Transcript PQI Summit ABR Presentations

Maintenance of
Certification – Part IV
PQI
Practice Quality Improvement
The Summit
August 19, 2006
The Summit - Objectives

Learn more about Quality Improvement and
the ABR’s PQI Program
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Learn about ideas-projects-plans of
participating organizations/societies
Identify ways for societies to engage in PQI to
help their members

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the tangible Benefits of PQI
how to engage, support, challenge Radiologists
Beginning to develop a National Database

Maintenance of
Certification
Mandate of the American Board of Medical
Specialties

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Goal to improve the quality of health care through physicianinitiated learning and quality improvement
Response to public expectation for physician competence

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generation of new knowledge  application in practice
recognition of medical errors
To Err is Human: Building a Safer Health Care System
- Institute of Medicine, 2000
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public concerns re underuse, overuse, misuse of health care in U.S.
MOC – a physician-based response to demonstrate, ensure
physician competence and continuing competence

Clinical practice, delivery of health care
The General Competencies – the
Basis of Maintenance of
Certification

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medical knowledge
patient care
interpersonal & communication skills
professionalism
practice-based learning & self-improvement
systems-based practice
Maintenance of Certification - ABR

From certification toward demonstration of
competency in practice of medicine

Responsibility of
-

physicians
institutions/organizations in medical education,
continuing medical education/training
ABMS identification of components of MOC
Part I – Professionalism
 Part II – Lifelong Learning and Periodic Self-Assessment
 Part III – Cognitive Expertise
 Part IV – Practice Performance

Maintenance of Certification
for Radiologists (DR, RO, RP)

MOC introduced for Radiology in 2005
 Formal implementation Parts I-IV: 2007

Parts I-III developed for radiology, radiation
oncology, radiation physics

Part IV under development – ABR, educational
and professional societies
Maintenance of Certification
- Part IV

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highlights competencies in medical practice,
delivery of care
Practice Quality Improvement (PQI)
practice-based focus
 based upon metrics
 includes action plan for quality improvement

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engage physicians, societies/organizations
in Practice Improvement (PQI)
Maintenance of Certification
- Part IV
Features of Practice Quality Improvement (PQI)
Project  choose
 Process  learn
 Participate  complete review
 Plan  ongoing improvement
 Progress  document
 Potential  benchmarks, national database

Practice Quality
Improvement – Role of
Societies
or
Why are you here?
George S. Bisset
Department of Radiology
Duke University Medical Center
Durham, NC
American Board of Radiology
Mission
“To serve patients, the public, and the
medical profession. . .”
“By certifying that its diplomates have
acquired, demonstrated, and maintained a
requisite standard of knowledge, skill, and
understanding. . .”
ABR Transition
OLD
Physics Exam
Clinical Exam
Oral Exam
NEW
Physics Exam
Clinical Exam
Oral Exam
Maintenance of
Certification
ABMS and MOC
• All 24 Boards committed to MOC
• ABMS must approve each board’s
program
Why “not” MOC?
New administrative and financial burdens
 May not improve patient care
 Self-assessment components – rigor?
 Not fully defined (WIP)

Why MOC?(Pragmatic)
All Boards – Time-limited certificates
 All Boards – MOC participation
 Provider privileging
 Market forces pushing pay-forperformance
 Federation of State Medical Boards –
“responsibility to public to ensure
competence of physicians seeking
relicensure”

Why MOC?(Philosophical)
We are all lifelong students of medicine
 Perversity
 Hypocrisy
 Patient expectations
 External regulators
 Prerogative of self-regulation (maintaining
autonomy)
 Public accountability

MOC Goals
Lifelong learning
 Self-directed learning
 Based on needs assessment
 Practice specific
Recognition of diversity of practice
 Continuous quality improvement

Benefits of Practice Improvement
Better patient….
 Care
 Outcomes
 Safety
 Better practice-based learning
 Quality of care puts us all on the same side

Why do we need PQI?
Lack of documentation for quality of care
for most important diseases
 Lack of resource evaluation
 Huge variations in care at local, regional
and national levels
 Lack of outcome assessment

Pay-for-Performance Push
Bridges to Excellence
 The Leapfrog Group
 The Integrated Healthcare Association
 Health Care Value Initiatives
 CMS/Premier

How is PQI done?
Select issues where change may be useful to
the practice
 Incorporate different types of evidence
 Continuously refresh data during process
 Utilize data to monitor departmental
progress
 Sharing of results (national database)

