A fellowship is the period of medical training in the United States that a physician may undertake after completing a specialty training program.

It can also be defined as "companionship of persons on equal and friendly terms."

When I was in training to become a kidney doctor at the University of Minnesota, the fellows would often partake in fellowship. Whether it was getting together for pizza or playing board games, the social time we spent helped us learn about one another outside the setting of nephrology and work. Unfortunately, as people nowadays get busier and busier, fellowship rarely happens because there is no time. Other priorities take over.

As Alegent Health continues to build a culture of excellence, fellowship is becoming a priority. Building bonds of friendship improve patient care because people work better together. Last Saturday night, my wife and I spent some quality time with our Alegent Cardiology friends and their spouses. I appreciated this opportunity, because even though I graduated 14 years ago, I'm relatively new to Omaha. Time spent playing Family Feud, Are You Smarter Than a Fifth Grader and Trivial Pursuit translated to fun, laughs and relationship building. I was thrilled my wife could get to know some of the people I work with.

I learned some interesting tidbits as well. Tara Whitmire is an advanced practice nurse who recently got accepted to the University of Iowa DNP program. The Doctor of Nursing Practice (DNP) is an advanced-level practice degree that focuses on the clinical aspects of nursing rather than academic research. The curriculum for the DNP degree generally includes advanced practice, leadership, and application of clinical research related to nursing. She starts in June and is going to get her doctorate degree. She is also really good at Family Feud. Jill Ogg-Gress has already completed her training and is a doctor of nursing practice. Dr. Joseph Thibodeau, in addition to his impressive bio, used to moonlight as an e-Focus physician while he was in training.

I am just so impressed with this group of people. They are down to earth, extremely modest, yet so well educated. There is no pomp and circumstance. And perhaps this is why they are such phenomenal clinicians with great rapport with their patients.

Did they learn anything about me? You betcha! While I was defining CPR, it came up that I set up two successful pancreas transplant programs in the Dakotas, a legacy I am quite proud of but don't usually mention.

Bottom line: Make time for fellowship. Whether it is with your co-workers, your family, or your friends, I'm sure you'll have a lot of fun!

Alegent Nephrology is happy to report a 95% success rate upon review of their 1st quality performance indicator!

This is phenomenal news! And there is more to this story. Here at Alegent Nephrology, we want to provide you with the best care in the nation. Our patients expect that. We expect that of ourselves. So how can we achieve that goal in an objective fashion? We need to compare how well (or how poorly) we are doing compared with the nation, and the way to do that is by reporting quality metrics.

Quality metrics is one of the latest buzzwords in healthcare. What is it, and why is it important? Quality metrics is a way for an organization to measure how well they are doing on a certain performance indicator. The reports are important because it gives you, the consumer, an objective way to evaluate our performance as kidney doctors. We decided that our goal for '09-'10 was to identify diabetic patients with protein in their urine (a risk factor for heart disease death) and make sure that those patients are taking an ACE inhibitor such as benazepril. An ACE inhibitor is a blood pressure medication that is available in a generic formulation that decreases protein in the urine and significantly decreases heart disease risk when taken.

The literature suggests that despite all of the evidence in favor of this form of treatment, only 43% of older diabetics with protein in their urine receive an ACE inhibitor (J Gen Intern Med. 2006 April; 21(4): 315–319). This suggests a major quality problem -- there is a cheap, effective, beneficial therapy for patients that 57% of the population is not taking! Therefore, if we can increase the number of people getting treated, we can save lives.

So the results are in: Alegent Nephrology has 95% of our population on appropriate treatment, which represents a whopping 52% higher score than the national average!

After the high-fives, the "hip, hip, horrah!" and the pats on the back, I was asked how I felt about scoring 95% when the average goal rate attainment is 43%. I replied, "why didn't we get 100%"?... And I am serious! We are in the top percentile of the country in terms of goal rate attainment, and in general, I'm a "glass is half full" kind of guy. So why was I unhappy with our results?

I was shocked that some our patients were "missed." I eat, drink, breathe, and sleep ACE inhibitors in diabetic kidney patients with protein in their urine. I strongly believe the therapy is the right thing to do for our patients. I have the Alegent Pharmacy $4.99 drug list framed on my wall next to a picture of my beautiful wife and children. During every patient encounter, I review whether an ACE inhibitor is indicated. In fact, I write so much benazepril that I can spell it backwards (lirpezaneb) while chewing a piece of gum and hopping up and down on one leg. So why didn't we get 100%?

To err is human. Things can get overlooked. And that is why I embrace these performance measures/quality metrics because a person can't be perfect all the time. The beauty of the Alegent Health system is that we are encouraged to constantly strive for perfection. The PROCESS of reviewing our population in an attempt to improve quality alerted us to the few patients that we missed. And instead of crying over spilt milk and using the cliched term "it is what it is," we decided to find out WHY the few patients weren't getting the therapy they were supposed to. By the end of the week, everyone was either getting the appropriate therapy or had documentation why they were not able to receive it. The result = zero patients missed. Now I am happy!

Here is a take-home pearl for you: if you happen to be a diabetic with protein in your urine and you are not taking one of the "prils," please ask your doctor why. And as always, if there are any concerns from a nephrology standpoint, we are here to help facilitate.

I hope you enjoyed our latest blog. We plan to continue to report our quality metrics in the future with the goal of giving you, our patients, "world class" care.