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Cynthia Kear and Shelly Rodrigues, CAE Taking Performance Improvement (PI) to the Next Level: Integrating PI Learnings into Traditional CME/CPD Modalities
Cynthia Kear and Shelly Rodrigues, CAE
Taking Performance Improvement
(PI) to the Next Level:
Integrating PI Learnings into
Traditional CME/CPD Modalities
Presenters
Cynthia Kear, CCMEP
Shelly Rodrigues, CCMEP, CAE
Ain’t got nuttin’ to disclose.
Who We Are
Largest state chapter of AAFP
Membership society – 7,100+
Multiple functional areas
CME top reason members join
ACCME provider
Large enough to get things done, small
enough to be flexible and innovative
Our PI-CME Experience
New Directions in Diabetes
CS2Day – Smoking Cessation
STOP
And You?
Who’s in the audience?
And You?
What region of the US?
East
Mid-Atlantic
Southeast
Mid-West
Southwest
Northwest
And You?
What type of provider?
University/Academic
Medical Specialty Society
State Medical Association
Hospital/Health System
MECC
Other
And You?
How many people are in the room with you?
Just you!
2
3
4
5
6
7
8
9
10
More than 10
More than 20
Learning Objectives
Understand the most salient concepts of PI as
it relates to the current CPD environment.
Marry tenets of PI to broader, more traditional
CPD modalities.
Implement intra-organizational
communication to maximize this marriage.
PI-CME Landscape
AMA / AAFP
ACCME
ABMS and Maintenance of Certification
P4P, private sector and CMS
IOM
QOIs
Others
And…
What is PI or PI-CME?
Is/Is Not…
Definition of PI-CME
PI-CME, which is a three-step process: First stage - begins with an assessment of each physician’s current practice
using identified evidence-based performance measures. Feedback to physicians compares their performance to national benchmarks and to the performance of peers.
Second stage of PI CME involves the implementation of an intervention based on the performance measures assessed in the practice.
Third stage involves revaluation of performance in practice, including reflection and summarization of outcome changes resulting from the PI CME activity.
Physicians completing all three components may claim a total of 20 credits in this nationally standardized format, adopted by the credit grantors (AMA and AAFP) and by the AAFP as an accreditor in the medical community.
A similar design is used in the osteopathic community with credit granted by the AOA.
Who is Doing PI-CME?
Questions for the Audience
Who is Doing PI-CME?
Are you currently providing the 3-step PI-CME?
Yes
No
Who is Doing PI-CME?
Are you providing…?
Collaborative, with live component
Online or learner self-directed
Hybrid?
Who is Doing PI-CME?
If haven’t started providing PI-CME, do you
expect to in:
2009
2010
More about Us
How we got started
Examples
Initiative Description
This 4-year initiative is designed for family physicians and melds excellence in the clinical care of patients with diabetes with organizational changes in physicians’ offices to implement care management systems and streamline patient care leading to improved efficiency and greater provider and patient satisfaction.
CAFP activities range from continuing medical and professional development, medical practice affairs and communications, legislative advocacy, regulatory participation, and more.
This initiative is the ―living laboratory‖ for our strategic plan and The Future of Family Medicine Report recommendations.
A Snapshot:
Integrating practice re-design principles into all CAFP
educational activities
Offering clinical education modules on a wide array of topics,
in a myriad of formats
Providing practice management education and assistance
Including clinical, research, diabetes resources, and, practice
information in communications
Advocating in Sacramento on issues such as soft drinks and
junk food in the schools
Talking to payors about issues like pay-for-performance
Reviewing and offering technology assistance with patient registries and EHRs
Participating in educational sessions, such as Institute for Healthcare Improvement’s (IHI) Breakthrough Series and Practice Re-Design conferences to stay abreast of the most current practices
Adopting the Academy-approved Care Model Change Package.
PI-CME
Collaboratory
Pre- and post- chart pulls
Common technology base
Educational design
Face-to-face, webex, monthly calls
Team approach
Initiative Description
Cease Smoking Today (CS2day) is a 2+ year strategic initiative designed to improve public health by reducing the number of persons who smoke. CS2day will increase knowledge of treatment options, improve counseling skills, and increase the smoking quit rates for patients of primary care providers, cardiologists, pulmonologists, psychiatrists, pharmacists, and other health care clinicians.
A SnapshotThe goal and scope of the CS2day Partners is to develop, implement, and evaluate a national educational campaign focused on elimination of smoking.