Why do we need database?
Need to know our baseline at a national
level
 Public disclosure of quality measurement
data lead to improvements in quality of
care

What should Societies do?
Design tools to support radiologists in their
efforts to enhance quality of patient care
 Strong physician leadership – develop and
execute radiologist-led initiatives
appropriate to subspecialty
 Focus on evidence-based clinical guidelines
 Form work groups to move process forward

Create leadership-driven
ad hoc committee
Choose topic to be measured
based on importance
Review current established guidelines
Measure performance
Develop measures
-Accurate and meaningful
-Trackable over time
-Universally available
Evaluate performance in relation
to agreement with guidelines
Interventions
Remeasure performance
Summary
MOC is essential for quality healthcare
 Practice Quality Improvement is a vital
component of MOC
 Societies can assist with development of
PQI projects

MOC Component 4
DIAGNOSTIC RADIOLOGY
&
SUBSPECIALTIES
Gary J. Becker, MD
PQI Summit
Chicago, Illinois, August 19, 2006
Then…
Pass a test, earn a lifetime
certificate
Now…
Maintenance of
Certification depends on
continuing competence…
Competent Physician
“Maintenance of competence should
be demonstrated throughout the
physician’s career by evidence of
lifelong learning and ongoing
improvement of practice.”
ABMS, September 1999
“Competency is not just
knowing what to do;
it is doing
1Blackwell
et al. [DRAFT] Final report of the committee on recognizing
new and emerging disciplines in internal medicine; ABIM 2006
1
it.”
MOC Components
Evidence of:
1: Professional standing
2: LLL and periodic self-assessment
3: Cognitive expertise
4: Evaluation and improvement
of performance in practice
In MOC, Component 4 is
where “the rubber hits the
road”!
The main purpose of
MOC is…
…to improve the quality
of care we deliver
individually & collectively
To accomplish this…
…we must participate in
Practice Quality
Improvement (PQI)
What Do We Need?
3 Essentials of Improvement
 Will –acknowledge defects exist; desire to improve
 Ideas –changes that will result in improvement
 Execution –effectively apply changes; sustain
D. Berwick, MD, Institute for Healthcare
Improvement
PQI project: diplomate focuses on
an important aspect of practice,
…measures performance, then…
plans, improves, & measures
again
Where are we
heading?
Years 1-5
Years 6-10
PQI Timeline
Role of ABMS
Mission: “…establishes standards for
physician specialty certification and
MOC…to support the public’s
quest for safe, high-quality
healthcare.”
Role of ABMS in MOC Process
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MOC guidelines
Timetable (deadlines)
Oversight, feedback
Approval of plans of member boards
Resources
Benchmarking
 Advice and consultation
 Education (symposia)
 Addressing issues common to all boards

-FSMB licensure verification
-Surveys, questionnaires
-Software, especially to support Part 4
Applying ABMS Guidelines to
Radiology Every Diagnostic Radiology
PQI Project MUST:
 Be relevant to diplomate’s practice
 Be doable in practice setting
 Be suited to trending over MOC cycle
 Effect quality improvement
 Include these competencies*:
Patient care
*May
Practice-based learning and improvement
Systems-based practice
also include others
Participating in Diagnostic Radiology
 Select PQI project PQI
 Communicate selection to ABR
 PW-protected reporting on ABR diplomate
Webpage
 Reporting follows template
 >1 PQI project in 1st 10-yr cycle (begins
01/2007)
 Trended data collection >3X/cycle
 Diplomate also reports on 6 competencies
DR
PQI
 EXPECT CHANGE
 PQI is under development (WIP)
 ABR monitoring national healthcare priorities for critical PQI
opportunities
 Incorporation of priorities into Part 4
 Expert consensus evolves with evidence
 Regional/national normative databases
 Participation in institutional CQI
 Accreditation status (JCAHO, VA, ACR, etc.) as basis for PQI
projects
 Practice-relevant SAMs; improvement plan
 Random audits
To Develop ABR’s Part 4 Program
ABR faced challenges of DR landscape, larger healthcare
picture
 Practice diversity
 Generalists & subspecialists
 Active practitioners, administrators
 Consultative & direct patient care
 Hospital-based, office-based & mixed
 Radiology: no disease-specific focus
 National healthcare priorities
5 PQI Project Categories for DR
 Practice guidelines & technical standards
 Referring physician surveys
 Patient safety
 Double reading
 Turnaround time
Two PQI Project Types
 Type I: local level

