Matthew Garber, MD, FAAP
Paul D. Hain, MD, FAAP
Brian K. Alverson, MD, FAAP
Erin R. Stucky Fisher, MD, FAAP
Daniel A. Rauch, MD, FAAP, Special Consultant/Committee on Hospital Care
Elena Aragona, MD, Liaison, Section on Medical Students, Residents, and Fellowship Trainees
S. Niccole Alexander, MPP, Manager, Division of Hospital and Surgical Services
Ruth Trailer, BGS, Coordinator, Division of Hospital and Surgical Services
Development of a Meaningful MOC 4 Project for a Pediatric Hospitalist Group
Scottish Rite Pediatric and Adolescent Consultants (SRPAC), at Children’s Healthcare of Atlanta at Scottish Rite, received approval from the American Board of Pediatrics (ABP) for MOC 4 credit for an ongoing project. SRPAC (a 20+ provider group at a 250-bed, freestanding pediatric hospital) handles ∼5800 admissions per year. The current quality improvement project focuses on measurement of the percentage of charts with documentation of communication with the primary medical physician at the time of discharge. This is an individual measure for each physician. Baseline group aggregate measurements showed 52% compliance, and the goal is ≥90% by the end of 2013. A financial incentive linked to the goals of the project underscores the group’s commitment to timely communication.
What was learned about the approval process?
Previous experience with writing quality improvement projects is helpful. Although gathering old data may be time-consuming, previous work can be reframed as a series of Plan-Do-Study-Act cycles for a new application. The application is online at the ABP Web site and is lengthy. The application fee is $500 and must be paid even if the project is not approved. Review and approval take ∼8 to 12 weeks, but previous work may be included in the approval. There is no way to know how many points of MOC 4 credit the ABP will award your project, but most seem to be worth ∼25 points. On the plus side, a very helpful and accessible ABP contact person can answer your questions. After approval, project data can be easily entered through the ABP’s Web portal. If there are people in a group who were integral in project design and data collection, but have no actual individual data, the ABP may provide an attestation allowing them to obtain MOC credit. So don’t forget to ask about this possibility if applicable. SRPAC wishes good luck to all other applicants!
American Academy of Pediatrics Acquires ABP MOC 4 Portfolio Status!
The American Academy of Pediatrics (AAP) is now one of several organizations with the ability to approve projects for ABP MOC 4 credit without having to pay the $500 fee. Currently, the quality cabinet reviews projects submitted by internal organizations such as the QuIIN (Quality Improvement Innovation Networks), which includes the VIP (Value in Inpatient Pediatrics Network) composed of our Section members.
In Memoriam: Laura Mirkinson, 1953–2013 Pioneer and Beloved Leader in Pediatric Hospital Medicine
Most articles and commentaries about pediatric hospital medicine (PHM) today include some statement about the tremendous growth of the field. The kind of sustained growth of PHM over the last 15 years doesn’t happen through good fortune alone. It takes the careful nurturing and dogged determination of many individuals. One of those critical early leaders was Laura Mirkinson.
Laura was part of the original provisional Section on Hospital Medicine (SOHM) and served on the Section Executive Committee (EC) when full section status was attained by the AAP. She, along with the other members of the SOHM EC at the time, helped Jack Percelay forge a place for PHM within the Academy. This included development of the Section newsletter, which later evolved into Hospital Pediatrics. It seems almost unbelievable now that there was a fair amount of resistance to overcome.
Laura then had the unenviable charge of following Jack as the second chair of SOHM. The entire PHM community knows of Jack and many of you know Jack personally, and he is a hard act to follow. I don’t think Laura ever felt that, however. One of the most difficult tasks for any new successful endeavor is to sustain growth after the initial burst and to survive the first changeover of leadership. Laura skillfully succeeded in filling the chair position, allowing for the firm establishment of SOHM within the Academy. Her knowledge of AAP structure and function worked to the Section’s advantage time and time again. Some of you recall that in the “early” days, the listserv allowed job listings. When that authority was challenged, Laura negotiated for a resolution that served not only the general membership but also as the first significant SOHM funding.
