025. This project aims to reduce the rate of fall-related fractures in Geriatrics Specialty Clinic (GSC) patients by closing gaps in the management of osteoporosis, and by reducing fall risk via panel management and the development of a Geriatric Bone Health Clinic within the GSC.Meredith Gilliam, MD, MPH

Antipsychotic Monitoring Program Improvement - Treatment of the Metabolic Side Effects of Second-Generation
Antipsychotics (SGA).
The project’s goal is to design, test, and implement best practices to monitor for and address metabolic side effects for patients receiving SGAs from providers in the UNC Department of Psychiatry. The UNC inpatient psychiatry units and the outpatient psychiatry clinics are settings in which a large percentage of patients are initiated or maintained on SGAs. Our primary outcome will be the percentage of patients on SGAs that receive metabolic side effect monitoring consistent with guidelines. Takahiro Soda, MD, PhD