The American Board of Pediatrics 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
The American Board of Pediatrics What our patients see • 54% of the time adults receive recommended appropriate care (Mc. Glynn) • 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………. ”) 2
The American Board of Pediatrics Maintenance Of Certification PMCP-G PMCP-S Competencies Part One: Professional Standing Professionalism Part Two: Lifelong Learning Medical knowledge QI knowledge System knowledge Part Three: Cognitive Expertise Medical knowledge QI knowledge (PBLI) System knowledge (SBP) Part Four: Performance in Practice Patient Care Medical knowledge Communication QI (PBLI) System-based practice
The American Board of Pediatrics 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 4
The American Board of Pediatrics 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) Assessment ABP Decision Skills Assessment Tools ABP Knowledge SA (literature review) AAP Neo. Reviews (ABP approved) Other Subspecialty Prep programs Part Three: Cognitive Expertise Secure, proctored exam Part Four: Performance in Practice 5 Web-based modules and/or Established QI effort (ABP approved) Patient/Peer Survey
The American Board of Pediatrics Part 1 • Valid, unrestricted license – Maintenance of licensure (MOL) • DANS national reporting system for physicians with restrictions to their medical license 6
The American Board of Pediatrics Part 2: Knowledge Self Assessment (Open book, low stakes, requires passing score) Existing Year ABP Knowledge self-assessment 2006 ABP Decision Skills 2006 AAP PREP (broad based general knowledge) 2003 Subspecialty modules (current best articles) 2006 -9 Subspecialty prep programs (eg. Neoreviews) 2006 -10 In Development QI Self Assessment 7 2008
The American Board of Pediatrics 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” 8
The American Board of Pediatrics Part 4 Diplomate enrolls in MOC On the ABP Web-site Patient Survey Part 4 Practice Assessment & Improvement Option A Web based modules Such as e. QIPP or ABMS Patient Safety Module Option B Participate in Established Improvement Project (including attestation forms) Complete QI Knowledge Self Assessment (Required with Option B) Credit for Part IV MOC 9
The American Board of Pediatrics 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 10
The American Board of Pediatrics Part 4 Diplomate enrolls in MOC On the ABP Web-site Patient Survey Part 4 Practice Assessment & Improvement Option A Web based modules Such as e. QIPP or ABMS Patient Safety Module Option B Participate in Established Improvement Project (including attestation forms) Complete QI Knowledge Self Assessment (Required with Option B) Credit for Part IV MOC 11
The American Board of Pediatrics 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 12 shape
The American Board of Pediatrics Looking for Bad Apples (historic approach to physician quality) 13 Brent James Patient Safety Reporting Systems and Applications IOM
The American Board of Pediatrics Improving Good Apples (ABP focus) 14 Brent James Patient Safety Reporting Systems and Applications IOM
The American Board of Pediatrics Part 4: Self-Evaluation of Performance in Practice 15 • 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.
The American Board of Pediatrics Part 4 A: Web Based QI Modules ABP Approved Products: – Education in Quality Improvement for Pediatric Practice (AAP e. QIPP) – Patient Safety Improvement Program (ABMS) – Performance Improvement Modules (being developed with the AAP) 16
The American Board of Pediatrics Performance Improvement Modules Diplomate Registers & Chooses Module Diplomate Measures Practice Quality Clinical Data Survey Data 17 Rapid Cycle Improvement Diplomate Chooses Change Package 1 Change Package 2 Change Package 3 Diplomate Re Measures Quality
The American Board of Pediatrics Part 4 B: Credit for Established QI • • 18 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 o participation for Part 4 credit.
The American Board of Pediatrics Part 4 Existing – 4 A Web based Year e. QIPP modules (Asthma & ADHD) 2004 In Development – 4 A Web based ABMS Patient Safety Module 2007 e. QIPP Nutrition & other modules 2007 Performance Improvement Modules (PIMs) 2007 In Development – 4 B Credit for ongoing projects 19 2007
The American Board of Pediatrics Medical Knowledge Quality Improvement Knowledge Measurement Improvement Re Measurement
The American Board of Pediatrics e. QIPP allows the learner to quickly assess their practice online. 21
The American Board of Pediatrics A real-time data analysis allows the learner to begin to identify opportunities for improvement. 22
The American Board of Pediatrics e. QIPP offers an interactive learning environment. The program also includes practical, easy-to-use tools that can be implemented quickly into the office setting. 23
The American Board of Pediatrics After completing the clinical content, the learner uses the Model for Improvement to identify opportunities for improvement in their practice. 24
The American Board of Pediatrics Within each step, the learner will receive advice for identifying, prioritizing, refining, and launching new improvement cycles. 25
The American Board of Pediatrics e. QIPP subscribers have access to the modules for three years. You will be able to track your progress, and monitor your successes over time.
The American Board of Pediatrics 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? 27
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