Physicians compare performance against own baseline

Some comparison among peers

Normative databases lacking
 Type II: sponsored by national specialty
society or organization

Regional or national database participation

Benchmarking

Feedback
Type II PQI Project Examples
 RADPEERTM
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Peer review of routine image interpretation

Summary stats for each participant by modality

Summary data for facility by modality

Data from all participating facilities by modality
 ABMS’ CAHPS Peer Survey1
 ABMS’ Web-based Patient Safety Project

1Consumer
Available mid-2007
Assessments of Health Plans Survey
PQI Timeline & Milestone Tracking
DR Diplomates
Year of
Cycle
1
What I must do each year of 10-year MOC cycle
Select project and metric(s)
Collect, analyze baseline data
Submit report / attestation via
the Personal Web Page
Yes
2
Develop improvement plan
Implement plan
Begin collecting improvement plan data
Yes
3
Complete collection of improvement plan data
Analyze data
Summarize data
Yes
4
Modify improvement plan
Implement plan
Begin collecting improvement plan data
Yes
5
Continue collecting data
Yes
PQI Timeline & Milestone Tracking
DR Diplomates
Year of
Cycle
What I must do each year of 10-year MOC cycle
Submit report / attestation via
the Personal Web Page
6
Complete collection of improvement plan data
Analyze data
Summarize data
Yes
7
Refine improvement plan
Implement plan
Begin collecting improvement plan data
Yes
8
Continue collecting data
Yes
9
Complete collection of improvement plan data
Analyze data
Summarize data
Yes
10
Prepare final report of results and conclusions
Sustain the gain of 1st cycle
Select topic for next cycle
Yes
PQI: Patient Safety
TOPIC LIST (MUST CHOOSE ONE)
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Safe use of iodinated RCM
ALARA
MR Safety
JCAHO Universal Protocol
National Patient Safety Goals
NQF Safe Practices for Better Healthcare
Prevention of medication errors
ABMS Web-based patient safety module
Other (with ABR approval)
PQI: Double Reading
MUST INCLUDE ALL 3 OF THESE ELEMENTS:
 Study of error rate; objective of rate reduction
 Analysis of root causes; plan to minimize
 Changes by 2nd reader: significance, time, cost
PQI: Turnaround Time
SUBTOPICS (Both):
 Access: FROM exam/procedure request TO
completion
 Reporting: FROM exam/procedure completion TO
final report availability
PQI
Practice Guidelines & Technical Standards
REQUIREMENTS
 ACR Communication Guideline (select at least 1)
-Comparison reports
-Communicating preliminary/final report discrepancies
-Communication of urgent/serious findings to referring physician
-Communication to self-referred patients
 Other Guidelines & Standards (select at least 1)
-Widely accepted standard of national specialty/subspecialty
organization
-ACR: ~100 available
PQI: Referring Physician Surveys
 CAHPS1 or institutional survey (>50 referring
physicians)
 All subtopics must be included in years 1-3
-Exam/procedure access
-Urgent examination and consultation
-Satisfaction in the interaction
-Comments about professionalism
-Report turnaround
1Consumer
Assessments of Health Plans Survey
ABR MOC: the 4 MOC Components & the 6 Competencies
Professional
Standing
Lifelong Learning and
Self-assessment
Cognitive
Expertise
Practice
Performance
Medical
Knowledge
State board license
requirements and
actions
Documentation and completion
of 500 CME credits. Minimum of
250 Category 1.
Achieve a passing
score on the ABR
cognitive exam.
Patient Safety
Double Reading
Practice Guidelines
Patient Care
State board license
requirements and
actions
Documentation: CME with review
of new techniques and protocols.
Achieve a passing
score on the ABR
cognitive exam,
which includes
patient care content.
Patient Safety
Double Reading
Turnaround Time
Practice Guidelines
Referring Physician Survey
Interpersonal &
Communication
Skills
Patient Safety
Double Reading
Turnaround Time
Practice Guidelines
Referring Physician Survey
SAMs with emphasis on
communications.
SAMs content on
professionalism.
General questions
about ethics and
charter on
professionalism
Practice Guidelines
Referring Physician Survey
Practice-based
Learning
&
Improvement
Specific CME and SAMs
developed for practice-based
learning and improvement.
General questions
about essential core
knowledge and
practice
improvement
principles.
Patient Safety
Double Reading
Turnaround Time
Practice Guidelines
Referring Physician Survey
Systems-based
Practice
Specific CME and SAMs
developed for systems-based
practice.
General questions
about CQI content.
Patient Safety
Double Reading
Turnaround Time
Practice Guidelines
Referring Physician Survey
Professionalism
State board license
requirements and
actions
Competencies Report for Diagnostic Radiology
Diplomate Name:____________ ABR ID:_________ Check one: 1st yr___ 5th
yr___ Final___
Professional
Standing
Lifelong Learning and
Periodic Self-Assessment
Cognitive Expertise
Medical Knowledge
CME required
by state board
for licensure
Practice-related exam
questions
Patient Care
Unrestricted
licensure
Fundamental (“general
content”) exam questions
Unrestricted
licensure
Practice environmentrelated exam questions
Interpersonal &
Communication
Skills
Professionalism
Practice-based
Learning &
Improvement
Practice environmentrelated exam questions
Systems-based
Practice
Practice environmentrelated exam questions
Evaluation of Performance
in Practice
Part 4: Roles for Professional
Societies
 Educational courses, SAMs on Part 4
 Identify key PQI focus areas
 Develop new tools, guidelines, metrics, project
templates
 How-to workshops for your members
 Work with other societies on database development
 Deliver message: PQI is work-in-progress!!! Expect
change!!!
Practice Performance
Radiation Oncology
PQI
Bruce G. Haffty, MD
Radiation Oncology MOC
10-Year Cycle

