Quality Improvement / Health Services Research Project

Overview
Each fellow will conduct a small 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, Dr. Johanna Folk or Dr. Rachel Loewy. Both project supervisors have extensive 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 mornings (Monday morning for CAP fellow) or 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 supervisors are available for as needed 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. The IRB 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. For projects involving DPH data, data request and data use agreement forms must be completed and an additional IRB application is required in order for fellows using SFDPH data to present their projects at the APA meeting, or for fellows who wish to publish study findings.

Once we have fully developed your project idea, we will either complete an IRB application or determine ourselves that the project does not constitute human subjects research, as well as complete any other necessary forms.

For fellows not using SFDPH data or settings: Of note, while the APA does not consider quality improvement efforts to be research and therefore does not require IRB approval on their posters, UCSF does require this. 

Ask Andy: https://irb.ucsf.edu/quality-improvement-qi-and-quality-assurance-qa
Research vs QA/QI: https://irb.ucsf.edu/quality-improvement-qi-and-quality-assurance-qa

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. The assistant will provide templates of abstracts, posters, and executive summaries; as well as, examples from prior projects, and assist with editing your work. In addition, you will gain experience in supervising someone through this project.

• Fellows, project supervisor and project assistant will meet regularly as a group on Wednesday mornings. 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 (with on-site approval as per COVID-19-related work guidelines).
• 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. We will also encourage clinical impact of your project by actively involving clinical site directors in both your project development and the dissemination process.

• 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 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.
• ZSFG Psychiatry Grand Rounds – TBD in May or June
• 1-page written Executive Summary of project (not scientific), 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). Since work towards publication of your results will likely continue after the end of the fellowship, faculty will be available to support you; but the project assistant will not be available to you in the same capacity as they will have begun working with a new cohort of fellows.
• Regarding authorship, in most cases the fellow will be the first author, Dr. Loewy, Fortuna or Mangurian will be the senior author and the RA will be the middle author. 

Stakeholder Participation
We believe it is beneficial and important to include the end-users of services in the QI process. We are developing a plan for consumer/family input at various stages of the projects (development, implementation and results), which may vary by clinic site.

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

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 IRB 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.