During her tenure, Laura served as the first non–Academic Pediatric Association (APA) chair of the PHM conference planning committee. The first 2 conferences had been led by the APA, and the AAP was next in leading the conference in the tri-sponsored model. Despite the success of the 2003 and 2005 conferences, there was still some doubt about the ongoing viability of a national PHM conference, especially on an annual basis. Laura continued the trend of the PHM conference being wildly successful, again providing a boost to the SOHM bottom line. Laura also served as the program chair for the SOHM program at the National Conference & Exhibition (NCE). She established the day-long program and achieved a level of success in getting other sessions into NCE that has not been matched since.
When I eventually succeeded Laura as chair, I inherited a Section that was a valued member of the Academy and that had a healthy reserve which allowed for development of many current SOHM programs, such as resident grants to the PHM conference and grants to the AAP Legislative Conference. Laura achieved all this while maintaining her day job as a hospitalist at Holy Cross Hospital in Silver Spring, Maryland, and raising two wonderful daughters. When her husband took a job in New York, she followed and became the Chair of Pediatrics at Blythedale Children’s Hospital in Valhalla, New York. She was also a proud member of the Section on Uniformed Services, having been a Navy officer.
Laura stepped down from her national activities several years ago to focus on her own fight against ovarian cancer. We all owe Laura a huge debt of gratitude for her vision and action. Too often we neglect to acknowledge people who have made a difference until after they pass, and while this tribute did not appear in print in time for Laura to read it, a version appeared on the SOHM listserv while Laura was still with us. The community of pediatric hospitalists responded with an outpouring of gratitude to Laura, just a few examples of which are included below in memoriam.
Dan Rauch, MD, FAAP, FHM
Responses from the Section Listserv:
“Laura mentored me in many ways, and her hard work made the field of pediatric hospital medicine a national force and allowed PHM to be integrated into most major hospitals.
For those new to the PHM community, please be part of honoring Laura. She made PHM possible for many of you.”
Timothy Hartzog, MD, FAAP
“From those of us who may not have had the fortune of knowing you personally, and certainly know your name, but benefit from all your years of dedication and recognize your invaluable contributions to pediatric hospital medicine, we THANK YOU, Laura! Our thoughts and hearts are with you as members of your hospitalist family.”
Cheryl D.G. Klein, MD, FAAP, FHM
“Dan, thank you for doing this. As someone who has not been as involved recently as I was in the past, I didn’t know this information and so was glad to receive it. Laura, thank you for all you have done for pediatric hospital medicine. Sending best wishes your way.”
Sheldon Berkowitz, MD
“What a wonderful tribute! I’d like to offer a few more words about Laura. I was lucky enough to have Laura as an attending supervisor when I was a pediatric resident and PHM fellow, and even more lucky to be part of the hospitalist group at Holy Cross after my training. Laura was (and is) an amazing teacher and mentor. I am so grateful for her example, her support, and her friendship. There are so many moments and conversations with Laura that remain fresh in my memory, that undoubtedly influenced me, and have helped shape me as I have grown in my professional and personal life. I know that many others feel the same. Laura, thank you for everything!”
“Laura: I knew you were good but not that good. Thank you for being my colleague and friend for so many years AND a founder of the SOHM! All kudos are well deserved. (Thank you, Dan, for iterating them all in the hospitalist field.) You deserve as much kudos for the person you are and for being a good friend. All my love is with you, Rich, and the girls.”
Phyllis Lewis, MD
“Thank you, Laura, for your guidance and leadership.”
“When I first engaged in Pediatric Hospital Medicine on a national level, Laura (along with Jack) was a very willing early mentor. When I became engaged in my institution’s EHR implementation with Meditech and found out that she was at a Meditech hospital, I knew that she would be a great ally in information and education on how to best implement the system in a pediatric hospital. She was a tremendous resource and willingly took time away from her busy schedule to engage and assist me. She, along with many of the early leaders in PHM, have created a culture in which we are all willing to learn and share with each other.
