ABP

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

MOC Part IV: The Role of the ABP in Improving Quality of Care for Children

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

PMCP-GPMCP-G PMCP-SPMCP-S

Part One: Professional Standing

Part Two: Lifelong Learning

Part Three: Cognitive Expertise

Part Four: Performance in Practice

Valid license, no restrictions

ABP Knowledge self assessmentAAP PREP (ABP approved)ABP Decision Skills Assessment

Secure, proctored exam

ABP Knowledge self assessment via literature review AAP Neo Reviews (ABP approved)

A. Pediatric CAHPS Survey (and Peer Survey)

B. eQIPP or eQIPP-like modules or local QI effort

ABP: Maintenance of Certification

ABP

Part 1

Valid, unrestricted license – Maintenance of licensure (MOL)Pediatric patient survey (CAHPS) 2007Professionalism survey - future

ABP

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

Part 2: Knowledge Self Assessment (Open book, low stakes, requires passing score)

ABP

ABP is considering requiring the secure exam every 10 years instead of every 7

years

Part 3

ABP

Part 4

Part 4 Practice Assessment & Improvement

Option A Option B Web based modules Participate in EstablishedSuch as eQIPP or ABMS Improvement ProjectPatient Safety Module (including attestation forms)

Complete QI Knowledge Self Assessmentor Stand Alone QI Module with Assessment

(Required with Option B)

Credit for Part IV MOC

Diplomate enrolls in MOCOn the ABP Web-site

ABP

Part 4Existing (Web based) Available

eQIPP modules (Asthma & ADHD)

2006

In Development – 4A Web based

ABMS Patient Safety Module 2007

eQIPP Nutrition & other modules

2007-10

Performance Improvement Modules (PIMs)

2007

In Development – 4B

Credit for ongoing projects 2007

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MedicalKnowledge

QualityImprovementKnowledge

MeasurementImprovement

Re Measurement

ABP

eQIPP allows the learner to quickly assess their practice online.

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A real-time data analysis allows the learner to begin to identify opportunities for improvement.

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eQIPP offers an interactive learning environment. The program also includes practical, easy-to-use tools that can be implemented quickly into the office setting.

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After completing the clinical content, the learner uses the Model for Improvement to identify opportunities for improvement in their practice.

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Within each step, the learner will receive advice for identifying, prioritizing, refining, and launching new improvement cycles.

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eQIPP subscribers have access to the modules for three years. You will be able to track your progress, and monitor your successes over time.

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Additional eQIPP Modules

• Nutrition• Bright futures (well child care)• Six to ten additional common topics by

2009

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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

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Performance Improvement Modules (PIMs)

DiplomateRegisters &

ChoosesModule

DiplomateMeasures PracticeQuality

DiplomateChooses ChangePackage

DiplomateRe Measures

Quality

ClinicalData

SurveyData

Rapid Cycle Improvement

ChangePackage

1

ChangePackage

2

ChangePackage

3

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Annotated Comparative Run Chart

0%10%20%30%40%50%60%70%80%90%

100%

Baseline Test #1 Test #2 Test #3 Test #4

Your Practice Comparison

AnnotationAnnotation

Annotation

Annotation

Annotation

Goal

Time

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Part 4

Part 4 Practice Assessment & Improvement

Option A Option B Web based modules Participate in EstablishedSuch as eQIPP or ABMS Improvement ProjectPatient Safety Module (including attestation forms)

Complete QI Knowledge Self Assessmentor Stand Alone QI Module with Assessment

(Required with Option B)

Credit for Part IV MOC

Diplomate enrolls in MOCOn the ABP Web-site

ABP

Pass a QI Knowledge Self Assessment Exercise: an open book multiple choice question exam Part 2 (in development)Complete a valid QI project

Competence in Quality Improvement

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ABP Standards for Part 4 B

Standards for Established Programs to receive ABP approval for Part 4Standards for meaningful participation by a diplomate in an Established Program

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“Perfect Care”: composite measure of severity classified, identified management plan, and controller medications for patients with persistent asthmaCopyright © 2005 Cincinnati Children’s Hospital Medical Center; all rights

reserved

ImprovementCollaborative on

Reliability|q

PerformanceFeedback Reports

|q

P4PProgram

|q

qP4P

Deadline

zSelf -

ManagementCollaborative

Initiated

qWeb-based

RegistryLaunched

ProjectInception

|q

q"Perfect Care"

