Transcript An overview of the structure of PIMs.

The ABIM Practice
Improvement Module (PIM)
for Residency Programs
Functional Anatomy of a PIM
Collect
Data
Survey
Patients
Review Charts
Data
Synthesized
and Returned
Develop
Improvement
Plan
Develop Practice
Improvement
Plan
P
Implement and
Test Change
Impact
A
D
S
Analyze
Practice
ABIM PIM Topics
• Asthma
• Diabetes
• Preventive Cardiology
• Clinical Preventive Services
• Hypertension
• Care of the Vulnerable Elderly
• Hospital Care (JCAHO measures)
• Subspecialty PIMs (2006)
– May be especially good for fellows
Learning (Improvement) Cycle
Deliver Care
Make a Change
Reflect on
Feedback
Measure Care
Practice Improvement Module – Step 1
Deliver Care
Chart Audit
Make a Change
MeasureSurvey
Care
Patient
Practice Survey
Reflect on
Feedback
Practice Improvement Module – Step 2
Deliver Care
Chart Audit
Make a Change
MeasureSurvey
Care
Patient
Practice Survey
Performance
Reflect on
Report
Feedback
Guided Reflection
Practice Improvement Module – Step 3
Deliver Care
Ideas to Change
MakeSystem
a Change
Chart Audit
MeasureSurvey
Care
Patient
Practice Survey
Performance
Reflect on
Report
Feedback
Guided Reflection
Practice Improvement Module – Step 4
New Process to
Deliver
Care
Deliver Care
Ideas to Change
MakeSystem
a Change
Chart Audit
MeasureSurvey
Care
Patient
Practice Survey
Performance
Reflect on
Report
Feedback
Guided Reflection
Purpose of PIM Chart Audit
• Physician self assessment
• Competence in practice-based
•
•
learning and improvement
Systematic analysis of care
processes under physician’s control
Experience with data collection and
management for population-based
medicine
9.
What was the date and results of the most recent lipid
profile?
(Enter 0 if unavailable)
Month
Year
DEC
Total cholesterol
230
105
43
98
LDL cholesterol
HDL cholesterol
Triglycerides
10.
mg dL
mm Hg
mm Hg
mm Hg
Has a screening test for type 2 diabetes been done?
Yes
11.
2002
No
What is the patient's 10-year risk of developing
myocardial infarction or coronary death?
<10%
10-20%
>20%
Patient Survey
• Invite patients to complete a
questionnaire
– Automated telephone or web
– Confidential and anonymous
• Provides valuable and specific
•
information about specific aspects of
care
Logistically most difficult in residency
clinic setting
Examine Practice Systems
• Builds awareness of systems-based
practice
– Residents often unaware of what
“systems” exist in clinic
• Identifies level of health information
•
•
technology
Identifies practice staff organization
and teamwork
Stimulates ideas for improvement
INFORMATION MANAGEMENT
1.
Patient medical records contain …
… a problem list that is regularly reviewed
and updated.
… a medication list that is reviewed and
updated at every visit.
… a display of key lab results that shows
trends, goals, and variation over time.
… a display of key clinical findings that
shows trends, goals, and variation over
time.
… an integrated treatment plan that
documents and guides treatment decisions
of the team.
Yes
+/-
No
Review Report and Develop a Plan
• Download practice performance
•
•
•
analysis compared to guidelines
Select opportunities for improvement
Develop a plan for improvement
Report the impact of the test through
re-measurement
Patient Characteristics
Demographics
Chart
Review
(n= 20)
Patient
Survey
(n= 31)
N
%
N
%
Male
10
50
7
23
Female
10
50
24
77
7
23
10
32
Very good to excellent health
Fair to poor health
Risk factors for CHD
N
%
N
%
Prior MI
2
10
4
13
Other clinical CHD
1
5
Symptomatic carotid artery disease
1
5
Peripheral artery disease
0
0
11
35
Abdominal aortic aneurysm
0
0
Diabetes mellitus
4
20
6
19
Outcomes of Care
Clinical outcomes
Chart
Review
(n= 20)
Patient
Survey
(n= 31)
N
%
N
%
Systolic BP <130 mm Hg
9
45
Diastolic BP <85 mm Hg
19
95
7
35
HDL Cholesterol >40 mg dL
10
50
Triglycerides <150 mg dL
12
60
N
%
N
%
Good fitness level
2
6
Physical activity >4 days/week
4
12
N
%
5
19
LDL cholesterol at goal
Functional outcomes and behaviors
Patient satisfaction
Patients rate practice of preventive
care excellent
N
%
PROCESSES OF CARE
Assessment of 10-year risk for coronary death or MI
10-year
risk
<10%
10–
20%
>20%
Your
Assessment
No.
correctly
identified
No.
with risk
overestimated
10
3
5
1
0
4
2
2
No.
with risk
underestimated
Insufficient
information
to calculate
risk
7
0
4
0
0
PROCESSES OF CARE
Patient Self-Care Support
Patient knows…
Patient
Survey
(n= 31)
N
%
…blood pressure level as measured within past year
30
97
…cholesterol level as measured within past 5 years
27
87
…encouraging questions
20
64
…providing information on preventing heart attacks
29
93
…providing information on side effects of medications
14
45
Doctor or practice is very good or excellent at…
PRACTICE IMPROVEMENT PLAN
Enter your goals for improvement:
From
%
To
%
Increase patients with LDL cholesterol at goal
35
50
Increase patients rating preventive care
excellent
19
60
From
%
To
%
Screening for diabetes done in high-risk
patients
20
80
Improve use of aspirin, antiplatelet or
anticoagulant
33
80
Outcome Measures
Process Measures
Availability
• PIMs available now
– Web-based
• $100 registration plus $25 dollars per
•
•
resident
5 medical record audits/resident with
a minimum of 25
5 patient surveys/resident
– Will score at 25 regardless of total
number of residents
• One practice assessment