The ABIM Practice Improvement Module PIM

• The ABIM Practice Improvement Module (PIM) for Residency Programs

Functional Anatomy of a PIM Collect Data Survey Patients Develop Improvement Plan Review Charts Data Synthesized and Returned 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 Measure Care Patient Survey Practice Survey Reflect on Feedback

Practice Improvement Module – Step 2 Deliver Care Chart Audit Make a Change Measure Care Patient Survey Practice Survey Performance Reflect on Report Feedback Guided Reflection

Practice Improvement Module – Step 3 Deliver Care Ideas to Change Make a Change System Chart Audit Measure Care Patient Survey Practice Survey Performance Reflect on Report Feedback Guided Reflection

Practice Improvement Module – Step 4 New Process to Deliver Care Ideas to Change Make a Change System Chart Audit Measure Care Patient Survey 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) DEC Month Year 2002 Total cholesterol LDL cholesterol HDL cholesterol Triglycerides 10. 11. 230 105 43 98 mg d. L mm Hg Has a screening test for type 2 diabetes been done? Yes 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 % 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 % 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 % 9 45 19 95 7 35 HDL Cholesterol >40 mg d. L 10 50 Triglycerides <150 mg d. L 12 60 N % Good fitness level 2 6 Physical activity >4 days/week 4 12 N % 5 19 Systolic BP <130 mm Hg Diastolic BP <85 mm Hg LDL cholesterol at goal Functional outcomes and behaviors Patient satisfaction Patients rate practice of preventive care excellent

PROCESSES OF CARE Assessment of 10 -year risk for coronary death or MI 10 -year risk Your Assessment No. correctly identified No. with risk overestimated No. with risk underestimated Insufficient information to calculate risk <10% 10 3 7 0 10– 20% 5 1 0 4 0 >20% 4 2 2 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