Transcript Physician Quality and Core Competencies: A Profound
MOC Part IV: The Role of the ABP in Improving Quality of Care for Children
Practice Performance Improvement Summit American Board of Radiology Chicago, Il August 19, 2006 Paul V. Miles MD Vice President, Director of Quality Improvement And Practice Assessment
“I am sorry for you, young men (and women) of this generation. You will do great things. You will have great victories, and standing on our shoulders, you will see far, but you can never have our sensations. To have lived through a revolution, to have seen a new birth of science, a new dispensation of health, reorganized medical schools, remodeled hospitals, a new outlook for humanity, is not given to every generation.” …Sir William Osler ABP
Demands on Physicians for Quality of Care
Professional obligation Maintenance of board certification Career development Maintenance of licensure Credentialing Malpractice Pay for performance ABP
The Program for Maintenance of Certification in Pediatrics™
PMCP-G ™ Generalist Pediatricians PMCP-S ™ Pediatric Subspecialists ABP
ABP: Maintenance of Certification PMCP-G PMCP-S Part One: Professional Standing Valid license, no restrictions Part Two: Lifelong Learning ABP Knowledge self assessment AAP PREP (ABP approved) ABP Decision Skills Assessment ABP Knowledge self assessment via literature review AAP Neo Reviews (ABP approved) Part Three: Cognitive Expertise Secure, proctored exam Part Four: Performance in Practice A. Pediatric CAHPS Survey (and Peer Survey) B. eQIPP or eQIPP-like modules or local QI effort
Part 1
Valid, unrestricted license – Maintenance of licensure (MOL) Pediatric patient survey (CAHPS) 2007 Professionalism survey - future ABP
Part 2: Knowledge Self Assessment (Open book, low stakes, requires passing score) Existing ABP Knowledge self-assessment ABP Decision Skills AAP PREP (broad based general knowledge) Subspecialty modules (current best articles) Subspecialty prep programs (eg. Neoreviews) In Development Patient Safety Self Assessment QI Self Assessment & QI Basics Module ABP Available 2006 2006 2006 2006-10 2006-10 2008 2008
Part 3
ABP is considering requiring the secure exam every 10 years instead of every 7 years ABP
Part 4
Diplomate enrolls in MOC On the ABP Web-site
Part 4 Practice Assessment & Improvement
Option A Option B Web based modules Participate in Established Such as eQIPP or ABMS Improvement Project Patient Safety Module (including attestation forms) Complete QI Knowledge Self Assessment or Stand Alone QI Module with Assessment (Required with Option B) Credit for Part IV MOC
ABP
Part 4
Existing (Web based) eQIPP modules (Asthma & ADHD) In Development – 4A Web based ABMS Patient Safety Module eQIPP Nutrition & other modules Performance Improvement Modules (PIMs) In Development – 4B Credit for ongoing projects ABP Available 2006 2007 2007-10 2007 2007
Medical Knowledge Quality Improvement Knowledge Measurement Improvement Re Measurement ABP
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QIPP allows the learner to quickly assess their practice online.
ABP
A real-time data analysis allows the learner to begin to identify opportunities for improvement.
ABP
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QIPP offers an interactive learning environment. The program also includes practical, easy-to-use tools that can be implemented quickly into the office setting.
ABP
After completing the clinical content, the learner uses the
Model for Improvement
to identify opportunities for improvement in their practice.
ABP
ABP Within each step, the learner will receive advice for identifying, prioritizing, refining, and launching new improvement cycles.
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QIPP subscribers have access to the modules for three years. You will be able to track your progress, and monitor your successes over time.
