ABQAURP Announces Winner of the 2025 CHCQM Diplomate Achievement Award

The American Board of Quality Assurance & Utilization Review Physicians is pleased to announce the selection of Karen Clark, MD, MACP, FRCP, CHCQM-PHYADV, as the winner of the 2025 CHCQM Diplomate Achievement Award.

NEW PORT RICHEY, Fla., May 15, 2025 /PRNewswire/ -- The American Board of Quality Assurance & Utilization Review Physicians (ABQAURP) is pleased to announce the selection of Karen Clark, MD, MACP, FRCP, CHCQM-PHYADV, as the winner of the 2025 CHCQM Diplomate Achievement Award. Dr. Clark provides Physician Advisory Services to the West Virginia University Health System and serves as Medical Director Utilization Management and Physician Advisory Services. She is also a Professor of Medicine in the Internal Medicine Department at WVU Medicine.

Dr. Clark was project lead for WVUH's Complex Care Plans for High Utilizers pilot program which has grown to be co-led by physician advisors and an interdisciplinary team to manage the overuse of emergency department services and resources while preventing adverse outcomes. Safety, utilization, and financial outcomes have been significant and positive, hospital staff and physician acceptance of the care plan model is high, and they have continued to examine processes for opportunities to improve through annual reviews utilizing QI principles.

The original mission/goals of the team were to improve communication between providers (ED, hospitalist, and consultants), streamline care, promote patient safety, reduce utilization, and control costs. Patients with very high utilization of services are potentially subject to harmful/unintended consequences from use of standardized order sets designed to improve efficiency; lack of continuity of providers; and provider fatigue and bias. Because of these concerns, patient safety was an important consideration as we contemplated best practices for our high utilizing patients. Evidence for improvement in patient safety was to be identified through reduction in numbers of tests involving radiation exposure. Also, reduced utilization of ED visits, reduced inpatient or observation hospitalizations and decreased numbers of readmissions was a goal that we categorized as indicative of safer patient care. Finally, completed outpatient visits were identified as a surrogate marker of safer care.

Patients are primarily identified for consideration for a complex care plan based upon high utilization. However, to be approved for the creation of a care plan, the team uses a standardized scoring tool designed to quantify utilization of ED and/or hospitalizations, complex medical conditions that are active and contributing to utilization, and complex social issues. Once approved for care plan development by committee endorsement, the multidisciplinary team creates an individualized care plan designed at improving communication and standardizing care. The plan is reviewed with the patient and subsequently uploaded into the medical record for use.

Highlights of the data regarding patient safety include:

1. Reduction in admissions from a "pre-care plan" patient average of 12.1 admits per year to 3.3 admits per year per patient (63%)
2. Reduction in readmissions per patient by 76% (10.5 readmissions per patient per year to 2.5)
3. Reduction in annual ED visits per patient from 11.7 to 8.4 (28%)
4. Radiology (x-ray and CT) procedures reduced from 25 procedures per patient per year to 9 procedures per patient per year, a reduction of 64%
5. Increase of 3% in completed outpatient visits
6. Reduction of 17% in cancelled outpatient appointments
7. Reduction in no-show appointments by 36%

Direct costs expended by the hospital on these patients have also shown significant reduction. Variance in the 12 months pre- and post-enrollment for patients with 1+ years in the program was -$4.2 million. The WVUH Complex Care Plan Team (CCPT) has been formally recognized as a subcommittee of the hospital's Utilization Review committee.

Dr. Karen Clark was chosen as winner of the CHCQM Diplomate Achievement Award based on a quality improvement initiative that is sustainable over time, has impressive results in resource utilization and management, and is impacting a growing number of individuals in a positive manner.

In acceptance of the Award, Dr. Clark states, "I am honored to receive the 2025 CHCQM Diplomate Achievement Award. The WVU Hospital Complex Care Plan project has been a multidisciplinary, team effort from inception, and I happily accept the award on behalf of all who have participated. High utilizing, medically complex patients are at risk to suffer unintended consequences from fragmented care. This is especially true in rural areas where emergency rooms and hospitals serve as safety nets for patients without traditional primary care ties. Our individualized care plans have effectively reduced utilization, improved patient safety and have been well received by both patients and physicians. This award further validates our team's important work."

ABQAURP extends a sincere Thank You to Dr. Clark, her team, and all those who submitted outstanding achievements in quality and patient safety that have led to improvement, positive outcomes, and the advancement of Health Care Quality Management and Patient Safety.

Join ABQAURP at the 2025 Annual Conference to hear more about the program and to congratulate Dr. Clark and celebrate all the Diplomate's achievements. For more event information, please visit: https://www.abqaurp.org/AnnualConference.

The CHCQM Diplomate Achievement Award presentation will take place on Friday, September 12, 2025, at ABQAURP's 2025 Annual Conference!

About ABQAURP
Established in 1977, the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) is an international membership association comprised of interdisciplinary health care professionals. Through its ultimate goal to improve the quality of health care, ABQAURP is dedicated to promoting health care quality through education and certification for physicians, nurses, and other members of the health care team. Learn more at: www.abqaurp.org.

SOURCE American Board of Quality Assurance and Utilization Review Physicians