Taking Performance Improvement (PI) to the Next Level ...

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

[email protected]

Shelly Rodrigues, CCMEP, CAE

Deputy Executive Vice President

415-345-8667

[email protected]

Thanks!

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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