CS2dayPartners will work collaboratively, and individually, on aspects of the campaign to provide educational activities including, but not limited to:
Needs assessment
Live activities
Enduring print activities
Online activities, 24/7 and real-time
Quality and Practice Improvement projects
Web portal and resource center
Tool development and dissemination
Activity and total project evaluation
Communications and marketing
Public outreach and patient education
Grant solicitation, support and reporting
Coordination of project activities among organizations, and with grantors
Collaboratory
Learner Initiated “Traditional”
Education
Control
Registry
Data Warehouse
In the Practice
Measure changes in
population health
PI-CME
Initiative Description
The OAB project, a 2+ year project, initiated by seven
partners, uses a common needs assessment, and will
include adoption of a common guideline, development
of common curriculum and tools, and project-wide
outcomes measurement. The project targets primary
care physicians, OB-GYN, urology and urogynecology
specialists, and their practice teams to improve the
screening and treatment of OAB.
A Snapshot
Live meetings at national conferences
Regional, state, and local meetings
Print and interactive on-line enduring materials
Performance improvement project
Level 4 activity outcomes and an integrated outcomes analysis
of all activities
Continuous improvement and focus on cultural health care
disparities will thread throughout this initiative
A research component will explore the unique aspects of
treating the geriatric population with OAB
PI-CME Providing knowledge to physicians isn’t enough: clinical change in practice is
needed to affect change in patient outcomes. Recruitment will focus on primary
care as well as urology and urogynecology practices. The key components of this
initiative include:
Advisory Board: This group will meet to review guidelines, assist in selection of
clinical measures, develop learning modules, and serve as faculty for the project.
The advisory board will meet at the end of the project to analyze results and assist
in report preparation.
Content Modules: A series of PI web-based modules covering PI topics such as
the small test of change cycle, understanding your data, the chronic care model,
team huddles, data walls, promising practices (group visits, team care), inter-
specialty communications, plus modules on the clinical content for OAB will be
developed and launched.
PI-CME QI Advisor Assistance – ―Open Mic‖: A monthly webinar QI Advice Open Mic
will be held for all interested learners. There will be a pre-registration process,
which will trigger a webinar address, phone number and login. A QI advisor will
present 15 minutes of content, followed by questions from individual learners.
(Other partner online activities may also be posted here.)
Web Learning Journal: Web site for learning. This site will house the web-based
resources, participation registration, data collection, reporting functions, and tools.
It will also be used for information-push to registered participants.
Data Collection: Learners will be offered an innovative web-based tool for use in
their performance improvement efforts. This tool will allow patient interaction,
data collection, quality measurement, push technology and more. A limited
number of the tools will be available, and a nominal fee will be charged to the
practices implementing them.
Spectrum of PI
Collaboratives/Collaboratories
NDDC, C4 and CS2day
Self-Directed Learning
CS2day and OAB
Metric is another example
Hybrids
CS2day
Work by AOA with residency programs
Content/Resources
Passive learning, no contact with CAFP
PI-CME… Latest Sandbox?
Challenges
Sense of urgency
Cost
Understanding
Uniqueness
Fear
Benefits
Direct involvement
Practice makes perfect
New partners
Education that makes a difference
Some of Our Learnings
This requires commitment
Know your institutional/organizational strengths and capacity
Be candid in your self-assessment of your strengths and weaknesses
You cannot be risk adverse
Requires support from the top of your organization
Some of Our Learnings
Learn new skills and approaches to the planning and
delivery of CME
Don’t have to be an expert in everything — if you
pick the right partners
Creates an environment where CME can be multi-
dimensional
Provides wonderful opportunities to talk with QIOs,
ABMS, Joint Commission, and other stakeholders
who may have a different perspective
Getting Started
Start small
Run a few small tests of change in your CME office?
Pick up the Dartmouth Green Book
Find a group of early adopters who are willing to champion
PI-CME
Think about the spectrum
Probably easier to start at the less intensive end of the spectrum; or
to find experienced partners to tackle the collaborative end.
Attend more sessions on PI-CME
Look for other organizations with whom to partner
Questions…
Useful URLs
www.IHI.org
www.NIQIE.org
www.ama-assn.org
www.acme-assn.org
www.dartmouth.edu
www.accme.org
www.familydocs.org
Thanks!
Cynthia Kear, CCMEP
VP, External Affairs
415-586-6660
Shelly Rodrigues, CCMEP, CAE
Deputy Executive Vice President
415-345-8667
Thanks!
Please take a moment to complete the brief evaluation.
We appreciate your feedback!
Join us for our next Takeout Tuesday webinar!
Evaluating your Evaluations:
Moving towards a Learner Focused Approach
Tuesday, September 15, 2009
2:00-3:00 PM ET
