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TABLE 1

Time Line of Interventions, Implementation Dates, Associated Drivers, and Description of Activities

InterventionImplementation DateAssociated Primary DriverDescription
Opt out auto text documentation February 2018 Standardization of documentation Verbiage regarding PCP communication was included within the discharge summary template and required manual removal if not applicable (Supplemental Fig 3). 
Hospitalist education February 2018 Increase provider buy-in; improve awareness of patients meeting high-risk criteria; standardization of documentation A project kickoff presentation was delivered to hospitalists sharing baseline underperformance, pertinent literature and national recommendations, project aims and measures, high-risk criteria, and instructions with visual aids outlining how to meet documentation expectations. 
Division-level performance feedback February 2018 Increase provider buy-in Outcome and process measure control charts were disseminated to hospitalists roughly each month. 
Opt in checkbox documentation March 2018 Standardization of documentation Passive checkbox prompts were inserted into workflows for mandatory discharge paperwork (Supplemental Fig 3). Intentional redundancy was created within existing documentation workflows. 
PCP direct contact information March 2018 Streamline communication processes Leveraging connections with medical informatics and physician liaisons, hospitalists were granted access to an internal database of PCP direct contact information. A link within the EMR was also connected to this database. During the project, database software was changed resulting in difficulty accessing this information. 
Hospitalist MOC Part IV credit May 2018 to October 2018 Increase provider buy-in Hospitalists who met participation requirements for 6 mo were awarded 25 MOC Part IV points. 
Abnormality Tracker June 2018 to August 2018 Improve awareness of patients meeting high-risk criteria A twice monthly abnormality tracker displaying criteria in which communication did not occur was shared with hospitalists. Intervention abandoned after 2 mo because of a low return on investment (significant time required to create with minimal impact). 
PCP MOC Part IV credit July 2018 to December 2018 Increase provider buy-in PCPs who met participation requirements for 6 mo were awarded 25 MOC Part IV points. 
Posting of high-risk criteria in hospitalist workrooms July 2018 Improve awareness of patients meeting high-risk criteria Laminated cards listing high-risk criteria were posted at each hospitalist workroom workstation. 
Weekday high-risk e-mail August 2018 Improve awareness of patients meeting high-risk criteria An automated report identified currently hospitalized patients on the hospitalist service meeting high-risk criteria. List automatically emailed to team coordinators each weekday. Suggested use of e-mail was given to team coordinators who were allowed to organically incorporate into daily workflow. 
Hospitalist notification of high-risk discharges October 2018 Improve awareness of patients meeting high-risk criteria Standardization of processes relating to automated weekday e-mail and notification of hospitalists. Each morning, team coordinators were to notify hospitalists about which discharging patients met criteria. 
Facilitation of PCP communication by team coordinator October 2018 Streamline communication processes Team coordinators developed personal workflows to aid in reducing time required to communicate with PCPs. While contacting clinics to schedule hospital follow-up visits, team coordinators facilitated a verbal handoff between providers as time allowed. 
Individual performance feedback February 2019 Increase provider buy-in With division leadership support, a confidential individual performance feedback dashboard was developed. Each month, hospitalists received an updated version of their individual performance dashboard, which included individual monthly and quarterly performance for each measure, a division-level comparator, and measure targets. Monthly performance was color coded (red or green) in relation to the division average. Quarterly performance was color coded (red, orange, yellow, or green) on the basis of quartile of performance in relation to other hospitalists (Supplemental Fig 5). 
Recognizing top performers February 2019 Increase provider buy-in Coinciding with individual performance feedback, each month, hospitalists achieving 100% performance in a measure were recognized through our division's internal recognition process. 
Transparent performance feedback February 2020 Increase provider buy-in After a period of sustainability was achieved, performance waned. With approval from division leadership and after advance notice was provided to hospitalists, a transparent performance feedback dashboard was implemented in accordance with unblinded physician performance feedback recommendations.37  Within the division, only ongoing monthly performance of each hospitalist was displayed by using a similar color-coded form at as previously described. 
