Self-Assessment, Lifelong Learning, & Assessment of Performance in Practice: Maintenance of Certification for Family Physicians Parts II &IV David Price,

Self-Assessment, Lifelong Learning, & Assessment of Performance in Practice:

Maintenance of Certification for Family Physicians Parts II &IV

David Price, MDColorado Permanente Medical GroupAssociate Professor Family Medicine

UCSHC Chair-elect, American Board of Family

Medicine

MedBiquitous April 2007

MOC

Response of ABMS & member boards to quality concerns & gaps

Multiple stakeholders (patients, FSMB, AMA, ACCME, physicians, etc.)

Components of MOC (MC-FP)

I. Professionalism

II. Periodic self-assessment (SAM*)• Knowledge assessments (KA*)• Clinical Simulations (ClinSim*)• CME

III. Cognitive expertise (Examination)

IV. Practice-based learning & improvement• PPM• MIMM• Pt-Clinician Communication• Pt Safety module

Extend Certification From7 to 7+3 Years

Old: 6 SAMs + 1 PPM then exam year 7 NOW: Diplomates engaged/remaining in MC-

FP process can extend certificate to 10 years by completing MC-FP requirements in 3 blocks: 2 SAMs + 1 PPM per 3 year block x 3 blocks with exam in 10th year.

Part II (SAMs + Simulations) 2004: DM, HTN 2005: CAD, Asthma 2006: Depression, Heart Failure 2007: Well child care, Pain management 2008: Health behavior change, Maternity care Eventual choice from about 20 modules

SAM: Diabetes MellitusDiagnosis 5 quest.

Recognition/mgmnt. macrovasc. Compl. 10 quest.

Recognition/mgmnt. microvasc. Compl. 10 quest.

Non-pharmacologic mgmnt 5 quest.

Pharmacologic mgmnt 15 quest.

DKA/HONK mgmnt 5 quest.

Clin. Impl. Insulin resistance 5 quest.

Prevention 5 quest.

Hypertension SAM/ClinSim Ratings as of April 1, 2005

0%10%20%30%40%

50%60%70%80%90%

6 5 4 3 2 1

Rating (high--> low)

Per

cent

Relevance Currency Usefulness Overall

N = 1744Means:Relevance 5.54Currency 5.66Usefulness 5.31Overall 5.18

ABFM Self-Assessment Modules: Completion Time

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

FinishHours

0

200

400

600

800Frequency

Diabetes

Changes Resulting from Diplomate Input

Questions printable for initial completion off line (“pre-test”)

Only incorrectly answered questions appear upon completion

On-line full text references for questions Direct link to references from questions

CME Process vs. QI cycle

Needs assessment

Objectives

Implementation

Evaluation

Follow-up

Plan

Do

Study

Act

Price D. Continuing medical education, quality improvement, and transfer of practice. Medical Teacher 2005;27(3): 259-268.

Part IV Patient-based, physician controlled improvement

model (HTN, DM, CAD, asthma, depression, HF) 6 or more quality indicators per condition Practice audit 10 charts/patients Feedback vs. peers & benchmarks Select area(s) for improvement Develop QI plan (from a “QI wizard”)

Re-audit (PDSA) 10 charts/patients

I hope this has been an eye opening experience