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
American Board of
Pediatrics
ABP
“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-likeABP
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
Available
ABP Knowledge self-assessment
2006
ABP Decision Skills
2006
AAP PREP (broad based general knowledge)
2006
Subspecialty modules (current best articles)
2006-10
Subspecialty prep programs (eg.
Neoreviews)
2006-10
In Development
Patient Safety Self Assessment
2008
QI Self Assessment & QI Basics Module
2008
ABP
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
Web based modules
Such as eQIPP or ABMS
Patient Safety Module
Option B
Participate in Established
Improvement Project
(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)
Available
eQIPP modules (Asthma & ADHD)
2006
In Development – 4A Web based
ABMS Patient Safety Module
eQIPP Nutrition & other modules
Performance Improvement
Modules (PIMs)
2007
2007-10
2007
In Development – 4B
Credit for ongoing projects
ABP
2007
Medical
Knowledge
Quality
Improvement
Knowledge
ABP
Measurement
Improvement
Re Measurement
eQIPP 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
eQIPP 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
Within each step, the learner will
receive advice for identifying,
prioritizing, refining, and launching
new improvement cycles.
ABP
eQIPP
subscribers
have access to
the modules
for three
years. You will
be able to
track your
progress, and
monitor your
successes over
time.
ABP
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
Diplomate
Chooses
Change
Package
Change
Package
1
Clinical
Data
Change
Package
2
Survey
Data
Change
Package
3
Rapid Cycle Improvement
ABP
Diplomate
Re Measures
Quality
Annotated Comparative Run Chart
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Goal
Annotation
Annotation
Annotation
Annotation
Annotation
Time 
Baseline
Test #1
Test #2
Your Practice
ABP
Test #3
Comparison
Test #4
Part 4
Diplomate enrolls in MOC
On the ABP Web-site
Part 4 Practice Assessment & Improvement
Option A
Web based modules
Such as eQIPP or ABMS
Patient Safety Module
Option B
Participate in Established
Improvement Project
(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%
Performance
Feedback
Reports
|
q
80%
70%
60%
50%
Improvement
Collaborative on
Reliability
|
q
P4P
Program
|
q
Project
Inception
|
q
40%
p
P4P
Deadline
30%
20%
z
Self Management
Collaborative
Initiated
p
Web-based
Registry
Launched
p
"Perfect Care"
Including
Flu Shot
10%
O
ct
03
N
ov
0
D 3
ec
0
Ja 3
n
0
Fe 4
b
0
M 4
ar
04
A
pr
0
M 4
ay
0
Ju 4
n
04
Ju
l0
4
A
ug
04
S
ep
0
O 4
ct
04
N
ov
0
D 4
ec
0
Ja 4
n
0
Fe 5
b
0
M 5
ar
05
A
pr
0
M 5
ay
0
Ju 5
n
05
Ju
l0
5
A
ug
05
S
ep
0
O 5
ct
05
N
ov
05
0%
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
Cumulative % of Asthma Population with "Perfect Care":
Commercial vs. Medicaid/Uninsured
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
Commercially Insured
Medicaid/Uninsured
Copyright © 2005 Cincinnati Children’s Hospital Medical Center; all rights reserved
ABP
Oct 05
Sep 05
Aug 05
Jul 05
Jun 05
May 05
Apr 05
Mar 05
Feb 05
Jan 05
Dec 04
Nov 04
Oct 04
Sep 04
Aug 04
Jul 04
Jun 04
May 04
Apr 04
Mar 04
Feb 04
Jan 04
Dec 03
Nov 03
Oct 03
0%
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
5 year survival rate
Acute Lymphoid Leukemia
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
1960-63
70-73
74-76
Simone J., Lyons, J: J Clin Oncology 1998 Sep;16(9):2904-5
ABP
77-79
80-82
83-90
Percent of Patients Meeting the NKFDOQI Target Urea Reduction Ratio of
65%
figure 4.25, prevalent hemodialysis patients, 1999, by HSA
Percent of
patients
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)
Oc t-De c
Oc t-De c
Oc t-De c
Oc t-De c
Oc t-De c
35
percent of patients
30
25
20
Ave ra ge
UR R
1993: 62.7%
1994: 63.8%
1995: 65.5%
1996: 66.8%
1997: 68.0%
'93
'94
'95
'96
'97
15
10
5
0
<50% 50-54% 55-59% 60-64% 65-69% 70-74% 75-79% 80+%
Urea Reduction 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
100
80
60
46
40
20
36
53
43
62
54
70
63
73
69
76
85
87
83
84
70
0
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
Adequate Hemodialysis
Dose, %
Hemodialysis Dose by Race
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
Rate of BSI per 1000 CL Days (reordered)
1
1
Rate of BSI per 1000 CL Days
25
PRE
20
2
POST
UCL=15.19
15
10
5
_
X=3.99
0
LB=0
1
5
9
13
17
21
25
29
time period
ABP
33
37
41
45
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