IncludingFlu Shot

Long Term Goal = 95%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Oct 0

3

Nov 0

3

Dec 0

3

Jan

04

Feb

04

Mar

04

Apr 0

4

May

04

Jun

04

Jul 0

4

Aug 0

4

Sep 0

4

Oct 0

4

Nov 0

4

Dec 0

4

Jan

05

Feb

05

Mar

05

Apr 0

5

May

05

Jun

05

Jul 0

5

Aug 0

5

Sep 0

5

Oct 0

5

Nov 0

5

OVPCA Network Practice 1 Practice 2 Practice 3 Practice 4 Practice 5 Practice 6

Cumulative % of Asthma Population with "Perfect Care": Network and Select Practices

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0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Oct 0

3

Nov 0

3

Dec 0

3

Jan 0

4

Feb 0

4

Mar 0

4

Apr 0

4

May 0

4

Jun 0

4

Jul 0

4

Aug 0

4

Sep 0

4

Oct 0

4

Nov 0

4

Dec 0

4

Jan 0

5

Feb 0

5

Mar 0

5

Apr 0

5

May 0

5

Jun 0

5

Jul 0

5

Aug 0

5

Sep 0

5

Oct 0

5

Commercially Insured Medicaid/Uninsured

Cumulative % of Asthma Population with "Perfect Care":Commercial vs. Medicaid/Uninsured

Copyright © 2005 Cincinnati Children’s Hospital Medical Center; all rights reserved

ABP

Subspecialty Care: What to do about small numbers?

Collaborative practice with standardization of careEnroll patients in multicenter studies with shared data to determine best practices

ABP

Acute Lymphoid Leukemia

0%10%20%30%40%50%

60%70%80%90%

100%

1960-63 70-73 74-76 77-79 80-82 83-90

Simone J., Lyons, J: J Clin Oncology 1998 Sep;16(9):2904-5

5 y

ear

surv

ival ra

te

ABP

Percent of Patients Meeting the NKF-DOQI 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 91.287.1 to 89.283.6 to 87.1below 83.6 (81.0)

USRDS Atlas

ABP

Quality of Care (ESRD)

0

5

10

15

20

25

30

35

<50% 50-54% 55-59% 60-64% 65-69% 70-74% 75-79% 80+%

Urea Reduction Ratio (URR)

perc

ent

of p

atie

nts

Oct-Dec '93Oct-Dec '94Oct-Dec '95Oct-Dec '96Oct-Dec '97

Average URR1993: 62.7%1994: 63.8% 1995: 65.5%1996: 66.8%1997: 68.0%

* Sixteen Network areas participated in the first ESRD Core Indicators assessment (Oct-Dec 1993); all Networkareas participated in subsequent years.

ABP

Adequacy of Hemodialysis

Hemodialysis Dose by Race

4653

70 73 7685 87

3643

5463

69 7083 8462

0

20

40

60

80

100

1993

1994

1995

1996

1997

1998

1999

2000

Adequate

Hem

odia

lysi

s D

ose

, %

WhitesBlacks

Sehgal A, JAMA 2003;289:1996-1000

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Initial Efforts in Subspecialty Care

PIBDnet – Inflammatory Bowel DiseaseCystic fibrosis - PulmonologyHigh risk newborns – NeonatologyCatheter Related Blood Stream Infections in PICU – Critical careNeonatal Congenital Heart Disease – Cardiology

ABP

Prevention of Catheter-related Blood Stream Infections

Marlene R. Miller, M.D., M.Sc.Christopher T. McKee, DOIvor 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

time period

Rate

of BSI per 1000 C

L Days

454137332925211713951

25

20

15

10

5

0

_X=3.99

UCL=15.19

LB=0

1 21

Rate of BSI per 1000 CL Days (reordered)

PRE POST

ABP

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

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

New Products and Programs that ABP has invested in

ABP

A collaboration of four major

national pediatric

organizations formed to

measurably improve

the quality of health care for

America’s children.

Alliance for Pediatric Quality

ABP

Timeline

Certificates expiring between 2003 and 2009 – Parts 1 and 3: Valid license and secure examCertificates expiring in 2010 and 2014 – all four Parts: One activity each in Parts 2 and 4