Quality and Performance Improvement Continuing Medical Education
Bird GC, Marian K, Bagley B. Effect of a performance improvement CME activity on management of patients with diabetes. J Contin Educ Health Prof. 2013;33:155–163.
509 family physicians assessed 11,538 patient charts for eight data elements based on the AMA’s physician Consortium for Performance Improvement measurement set. Learners selected interventions for improvement. Reassessments took place in different learner cohorts at 1-3 months, 4 – 6 months, 7 – 9 months, and 10- 12 months. This study demonstrated improvement in both procedural performance and in systems-based practice measures of physician learners as a result of their completion of the education.
Learners showed in aggregate strong improvement (>13%) in the number of patients who received appropriate diabetes care related to foot examinations, flu vaccination, and in coordination of care for diabetic retinopathy screening from baseline to follow-up. The data was encouraging as the entire activity was based on a plan-do-study-act (PDSA) design, and results were drawn from just the initial cycle.
Marshall JL, Cartwright TH, Berry CA, et al. Implementation of a performance improvement initiative in colorectal cancer care. J Oncol Pract. 2012; 8:309–314.
540 patient charts were reviewed by 27 clinicians. Topics assessed through a review of patient charts included 22 topics, among them patient safety and supportive care, evidence-based surveillance, and evidenced-based treatment. The topics were derived from guidelines and other successful QI initiatives. The clinicians (89% of whom were MDs) selected their areas for improvement, with 23/27 focusing their improvement plans on patient safety and supportive care. As a result, quantified assessments of patient pain increased by 30%, and psychological assessments of CRC patients increased by 34% after completion of the program.
Participation in this program had a clear impact on the practices of those physicians who sought to improve the quality of their supportive care practices. It did not measure responsive actions by oncologists who determine that a patient is in need of emotional and psychological support.
Shershneva MB, Larrison C, Robertson S, Speight M. Evaluation of a collaborative program on smoking cessation: translating outcomes framework into practice. J Contin Educ Health Prof. 2011; 31(Suppl 1):S28–36.
Nearly 43,000 clinicians participated in a multi-part initiative on smoking cessation. Three of the activities were PI-CME. Performance outcomes of the 3 PI activities varied, with greater improvements observed in one activity (9.0% to 36.2% improvement across 8 measures). Lower clinician performance outcomes were observed in the 2 other PI activities. However, these two PI CME activities observed a smoking quit rate of 231/494 patents, or 46.8%.
Zisblatt L, Kues JR, Davis N, Willis CE. The long-term impact of a performance improvement continuing medical education intervention on osteoporosis screening. J Contin Educ Health Prof. 2013 Fall; 33(4):206-14.
The purpose of this study was to determine whether a performance improvement continuing medical education (PI CME) initiative that utilizes quality improvement (QI) principles and educational interventions, focused on the documented gaps in performance is effective in producing sustainable change in practice to improve the screening of patients at risk for osteoporosis. The percentage of tests for osteoporosis ordered and performed increased significantly from Stage A to Stage C of the PI CME activity and continued to increase after the completion of the PI CME activity. Follow-up data at 4 and 40 months (for ordering and performing osteoporosis screening) and 49 months (for performing the screening only) reflect the impact of the PI CME activity plus the continuing QI interventions.
This study’s major contribution to the literature is to demonstrate that PI CME education has the capacity to promote embedded change in leaners that lasts well beyond the end of the original educational intervention
Sutton LM, Geradts J, Hamilton EP, et al. CHAMBER: A Regional Performance Improvement CME Initiative for Breast Cancer Health Care Providers. J Natl Compr Canc Netw. 2015 Aug;13(8):1005-11.
Eleven of 18 clinicians who treat patients with breast cancer completed a three-step performance improvement CME (PI-CME) activity. The steps included an initial clinical practice assessment and educational activities, and focused on the documented gaps in care and a reassessment.
A total of 208 patient charts were entered at the initial assessment. At the reassessment, 196 charts were entered. Chart review revealed a high rate of HER2 testing (98%) before and after education.
Targeted therapy for patients with HER2+ breast cancer declined after the program (from 96% to 61%), perhaps attributable to an increase in awareness of medical reasons to avoid use of targeted therapy. Assessment for patients' emotional coping ability increased after education (from 55% to 76%; P=.01).
