Self-Assessment, Lifelong Learning, & Assessment of Performance in

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					 Self-Assessment, Lifelong Learning, &
Assessment of Performance in Practice:
    Maintenance of Certification for
      Family Physicians Parts II &IV


            David Price, MD
   Colorado Permanente Medical Group
   Associate Professor Family Medicine
                  UCSHC
   Chair-elect, American Board of Family
                 Medicine

                MedBiquitous April 2007
MOC
   Response of ABMS & member boards to
    quality concerns & gaps
   Multiple stakeholders (patients, FSMB, AMA,
    ACCME, physicians, etc.)
Components of MOC (MC-FP)
I.         Professionalism
II.        Periodic self-assessment (SAM*)
       •     Knowledge assessments (KA*)
       •     Clinical Simulations (ClinSim*)
       •     CME
III.       Cognitive expertise (Examination)
IV.        Practice-based learning & improvement
       •     PPM
       •     MIMM
       •     Pt-Clinician Communication
       •     Pt Safety module
Extend Certification From
7 to 7+3 Years
   Old: 6 SAMs + 1 PPM then exam year 7
   NOW: Diplomates engaged/remaining in MC-
    FP process can extend certificate to 10
    years by completing MC-FP requirements in
    3 blocks:
       2 SAMs + 1 PPM per 3 year block x 3 blocks
       with exam in 10th year.
    Part II (SAMs + Simulations)
   2004: DM, HTN
   2005: CAD, Asthma
   2006: Depression, Heart Failure
   2007: Well child care, Pain management
   2008: Health behavior change, Maternity care
   Eventual choice from about 20 modules
SAM: Diabetes Mellitus
Diagnosis                              5 quest.
Recognition/mgmnt. macrovasc. Compl.   10 quest.
Recognition/mgmnt. microvasc. Compl.   10 quest.
Non-pharmacologic mgmnt                5 quest.
Pharmacologic mgmnt                    15 quest.
DKA/HONK mgmnt                         5 quest.
Clin. Impl. Insulin resistance         5 quest.
Prevention                             5 quest.
                Hypertension SAM/ClinSim Ratings as of April 1, 2005

          90%
          80%                                                N = 1744
          70%                                                Means:
          60%                                                Relevance 5.54
Percent




          50%                                                Currency    5.66
                                                             Usefulness 5.31
          40%
                                                             Overall      5.18
          30%
          20%
          10%
           0%
                 6          5              4             3               2       1
                                         Rating (high--> low)

                             Relevance    Currency   Usefulness     Overall
ABFM Self-Assessment Modules: Completion Time
                                                         Diabetes
               800




               600
   Frequency




               400




               200




                 0
                     0   1   2   3   4   5   6   7   8    9 10 11 12 13 14 15 16
                                             FinishHours
Changes Resulting from Diplomate
Input
   Questions printable for initial completion off
    line (“pre-test”)
   Only incorrectly answered questions appear
    upon completion
   On-line full text references for questions
   Direct link to references from questions
       CME Process vs. QI cycle
Price D. Continuing medical education, quality improvement, and transfer
of practice. Medical Teacher 2005;27(3): 259-268.

           Needs assessment                                  Plan

           Objectives

           Implementation                                    Do

           Evaluation                                        Study

           Follow-up                                         Act
Part IV
   Patient-based, physician controlled
    improvement model (HTN, DM, CAD, asthma,
    depression, HF)
       6 or more quality indicators per condition
       Practice audit 10 charts/patients
       Feedback vs. peers & benchmarks
       Select area(s) for improvement
       Develop QI plan (from a “QI wizard”)
       Re-audit (PDSA) 10 charts/patients
I hope this has been an eye
opening experience

				
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