Professional Standing
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Life-long Learning and Self Assessment
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CME-20 Hours/Year Total 200 Hours
Self-Assessment Modules-8 Required over 10 Years
Cognitive Expertise
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Licensure-Maintained Throughout
Examination-Year 8,9 or 10
Practice Performance Improvement Projects (PQI)
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3 Required Over 10 Years
PQI Projects
Fundamentals
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Individual Physician Based
Patient Care Related
Measurable Endpoints/Benchmarks
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Evidence Based Guidelines, Consensus or Peer
comparison
Action Plan/Improvement Plan
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Baseline Assessment
Improvement Plan
Follow-up assessment of the effect of improvement
PQI Projects
Fundamentals

Each of 6 Competencies Should be assessed
at least once during MOC cycle
Medical Knowledge
 Patient Care
 Interpersonal and communication skills
 Practice Based learning and Improvement
 Professionalism
 Systems Based Practice

Radiation Oncology PQI Projects
Type I and Type II

Type I
Individual/Departmental/Institutionally
Developed
 Should Address the fundamental elements of a
PQI program (Physician based, patient care,
measurable endpoints, Action Plan, etc)
 Self Attestation
 Subject to ABR Random Audit
 Creativity/Novel Approaches Encouraged

Radiation Oncology-Type I
Projects

Institutional Quality Improvement Projects
Physician-or Practice-Based Patient Care
 Measurable outcomes
 Benchmarks
 Action Plans

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Outcomes projects (i.e., retrospective reviews)
Should be related to patient care outcomes
 Physician based
 Action Plans

Radiation Oncology PQI Projects
Type I and Type II

Type II
Developed externally by Professional Societies
 Should address the fundamental elements of a
PQI program (physician based, patient care,
measurable endpoints, action plan, etc.)
 Requires submission to and qualification by
ABR
 Establishment of centralized databases, pooled
data for comparisons and benchmarks
encouraged

Type II (Society Initiated)
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Submitted and “Qualified” by ABR in RO
Must meet fundamental elements of ABMS
PQI type programs
Current examples:
ACR-RO - PEER
 ASTRO - PAAROT
 ABS - under development

Radiation Oncology PQI Projects
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Proposed model is as follows:

Three Projects over 10 Year Cycle

Type II - at least one of the 3 must be Type II

Up to two of the three can be Type I Individual/Institutional
 creativity is encouraged
Radiation Oncology
PQI Projects-Phase in for MOC