Additional eQIPP Modules
• Nutrition • Bright futures (well child care) • Six to ten additional common topics by 2009 ABP
ABMS Patient Safety Module
Accurate and Complete Medication List Safer Prescription and Medication Order Writing Accurate and Complete Allergy Information Hand Hygiene Correct Patient/Site/Procedure Critical Test Results Notification ABP
Performance Improvement Modules (PIMs)
Diplomate Registers & Chooses Module Diplomate Measures Practice Quality Clinical Data Survey Data Rapid Cycle Improvement ABP Diplomate Chooses Change Package Change Package 1 Change Package 2 Change Package 3 Diplomate Re Measures Quality
Annotated Comparative Run Chart
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
Annotation Annotation Annotation Annotation Annotation
Baseline
Time
Test #1 Test #2 Your Practice Test #3 Comparison Test #4
Goal ABP
Part 4
Diplomate enrolls in MOC On the ABP Web-site
Part 4 Practice Assessment & Improvement
Option A Option B Web based modules Participate in Established Such as eQIPP or ABMS Improvement Project Patient Safety Module (including attestation forms) Complete QI Knowledge Self Assessment or Stand Alone QI Module with Assessment (Required with Option B) Credit for Part IV MOC
ABP
Competence in Quality Improvement
Pass a QI Knowledge Self Assessment Exercise: an open book multiple choice question exam Part 2 (in development) Complete a valid QI project ABP
ABP Standards for Part 4 B
Standards for Established Programs to receive ABP approval for Part 4 Standards for meaningful participation by a diplomate in an Established Program ABP
Cumulative % of Asthma Population with "Perfect Care": Network and Select Practices 100% Long Term Goal = 95% 90% 80% 70% 60% 50% Project Inception | q Performance Feedback Reports | q Improvement Collaborative on Reliability | q P4P Program | q z Self Management Collaborative Initiated p Web-based Registry Launched 40% 30% p P4P Deadline 20% 10% p "Perfect Care" Including Flu Shot 0% Oc t 0 3 No v 03 De c 0 3 Ja n 04 Fe b 04 Ma r 0 4 Ap r 0 4 Ma y 04 Ju n 04 Ju l 0 4 Au g 04 Se p 04 Oc t 0 4 No v 04 De c 0 4 Ja n 05 Fe b 05 Ma r 0 5 Ap r 0 5 Ma y 05 Ju n 05 Ju l 0 5 Au g 05 Se p 05 Oc t 0 5 No v 05 OVPCA Network Practice 1 Practice 2 Practice 3 Practice 4 Practice 5 “Perfect Care”: composite measure of severity classified, identified management plan, and controller medications for patients with persistent asthma Copyright © 2005 Cincinnati Children’s Hospital Medical Center; all rights reserved ABP Practice 6
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Cumulative % of Asthma Population with "Perfect Care": Commercial vs. Medicaid/Uninsured Commercially Insured Medicaid/Uninsured Copyright © 2005 Cincinnati Children’s Hospital Medical Center; all rights reserved ABP
Subspecialty Care: What to do about small numbers?
Collaborative practice with standardization of care Enroll patients in multicenter studies with shared data to determine best practices ABP
Acute Lymphoid Leukemia
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1960-63 70-73 74-76 77-79 80-82 83-90
Simone J., Lyons, J: J Clin Oncology 1998 Sep;16(9):2904-5 ABP
Percent of Patients Meeting the NKF DOQI Target Urea Reduction Ratio of 65%
figure 4.25, prevalent hemodialysis patients, 1999, by HSA 91.2 + (93.1) 89.2 to 91.2
87.1 to 89.2
83.6 to 87.1
below 83.6 (81.0) USRDS Atlas ABP
Quality of Care (ESRD)
35 30 25 20 15 Ave ra ge UR R 1993: 62.7% 1994: 63.8% 1995: 65.5% 1996: 66.8% 1997: 68.0% Oc t-De c '93 Oc t-De c '94 Oc t-De c '95 Oc t-De c '96 Oc t-De c '97 10 5 0 <50% 50-54% 55-59% 60-64% 65-69% 70-74% 75-79% 80+%
Ure a Re duction Ratio (URR)
* Sixteen Network areas participated in the first ESRD Core Indicators assessment (Oct-Dec 1993); all Network areas participated in subsequent years. ABP
Adequacy of Hemodialysis
Hemodialysis Dose by Race 100 80 60 40 20 0 46 36 53 43 62 54 70 63 73 69 76 70 85 83 19 93 19 94 19 95 19 96 19 97 19 98 19 99 20 00 87 84
Sehgal A, JAMA 2003;289:1996-1000 ABP
Whites Blacks
Initial Efforts in Subspecialty Care
PIBDnet – Inflammatory Bowel Disease Cystic fibrosis - Pulmonology High risk newborns – Neonatology Catheter Related Blood Stream Infections in PICU – Critical care Neonatal Congenital Heart Disease – Cardiology ABP
Prevention of Catheter-related Blood Stream Infections
Marlene R. Miller, M.D., M.Sc.
Christopher T. McKee, DO Ivor Berkowitz, M.D.
Claire Beers, R.N., M.S.N.
Johns Hopkins Children’s Center and Hospital Epidemiology and Infection Control
ABP
Subsequent BSI Outcomes
25 1
Rate of BSI per 1000 CL Days (reordered)
1 2 20
PRE POST
15 10 5 0 1 5 UCL=15.19
9 13 17 21 25
time period
ABP 29 33 37 41 _ X=3.99
45 LB=0
New Products and Programs that ABP has invested in
Part 2 General pediatric knowledge self assessment Decision skills exercise Subspecialty specific (13 subspecialties) knowledge modules Quality Improvement knowledge self assessment exam ABP
New Products and Programs that ABP has invested in
Part 4 Web based modules AAP eQIPP nutrition module Performance Improvement Modules Patient safety module Practice based QI efforts Pediatric GI – inflammatory bowel disease database and collaborative Critical care – catheter related blood stream infections Cardiology – Congenital heart disease project General pediatrics – RWJF funded Improving Performance in Practice (IPIP) with internal medicine and family medicine ABP
Alliance for Pediatric Quality
A collaboration of four major national pediatric organizations formed to measurably improve the quality of health care for America’s children.
ABP
Timeline
Certificates expiring between 2003 and 2009 – Parts 1 and 3: Valid license and secure exam Certificates expiring in 2010 and 2014 – all four Parts: One activity each in Parts 2 and 4 ABP