Thank you, Laura, for your example, your help, and your leadership.”
With much gratitude and blessings to you and your family,
Jeanann P. Pardue, MD
“Dan, thanks for the eloquent tribute.
When we started as the Proposed Provisional Section on Hospitalists/Hospital Care in the late spring of 1998, Laura’s response to the initial questionnaire revealed a woman with great energy, commitment, and capability. Her leadership through the years have confirmed these traits, along with diligence, tenacity, integrity, and dignity.
Laura and fellow founding SOHM EC members Paul Bellet and Gary Strong had been primary care pediatricians before becoming hospitalists. Those perspectives were crucial in the formative years of the Section, and no less important now. Laura in particular has had a laser-like focus on what is best for children and their families in guiding the Section’s activities and the development of the Pediatric Hospital Medicine field. She epitomizes the mission of the AAP. The biggest tribute we can pay her is to follow the precedents she has set in her service to country, family, friends, AAP, and the children we all care for.
Laura, our thoughts and love are with you and your family.”
“Like Jen Maniscalco, I too had the benefit of having Laura as an attending at Holy Cross. I gained so much from the experience and became a hospitalist as a result of watching Laura as an attending, as well as many of the other hospitalists there. I appreciate so much of what she has done for the field of Pediatric Hospital Medicine and for opening my eyes to the existence of such an amazing field. I also agree that Dan deserves kudos for putting together such a touching tribute.”
“I remember meeting in a room with 5 or 6 people in San Francisco to discuss hospital medicine in 1998. Laura was there, poised, articulate, and well spoken. That began our friendship and mutual mission—passion for care of the hospitalized child. Throughout the ensuing years, Laura and I became friends. She supported the idea of an AAP Section on Hospice and Palliative Medicine. As we continued our dialogue through the years and through her illness, I realized AGAIN that we held the same ideals. Her family support awed and amazed me, as she embarked on her difficult journey. Laura, my only regret is that I never had the honor of practicing alongside you.”
With much love, respect, and honor.
“I am fortunate enough to have had the pleasure and privilege of working alongside Laura as a hospitalist at Holy Cross Hospital, collaborating with her on programming for the Section on Hospital Medicine at the AAP National Conferences and, above all, developing a friendship with her and her family over the years. I agree with all that has been said about Laura, attributes that make her an amazing pediatrician and friend. She is such a kind, smart, articulate, efficient (I have to include that), and well-rounded person. Our office was decorated with her photography and art, for which her passion really grew over the years. We frequently had good discussions about books we’ve read and were eager to share titles. She was always there to listen and offer sage advice on any matter—work or personal.
Thank you, Laura, for being such a wonderful friend and colleague. All of my love to you and your beautiful family!”
Rebecca Gould Carlisle, MD, FAAP
“I would like to add a tribute to my wonderful friend, Laura Mirkinson. I had the great fortune of working with Laura many years ago when we were young attendings at Holy Cross Hospital. If anyone needed anything done and they wanted it to be done efficiently and expertly, Laura was the one to ask. We became fast friends sharing an office, and though she never complained about my mess, I often returned to my desk to find that she had straightened it up (which I greatly appreciated!). I have many stories to tell about Laura’s wonderfulness, but there is one that I am particularly grateful for.
During my first year of private practice after leaving hospital medicine, I hospitalized a baby who had severe hypernatremia, and Laura was attending that evening. Laura could sense my worry and fear about bringing the baby’s sodium level down safely. Although it was not her job to do so, she spent the entire night with me, awake by the baby’s bedside adjusting his IV fluids, and the sodium level came down so meticulously it could have been a textbook case. I have always loved Laura for saving that baby’s life and for staying by the bedside with me. Laura is a beautiful soul and a wonderful physician, and she has enriched my life as well as many other physicians with whom she has worked.”
- Copyright © 2013 by the American Academy of Pediatrics