InterventionImplementation DateAssociated Primary DriverDescription
Opt out auto text documentation February 2018 Standardization of documentation Verbiage regarding PCP communication was included within the discharge summary template and required manual removal if not applicable (Supplemental Fig 3). 
Hospitalist education February 2018 Increase provider buy-in; improve awareness of patients meeting high-risk criteria; standardization of documentation A project kickoff presentation was delivered to hospitalists sharing baseline underperformance, pertinent literature and national recommendations, project aims and measures, high-risk criteria, and instructions with visual aids outlining how to meet documentation expectations. 
Division-level performance feedback February 2018 Increase provider buy-in Outcome and process measure control charts were disseminated to hospitalists roughly each month. 
Opt in checkbox documentation March 2018 Standardization of documentation Passive checkbox prompts were inserted into workflows for mandatory discharge paperwork (Supplemental Fig 3). Intentional redundancy was created within existing documentation workflows. 
PCP direct contact information March 2018 Streamline communication processes Leveraging connections with medical informatics and physician liaisons, hospitalists were granted access to an internal database of PCP direct contact information. A link within the EMR was also connected to this database. During the project, database software was changed resulting in difficulty accessing this information. 
Hospitalist MOC Part IV credit May 2018 to October 2018 Increase provider buy-in Hospitalists who met participation requirements for 6 mo were awarded 25 MOC Part IV points. 
Abnormality Tracker June 2018 to August 2018 Improve awareness of patients meeting high-risk criteria A twice monthly abnormality tracker displaying criteria in which communication did not occur was shared with hospitalists. Intervention abandoned after 2 mo because of a low return on investment (significant time required to create with minimal impact). 
PCP MOC Part IV credit July 2018 to December 2018 Increase provider buy-in PCPs who met participation requirements for 6 mo were awarded 25 MOC Part IV points. 
Posting of high-risk criteria in hospitalist workrooms July 2018 Improve awareness of patients meeting high-risk criteria Laminated cards listing high-risk criteria were posted at each hospitalist workroom workstation. 
Weekday high-risk e-mail August 2018 Improve awareness of patients meeting high-risk criteria An automated report identified currently hospitalized patients on the hospitalist service meeting high-risk criteria. List automatically emailed to team coordinators each weekday. Suggested use of e-mail was given to team coordinators who were allowed to organically incorporate into daily workflow. 
Hospitalist notification of high-risk discharges October 2018 Improve awareness of patients meeting high-risk criteria Standardization of processes relating to automated weekday e-mail and notification of hospitalists. Each morning, team coordinators were to notify hospitalists about which discharging patients met criteria. 
Facilitation of PCP communication by team coordinator October 2018 Streamline communication processes Team coordinators developed personal workflows to aid in reducing time required to communicate with PCPs. While contacting clinics to schedule hospital follow-up visits, team coordinators facilitated a verbal handoff between providers as time allowed. 
Individual performance feedback February 2019 Increase provider buy-in With division leadership support, a confidential individual performance feedback dashboard was developed. Each month, hospitalists received an updated version of their individual performance dashboard, which included individual monthly and quarterly performance for each measure, a division-level comparator, and measure targets. Monthly performance was color coded (red or green) in relation to the division average. Quarterly performance was color coded (red, orange, yellow, or green) on the basis of quartile of performance in relation to other hospitalists (Supplemental Fig 5). 
Recognizing top performers February 2019 Increase provider buy-in Coinciding with individual performance feedback, each month, hospitalists achieving 100% performance in a measure were recognized through our division's internal recognition process. 
Transparent performance feedback February 2020 Increase provider buy-in After a period of sustainability was achieved, performance waned. With approval from division leadership and after advance notice was provided to hospitalists, a transparent performance feedback dashboard was implemented in accordance with unblinded physician performance feedback recommendations.37  Within the division, only ongoing monthly performance of each hospitalist was displayed by using a similar color-coded form at as previously described. 

Any implementation date without an end date continued through the project end date.

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