The Hospital Medicine Reengineering Network (HOMERuN): a learning organization focused on improving hospital care.
Converting the health care delivery system into a learning organization is a key strategy for improving health outcomes. Although the collaborative learning organization approach has been successful in neonatal intensive care units and disease-specific collaboratives, there are few examples in general medicine and none in adult medicine that have leveraged the role of hospitalists nationally across multiple institutions to implement improvements. The authors describe the rationale for and early work of the Hospital Medicine Reengineering Network (HOMERuN), a collaborative of hospitals, hospitalists, and multidisciplinary care teams founded in 2011 that seeks to measure, benchmark, and improve the efficiency, quality, and outcomes of care in the hospital and afterwards. Robust and timely evaluation, with learning and refinement of approaches across institutions, should accelerate improvement efforts. The authors review HOMERuN's collaborative model, which focuses on a community-based participatory approach modified to include hospital-based staff as well as the larger community. HOMERuN's initial project is described, focusing on care transition measurement using perspectives from the patient, caregiver, and providers. Next steps and sustainability of the organization are discussed, including benchmarking, collaboration, and effective dissemination of best practices to stakeholders.
Dr. Auerbach is professor of medicine, University of California, San Francisco Division of Hospital Medicine, San Francisco, California. Dr. Patel is resident physician, Perelman School of Medicine, University of Pennsylvania, Section of Hospital Medicine, Philadelphia, Pennsylvania. Dr. Metlay is professor of medicine, Perelman School of Medicine, University of Pennsylvania, Section of Hospital Medicine, Philadelphia, Pennsylvania. Dr. Schnipper is associate professor of medicine, Division of General Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts. Dr. Williams is professor of medicine, Northwestern University Feinberg School of Medicine, Division of Hospital Medicine, Chicago, Illinois. Dr. Robinson is physician in chief and associate chief medical officer, Christiana Care Health System, Wilmington, Delaware. Dr. Kripalani is associate professor, Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, Tennessee. Dr. Lindenauer is associate professor of medicine, Tufts University School of Medicine, Boston, Massachusetts, and director, Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts.
Andrew D
AD
Auerbach
Mitesh S
MS
Patel
Joshua P
JP
Metlay
Jeffrey L
JL
Schnipper
Mark V
MV
Williams
Edmondo J
EJ
Robinson
Sunil
S
Kripalani
Peter K
PK
Lindenauer
D019985:Benchmarking; D055812:Community-Based Participatory Research; D003299:Cooperative Behavior; D064416:Hospital Medicine / Q000193:education / Q000379:methods*; D006801:Humans; D008485:Medical Audit; D010351:Patient Discharge / Q000592:standards; D062209:Patient Handoff / Q000592:standards; D016730:Program Development; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D011787:Quality of Health Care