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3 Projects over the 10-year Cycle
 Goal of one project within each 3-year
interval
For those diplomates whose time-limited
certificates expire within the next few years,
PQI requirement will be phased in

diplomates with TLC expiring in 2090 or 2010
will need to complete one PQI by December
2009 or 2010, respectively)
Radiation Oncology
Practice Quality Improvement
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This element of MOC remains the least
developed and most difficult to manage
Remains the component that can have the
greatest impact on one of the critical goals
of the MOC program - Improvement in the
Quality of Patient Care and Outcomes
Practice Quality Improvement
RO Objectives for the Summit
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Discuss Fundamental Elements of PQI Programs
Discuss Type I and Type II Programs
Provide Guidance to Individuals/Practices for
Developing Type I Programs
Provide Guidance to Societies for Developing Type
II Programs
Encourage the Engagement of ABR Diplomats
Discuss Options for Reporting, Documentation
and Validation of PQI Programs
Practice Quality Improvement:
The Specifics for Radiologic
Physics
Trustees, Radiologic Physics:
G. Donald Frey, Ph.D. – Medical Nuclear Physics
Richard L. Morin, Ph.D. – Diagnostic RP
Bhudatt R. Paliwal, Ph.D. – Therapeutic RP
Assoc Exec Director, Radiologic Physics:
Stephen R. Thomas, Ph.D.
PQI Summit:
Additional Considerations for
Radiologic Physics (1)
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Review the Challenges: Define how PQI
applies to radiologic physics and identify
the potential role of PQI projects in
promoting quality improvement in RP
practice.
Call to Action: Encourage societies with a
component of RP to participate in the
development of PQI programs for medical
physicists.
PQI Summit:
Additional Considerations for
Radiologic Physics (2)
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
Establish a Working Environment: Create a
framework wherein both medical physicists
and RP societies work together defining tools
for enabling medical physicists to incorporate
PQI programs as an integral part of their
practice.
Projections for the Future: Where do we want
to go? How will we get there? What happens
after we arrive?
PQI for Radiologic Physics –
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The Unique Position of Medical
Physicists
Only 2 of the 24 boards of the ABMS have nonphysician members.
ABMS Website description of Part IV: Directed
toward evidence of evaluation of performance
in practice for physicians.
The PQI program development in RP will be
focused on the physicist as a medical
professional who contributes to and supports
patient care within the healthcare system, while
not having primary responsibility for the
patient.
ABMS Guidelines for Part IV:
Application to the Practice of
Medical Physics
The challenges
for
Radiologic Physics:
What fits - What doesn’t (Quite)!
Selected Guideline Illustrations


Guideline #1: PQI programs: Phase-in,
evaluate effectiveness, systematically improve,
update diplomates on development:
RP – Ok in concept.
Guideline #2: Assessment process reflective
of activities related to patients or patient care:
RP – Ok under the label of patient care.
Selected Guideline Illustrations


Guideline #6: Assessment of patient care
focus on sampling of patients in practice with
a key disease or clinical process.
RP – Needs adjustment
Guideline #12: Assessment of physician
performance begin during residency and
continue throughout practice.
RP – Currently, the residency considerations
are not applicable.
The Evolving Nature of PQI
Projects for Radiologic Physics
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Recognition that operational PQI projects
for RP have not been finalized at this point.
Importance of this Summit as a vehicle for
open
communication,
brainstorming
options, and establishing cooperative
engagement in moving forward.
Importance of initiating PQI projects even
if understood to be interim/evolving Getting RP Diplomates committed to the
concepts and started down the pathway.
Society Initiation of PQI Projects
for Radiologic Physics:
American Association of Physicists in
Medicine (AAPM)
AAPM TG-127 on MOC
Educational Council
Professional Council
 ACMP, RSNA, ASTRO, ACR, SNM, ….
 CAMPEP – Commission on Accreditation
of Medical Physics Educational Programs

PQI Principles for Radiologic Physics:
Framework for Consideration

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Choose 1 RP PQI project for the 10-year cycle
Selected from a list of defined and approved
projects
Data collected and reported at 2 time points –
potentially within the 4th and 7th years
A normative peer review process to be used
Diplomates identify/contact their own
qualified reviewer who will use ABR
prescribed instruments for the evaluation
PQI Projects under consideration
for Radiologic Physics

ABMS application (Dec 2005)
1.) Professional and Regulatory Guidelines:
Performance based on fulfillment of physics
component according to established criteria.
2.) Safety for Patients, Employees, Public:
Performance based on fulfillment of established
standards related to safety program responsibilities.
3.) Educational Activities:
Performance based on documented evaluation
according to national standards for teaching.

Evaluation of Scope of Practice
PQI Project Example for RP:
Professional & Regulatory Guidelines
Normative guidelines
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RP based procedures: AAPM Task Group Reports
Practice Guidelines/Technical Standards: ACR, ACMP
Mammography Quality Standards ACT: MQSA
Accreditation programs (RP component): ACR, ACRO
Equipment Acceptance Testing: NEMA
Endpoints

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Compliance: Dichotomous outcome – Successful or
not-successful, but….
Identify the opportunities for quality improvement
PQI Project Example for RP:
Professional & Regulatory Guidelines

Methodology: Implementation of activities
according to protocols as defined in the programs.
 Measurement: Comparison of performance as
documented by the diplomate to the criteria as
established by the program. The results are peer
reviewed using the practice performance evaluation
instrument.
 Feedback: Local self-assessment of performance
according to the degree of fulfillment of the
established criteria/standard, and feedback by the
peer reviewer.
Evaluation of Scope of Practice:
Model Example
AAPM TG 103 Report: Peer Review in Clinical
Radiation Oncology Physics (2005)

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Guidelines: Primarily focused on the solo practice,
but, may also be appropriate for group settings.
Time Frame: Site visit designed to be completed in
one working day.
Review Areas Specified:

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Processes used in routine clinical practice at facility
Product of the physics group work
Physics policies of the institution
Checklists: Provided as tools for the reviewer
Goals in Establishing Effective
Scope-of-Practice PQI Tools
Thoughts under consideration:

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Develop streamlined review templates for all RP
disciplines (subsets of AAPM TG 103 Report)
Develop guidelines for implementation of
Scope-of-Practice reviews
Establish a pool of trained reviewers
Provide courses in PQI Scope-of-Practice
procedures at upcoming AAPM annual meeting
In Summary …

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We are underway in the opening stages of defining
PQI projects for Radiologic Physics.
Processes will evolve as we move through the first
cycle.
It is expected that enhanced tools for assessing
quality improvement in RP will be forthcoming as
experience is acquired.
Of importance for this Summit:
To identify and reach consensus on initial pathways
for implementation of viable PQI programs for RP.
 To engage in a collaborative, intersociety effort to
provide effective PQI projects for RP.

“Nuts and Bolts”
The ABR’s Part IV Program:
Practice Quality Improvement
Jennifer Bosma, PhD
Some Essential Elements

Every PQI project must include:
 Data collection based on own practice
 Measures – the “metric”
 Data analysis/synthesis
 Documentation of improvement plan
based upon performance
What does ABR want?




Keeping it simple this first 10-year DR cycle
Allowing creativity by individuals & societies
Allowing diplomates to gain knowledge of QI
The diplomate:

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Reports project selected
Attests to participation: answers “yes, I have
participated” in the current step of the PQI process
Is ready to provide evidence of activity if asked, similar
to state board random audits of CME
The Process - DR
PQI: Years 1-3
•
•
•
Collect & analyze baseline data.
Develop & implement improvement plan.
Collect & analyze more data.
First segment complete.
The Process – DR (cont’d)
PQI: Years 4-6
•
•
•
Modify & implement
improvement plan.
Collect more data.
Analyze data.
Second segment
complete.
PQI: Years 7-9
•
•
•
Refine & implement
improvement plan
Collect more data.
Analyze data.
Third segment complete.
PQI - DR: Year 10

Brief summary of results and conclusions.

Work to sustain the gains.

Select project(s) for the next cycle.
Reporting MOC Participation



“Personal Page” on ABR web site
11,000+ time-limited certificate holders
First phase complete
Update contact information
 Pay annual fee online
 Access via initial registration process


Second phase – Rad Physics example
Professional Standing
 Lifelong Learning

PQI Timeline & Milestone Tracking
Diagnostic Radiology Diplomates
Year of
Cycle
1
What I must do each year of 10-year MOC cycle
Select project and metric(s)
Collect baseline data
Submit report / attestation via
the Personal Web Page
Yes √
2
Develop improvement plan
Implement plan
Begin collecting improvement plan data
Yes
3
Complete collection of improvement plan data
Analyze data
Summarize data
Yes
4
Modify improvement plan
Implement plan
Begin collecting improvement plan data
Yes
Personal Page - future

PQI participation
Project selected
 Attestation


Gateway
CME: Authenticated credits direct from
societies
 PQI credit ?

Summary



PQI process – 3 cycles in 10 years
PQI reporting – ABR personal page, Gateway
potential
The process will evolve and improve as we all
learn