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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. What our patients see.

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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


What our patients see
What our patients see

  • 54% of the time adults receive recommended appropriate care (McGlynn)

  • 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……….”)


Maintenance

Of Certification

PMCP-G

PMCP-S

Competencies

Part One: Professional Standing

Professionalism

Medical knowledge

QI knowledge

System knowledge

Part Two: Lifelong Learning

Medical knowledge

QI knowledge (PBLI)

System knowledge (SBP)

Part Three: Cognitive Expertise

Patient Care

Medical knowledge

Communication

QI (PBLI)

System-based practice

Part Four: Performance in Practice


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


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)

ABP Decision Skills Assessment

ABP Knowledge SA (literature review)

AAP NeoReviews (ABP approved)

Other Subspecialty Prep programs

Assessment

Tools

Part Three: Cognitive Expertise

Secure, proctored exam

Part Four: Performance in Practice

Web-based modules and/or Established QI effort (ABP approved) Patient/Peer Survey


Part 1
Part 1

  • Valid, unrestricted license – Maintenance of licensure (MOL)

  • DANS national reporting system for physicians with restrictions to their medical license


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


Part 3 secure cognitive examination
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”


Part 4
Part 4

Diplomate enrolls in MOC

On the ABP Web-site

Patient Survey

Part 4 Practice Assessment & Improvement

Option AOption B

Web based modules Participate in Established

Such as eQIPP or ABMS Improvement Project

Patient Safety Module (including attestation forms)

Complete QI Knowledge Self Assessment

(Required with Option B)

Credit for Part IV MOC


Pediatric cahps
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


Part 41
Part 4

Diplomate enrolls in MOC

On the ABP Web-site

Patient Survey

Part 4 Practice Assessment & Improvement

Option AOption B

Web based modules Participate in Established

Such as eQIPP or ABMS Improvement Project

Patient Safety Module (including attestation forms)

Complete QI Knowledge Self Assessment

(Required with Option B)

Credit for Part IV MOC


Abp focus on quality improvement
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

shape


Looking for bad apples historic approach to physician quality
Looking for Bad Apples(historic approach to physician quality)

Brent James Patient Safety Reporting Systems and Applications IOM


Improving good apples abp focus
Improving Good Apples (ABP focus)

Brent James Patient Safety Reporting Systems and Applications IOM


Part 4 self evaluation of performance in practice
Part 4: Self-Evaluation of Performance in Practice

  • 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.


Part 4a web based qi modules
Part 4A: Web Based QI Modules

ABP Approved Products:

  • Education in Quality Improvement for Pediatric Practice (AAP eQIPP)

  • Patient Safety Improvement Program (ABMS)

  • Performance Improvement Modules (being developed with the AAP)


Performance improvement modules
Performance Improvement Modules

Diplomate

Registers &

Chooses

Module

Diplomate

Measures

Practice

Quality

Diplomate

Chooses

Change

Package

Diplomate

Re Measures

Quality

Change

Package

1

Clinical

Data

Change

Package

2

Survey

Data

Change

Package

3

Rapid Cycle Improvement


Part 4b credit for established qi
Part 4B: Credit for Established QI

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 of participation for Part 4 credit.



Medical

Knowledge

Quality

Improvement

Knowledge

Measurement

Improvement

Re Measurement


eQIPP allows the learner to quickly assess their practice online.


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


e identify opportunities for improvement.QIPP offers an interactive learning environment. The program also includes practical, easy-to-use tools that can be implemented quickly into the office setting.


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


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


e identifying, prioritizing, refining, and launching new improvement cycles.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 challenge for medical education
The Challenge for Medical Education identifying, prioritizing, refining, and launching new improvement cycles.

  • 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?


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