Quality Improvement / Program Evaluation Research Project
UCSF Public Psychiatry Fellowship at ZSFG

Overview

Each fellow will conduct a Capstone Project over the course of the year. This project aims to improve the quality of care received by people served in your clinic. The topic should be of interest to both the fellow and the clinic site medical director: a true public-academic partnership. This project needs to be feasible given the available resources (fellow’s time, research assistant time and other resources). We will help you do this :). Your project could be developed in any of the following ways:

• Projects could be selected from areas of active interest to the health care system or specific clinics.
• Projects could arise out of a better understanding of the clinics’ needs (logic and congruence models).
• Projects could build upon work from prior fellows.
• Projects could arise out of shared interest with your site supervisor.

Supervision

Each fellow will receive weekly supervision with the project supervisor. This project supervisor has expertise in mental health services research, as do both of the program directors. As such, in doing your capstone project, you will gain skills in developing partnerships with scientists and understand how they might approach understanding and addressing a systems-level issue. We will use most Wednesday afternoons for project supervision time with a mix of individual and group supervision. You will also receive co-mentorship from PPF faculty during group supervision time. The capstone project supervisor is available for PRN consultation throughout the year. Please take advantage of this resource.  

Protection of Human Subjects

The line between research and quality improvement is something we will be discussing at length. When you conduct a typical research study, you need to obtain IRB (Institutional Review Board) approval. Here at UCSF, the IRB is called the Committee on Human Research (CHR). The CHR has a Quality Improvement Unit (QIU). The purpose of the QIU is to provide information to faculty and staff on regulatory compliance and Good Clinical Practice (GCP) Guidelines related to human research participants, data collection and data management; to verify that safeguards protecting the rights and welfare of human research participants are met; to verify investigator adherence to the study design as approved by the CHR protocol, and applicable regulatory requirements; and rarely, to investigate complaints and/or allegations of noncompliance with research regulations.  

Once we have fully developed your project idea, we will either complete a CHR application or discuss the project with QIU and receive written clarification that your project is QI and CHR approval is not necessary. 

Of note, the APA does not consider quality improvement efforts to be research and therefore does not require IRB approval on their posters.

Capstone Project Assistant

One of the unique aspects of the UCSF Public Psychiatry Fellowship at ZSFG is the access to a project assistant for six hours a week. This person will help you with all aspects of your study from study design to data collection to preparation of your poster. In addition, you will have the opportunity to learn how to supervise someone through this experience.

• Fellows, project supervisor and project assistant will meet regularly as a group on Wednesday afternoons. We will work together to make a schedule of individual and group meetings.  
• The assistant is allowed to work at the clinics or at ZSFG as needed.
• The assistant will be one of the co-authors on the poster presentation. 

Project Products

We believe that it is important for your work to be disseminated. This is important both for the information to help guide best practices for patient care, and also to further your career development.  The following are the specific deliverable products you will create by the end of the year.

• American Psychiatric Association abstract submission (www.psych.org submissions open in September) + poster presentation if abstract accepted (examples on CLE)
• Oral presentations 
• Staff at clinic placement – to be scheduled by you in May or June
• SFHN-BH medical directors meeting, TBD in late May or June 
• Audience: This is a very friendly audience. You present at a meeting that is normally attended by about 15-20 medical directors from various SFHN clinics. They are often enthusiastic to learn about our fellows’ results.  
• 1-page written Executive Summary of project, suitable for distribution to clinic staff and SFHN-BH medical directors (examples on CLE)
• Publication (optional)
• If you would like, PPF faculty are willing to help you publish your results, likely as a Letter to the Editor or Frontline Reports in Psychiatric Services. These pieces do not exceed 500/750 words and may have a maximum of three authors and five references (no references for column). 
• Regarding authorship, in most cases the fellow will be the first author, Dr. Loewy or Mangurian will be the senior author and the RA will be the middle author. 

Resources

The CLE website had several documents to help you with your project, including but not limited to: 1) a menu of project ideas; 2) prior CHR proposals; 3) prior drafts of PPF publications, 4) prior APA posters; 5) computer issues (MyAccess/MyResearch/VPN, PubMed, HIPPA, REDCap); and 6) guide to working with assistants.

Time Line

The following timeline indicates the general expected timeframe as well as deadlines/deliverables for the project: