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Closing the Quality Gap

The Role of Maintenance of Certification In Maintaining and Promoting Physician Competency. Closing the Quality Gap. Paul V. Miles MD Vice President, Director of Quality Improvement And Assessment Performance in Practice American Board of Pediatrics. What our patients see.

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Closing the Quality Gap

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  1. The Role of Maintenance of Certification In Maintaining and Promoting Physician Competency Closing the Quality Gap Paul V. Miles MD Vice President, Director of Quality Improvement And Assessment Performance in Practice American Board of Pediatrics

  2. What our patients see • 54% of the time adults receive recommended appropriate care (McGlynn) • 42% of the time children receive recommended appropriate care (Mangione-Smith) • “With that much variation, they can’t all be right” …..Jack Wennberg • There is a gap between knowing and doing (“every system……….”)

  3. Maintenance Of Certification PMCP-G PMCP-S Competencies Part One: Professional Standing Professionalism Medical knowledge QI knowledge System knowledge Part Two: Lifelong Learning Medical knowledge QI knowledge (PBLI) System knowledge (SBP) Part Three: Cognitive Expertise Patient Care Medical knowledge Communication QI (PBLI) System-based practice Part Four: Performance in Practice

  4. PMCP • First cohort began in 2003 • Approximately 4500 pediatricians each year • By 2010 this group must meet the requirements for all four parts of MOC

  5. Maintenance Of Certification PMCP-G PMCP-S Part One: Professional Standing Valid license, no restrictions Part Two: Lifelong Learning ABP GP knowledge SA AAP PREP (ABP approved) ABP Decision Skills Assessment ABP Knowledge SA (literature review) AAP NeoReviews (ABP approved) Other Subspecialty Prep programs Assessment Tools Part Three: Cognitive Expertise Secure, proctored exam Part Four: Performance in Practice Web-based modules and/or Established QI effort (ABP approved) Patient/Peer Survey

  6. Part 1 • Valid, unrestricted license – Maintenance of licensure (MOL) • DANS national reporting system for physicians with restrictions to their medical license

  7. Part 2: Knowledge Self Assessment (Open book, low stakes, requires passing score)

  8. Part 3: Secure Cognitive Examination • Cognitive simulation of practice • Predominantly assesses higher-order intellectual abilities—not recall Clinical Judgment: >50% Synthesis: 20 to 35% Recall Knowledge: <15% • Includes conditions that could present to any practice, but doesn’t require knowledge that good practitioners would normally “look up”

  9. Part 4 Diplomate enrolls in MOC On the ABP Web-site Patient Survey Part 4 Practice Assessment & Improvement Option AOption 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 (Required with Option B) Credit for Part IV MOC

  10. Pediatric CAHPS • Developed for ambulatory care • Provide feedback to pediatricians on how well they communicate with patients and involve them in care • Built into an improvement model (physicians will be given strategies to test to improve their communication performance) • Has the ability to discriminate at the individual or the group level

  11. Part 4 Diplomate enrolls in MOC On the ABP Web-site Patient Survey Part 4 Practice Assessment & Improvement Option AOption 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 (Required with Option B) Credit for Part IV MOC

  12. ABP Focus on Quality Improvement • The MOC process is focused on helping pediatricians measure and improve quality of care and their professional development • The ABP is not interested in trying to measure individual physician practice performance shape

  13. Looking for Bad Apples(historic approach to physician quality) Brent James Patient Safety Reporting Systems and Applications IOM

  14. Improving Good Apples (ABP focus) Brent James Patient Safety Reporting Systems and Applications IOM

  15. Part 4: Self-Evaluation of Performance in Practice • Understand the benefits of collecting data from your own practice. • Collect data on a specific disease entity or problem from your patients’ charts. • After collecting data, interpret and analyze it so you can use it. • Compare your care with peers and benchmarks to be able to learn from others • Based on your analysis, identify and test opportunities for improvement within your practice.

  16. Part 4A: Web Based QI Modules ABP Approved Products: • Education in Quality Improvement for Pediatric Practice (AAP eQIPP) • Patient Safety Improvement Program (ABMS) • Performance Improvement Modules (being developed with the AAP)

  17. Performance Improvement Modules Diplomate Registers & Chooses Module Diplomate Measures Practice Quality Diplomate Chooses Change Package Diplomate Re Measures Quality Change Package 1 Clinical Data Change Package 2 Survey Data Change Package 3 Rapid Cycle Improvement

  18. Part 4B: Credit for Established QI Recognition of valid participation in an ABP approved structured quality improvement program • Boards set standards for design, implementation, and results of structured QI programs. • Boards set standards defining meaningful participation in accredited programs. • Programs apply for accreditation. • Physicians supply attestation and documentation of participation for Part 4 credit.

  19. Part 4

  20. Medical Knowledge Quality Improvement Knowledge Measurement Improvement Re Measurement

  21. eQIPP allows the learner to quickly assess their practice online.

  22. A real-time data analysis allows the learner to begin to identify opportunities for improvement.

  23. eQIPP offers an interactive learning environment. The program also includes practical, easy-to-use tools that can be implemented quickly into the office setting.

  24. After completing the clinical content, the learner uses the Model for Improvement to identify opportunities for improvement in their practice.

  25. Within each step, the learner will receive advice for identifying, prioritizing, refining, and launching new improvement cycles.

  26. eQIPP subscribers have access to the modules for three years. You will be able to track your progress, and monitor your successes over time.

  27. The Challenge for Medical Education • How do we integrate medical education with the delivery of quality care so that students see and participate in the ongoing assessment and improvement of care that is safe, timely, effective, efficient, patient centered and equitable?

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