This study demonstrated that clinicians follow protocols in testing, but that CME activities had a positive impact on healthcare provider practice regarding medical and emotional treatment of patients with breast cancer.
509 family physicians assessed 11,538 patient charts for eight data elements based on the AMA’s physician Consortium for Performance Improvement measurement set. Learners selected interventions for improvement. Reassessments took place in different learner cohorts at 1-3 months, 4 – 6 months, 7 – 9 months, and 10- 12 months. This study demonstrated improvement in both procedural performance and in systems-based practice measures of physician learners as a result of their completion of the education.
Learners showed in aggregate strong improvement (>13%) in the number of patients who received appropriate diabetes care related to foot examinations, flu vaccination, and in coordination of care for diabetic retinopathy screening from baseline to follow-up. The data was encouraging as the entire activity was based on a plan-do-study-act (PDSA) design, and results were drawn from just the initial cycle.
Marshall JL, Cartwright TH, Berry CA, et al. Implementation of a performance improvement initiative in colorectal cancer care. J Oncol Pract. 2012; 8:309–314.
540 patient charts were reviewed by 27 clinicians. Topics assessed through a review of patient charts included 22 topics, among them patient safety and supportive care, evidence-based surveillance, and evidenced-based treatment. The topics were derived from guidelines and other successful QI initiatives. The clinicians (89% of whom were MDs) selected their areas for improvement, with 23/27 focusing their improvement plans on patient safety and supportive care. As a result, quantified assessments of patient pain increased by 30%, and psychological assessments of CRC patients increased by 34% after completion of the program.
Participation in this program had a clear impact on the practices of those physicians who sought to improve the quality of their supportive care practices. It did not measure responsive actions by oncologists who determine that a patient is in need of emotional and psychological support.
Shershneva MB, Larrison C, Robertson S, Speight M. Evaluation of a collaborative program on smoking cessation: translating outcomes framework into practice. J Contin Educ Health Prof. 2011; 31(Suppl 1):S28–36.
Nearly 43,000 clinicians participated in a multi-part initiative on smoking cessation. Three of the activities were PI-CME. Performance outcomes of the 3 PI activities varied, with greater improvements observed in one activity (9.0% to 36.2% improvement across 8 measures). Lower clinician performance outcomes were observed in the 2 other PI activities. However, these two PI CME activities observed a smoking quit rate of 231/494 patents, or 46.8%.
Zisblatt L, Kues JR, Davis N, Willis CE. The long-term impact of a performance improvement continuing medical education intervention on osteoporosis screening. J Contin Educ Health Prof. 2013 Fall; 33(4):206-14.
The purpose of this study was to determine whether a performance improvement continuing medical education (PI CME) initiative that utilizes quality improvement (QI) principles and educational interventions, focused on the documented gaps in performance is effective in producing sustainable change in practice to improve the screening of patients at risk for osteoporosis. The percentage of tests for osteoporosis ordered and performed increased significantly from Stage A to Stage C of the PI CME activity and continued to increase after the completion of the PI CME activity. Follow-up data at 4 and 40 months (for ordering and performing osteoporosis screening) and 49 months (for performing the screening only) reflect the impact of the PI CME activity plus the continuing QI interventions.
This study’s major contribution to the literature is to demonstrate that PI CME education has the capacity to promote embedded change in leaners that lasts well beyond the end of the original educational intervention
Sutton LM, Geradts J, Hamilton EP, et al. CHAMBER: A Regional Performance Improvement CME Initiative for Breast Cancer Health Care Providers. J Natl Compr Canc Netw. 2015 Aug;13(8):1005-11.
Eleven of 18 clinicians who treat patients with breast cancer completed a three-step performance improvement CME (PI-CME) activity. The steps included an initial clinical practice assessment and educational activities, and focused on the documented gaps in care and a reassessment.
A total of 208 patient charts were entered at the initial assessment. At the reassessment, 196 charts were entered. Chart review revealed a high rate of HER2 testing (98%) before and after education.
Targeted therapy for patients with HER2+ breast cancer declined after the program (from 96% to 61%), perhaps attributable to an increase in awareness of medical reasons to avoid use of targeted therapy. Assessment for patients' emotional coping ability increased after education (from 55% to 76%; P=.01).
This study demonstrated that clinicians follow protocols in testing, but that CME activities had a positive impact on healthcare provider practice regarding medical and emotional treatment of patients with breast cancer.
