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Knowledge Map

D-H Knowledge Map’s mission is to create and sustain a care environment where teams can easily access and apply the best available evidence with every patient every time. Our vision is care delivery founded upon the best available evidence and informed patient preference.

Clinical guidelines

Knowledge Map (KM) creates clinical practice guidelines in order to reduce unwarranted variation in clinical practices. A decrease in variation leads to improvements in safety metrics, costs, and quality.  Our evidence-based products inform care models, standardize care delivery processes and provide at-the-elbow support to clinicians.  We build systems that make it inescapably easy for care teams to provide the right care at the right time.

Knowledge Map guideline process

Knowledge Map guideline process

Knowledge Map Guideline team

Knowledge Map Guideline Team: Charles Brackett, MD, MPH; Brooke Herndon, MD, MS; and Cindy Reuter, ND, LAc, MPH

The guideline team recently completed the first stage of a multifaceted project engaging various stakeholders to develop a breast cancer risk assessment and screening guideline. In order to enhance participation of our collaborating clinical experts, the KM guideline team used elements of appreciative inquiry (AI) to inform and guide this project. AI provides a framework to guide group conversations about system change from a place of what’s right as opposed to solely what's wrong.

In a 5-part process (Define, Discover, Dream, Design, Deliver), the AI method draws participants into a collaborative process to create system change. Using AI techniques, we worked with our experts to bridge many controversies and craft a guideline with the goal of improving breast cancer screening activities at D-H.

eConsults

eConsults stats

eConsults are an effective clinical tool that utilizes the electronic medical record to facilitate high-quality patient care coordination and communication between primary care providers and specialists for low-complexity cases. They enhance the patient experience through timely access to specialty expertise while avoiding unnecessary specialist referrals. Dartmouth-Hitchcock was part of the first CORE (Coordinating Optimal Referral Experiences) team to participate in a CMMI (Centers for Medicare & Medicaid Innovation) grant† to roll out eConsults.

Fantastic…quick answers to anything {my PCP} was considering doing."

Patient quote

The D-H eConsult team is a national leader in this arena with 39 participating specialties, a highly efficient build process, and robust quality assurance to ensure effectiveness.  The team has acted as subject matter experts for the CORE 3 group in 2017 and was asked to represent D-H at this year’s AAMC Integrating Quality conference. They presented the poster, "Ambulatory Pharmacy eConsults: The Right Prescription in our Evolving Health Care Environment." The clinical lead also presented lessons learned from eConsults during the session "Bridging the Divide - Enhanced Communication and Coordination between Primary Care and Specialty Care."

The picture below is from the conference session showing representatives from CORE, CORE 2, and CORE 3 groups with a graphic display of how far the eConsult model has spread.

CORE reps

FROM LEFT TO RIGHT: Megan Colgan (D-H), Michelle L’Heureux, MD (Previously D-H), Anne Fuhlbrigge, MD (Colorado), Meaghan Quinn, MHSA (AAMC), Lisa Chew, MD (Washington), and Scott Shipman, MD (AAMC).

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