title: A longitudinal, collaborative, practice-based learning and improvement model to improve post-discharge heart failure outcomes.
abstract: BACKGROUND
  Practice-based learning and improvement is one of the Accreditation Council of Graduate Medical Education's core competencies fortrainees. Residencyprograms have grappled with how to accomplish this goal.
  
  
  OBJECTIVE
  We describe our institution's unique, longitudinal post-graduate year process and project.
  
  
  METHODS
  West Haven, VA Medical Center.
  
  
  METHODS
  Yale University School of Medicine junior residents on ambulatory electives and faculty preceptor.
  
  
  METHODS
  Longitudinal program aimed to decrease re-admissions for hospitalized patients with congestive heart failure.
  
  
  CONCLUSIONS
  We feel that our longitudinal project is a novel innovation worthy of further study.
authors.affiliation: Department of Internal Medicine, Yale-New Haven Hospital, New Haven, USA.
authors.forename: Valsamo K
authors.initials: VK
authors.lastname: Anagnostou
authors.affiliation: Department of Internal Medicine, Yale-New Haven Hospital, New Haven, USA.
authors.forename: Grant
authors.initials: G
authors.lastname: Bailey
authors.affiliation: Department of Internal Medicine, Yale-New Haven Hospital, New Haven, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Sze
authors.affiliation: Department of Medicine,Yale University School of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, USA.
authors.forename: Seonaid
authors.initials: S
authors.lastname: Hay
authors.affiliation: Department of Medicine,Yale University School of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Hyson
authors.affiliation: Department of Medicine,Yale University School of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, USA.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Federman
mesh_terms: D006333:Heart Failure; D006801:Humans; D007396:Internship and Residency; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D018794:Problem-Based Learning; D058996:Quality Improvement / Q000458:organization & administration*; D011795:Surveys and Questionnaires