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Professional Practice Gap Analysis Form by 7m4ysl36

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									                                               Professional Practice Gap Analysis Form
Please complete and submit to the Speaker Portal or send directly to:                  Britt Rognes, Milliman E: britt.rognes@milliman.com
                                                                                       F: 206-749-6240        P: 206-504-5697
Joint Sponsor Name: Milliman
Activity Title:      Client Forum 2012: The Effective Healthcare Conference
Person completing this form: ______________________
Date of Activity:    September 30 – October 3, 2012
Before each CME-certified activity, Milliman undergoes a thorough gap analysis as part of the educational needs assessment process (Criteria 2-4). The
selection of educational formats methods and media that lend themselves to the desired activity results are chosen based on the gap analysis (Criterion 5). This
form is designed to assess professional practice gaps, select appropriate educational formats, and evaluate the outcomes (Criterion 11) in terms of improved
competence, performance, or patient health in accordance with the ACCME’s Updated Accreditation Criteria. Page 1 is a sample, please complete page 2.

                                                                                                                                                           Level(s) of
                                                                                                                           Rationale for                  Educational
                                                                                                                             Selected                      Outcome
   Standardized                                                                                Proposed                    Educational                   Measurement to
     Measure                   Current Practice               Resulting Gap                  Intervention                   Format(s)                       Be Used
Example
                                                                                                                      A clinical case-based
                                                                                                                      format will be conducive to
                                                                                                                      competence, performance,
                                                                                                                      and patient health
                                                                                                                      improvement. Postactivity
                                                                                                                      academic detailing will
                                                                                                                      serve as positive
                                                                                        Grand rounds in our           reinforcement for adoption
                                                                                        hospital will be employed     of the clinical changes to
                                                                                        followed by academic          reduce the number of
                                                                                        detailing. A checklist and    transfusion reactions. The
                             There is a lack of                                         communication guide will      checklist will help facilitate
                             communication between                                      be provided for physicians    communication about
AHRQ PSI#16 –                physicians, nurses, and                                    to include in patients’       patient and donor blood
Transfusion Reactions All    blood bank lab technicians   As a result, the number of    charts. The objective will    testing and analysis to
blood used in transfusions   prior to the release of a    transfusion reactions in      be to reduce the number       determine antibody               Level 4 (performance) and
must be crossmatched to      unit of blood (or blood      our hospital is greater       of transfusion reactions in   reaction prior to                Level 5 (patient health) will
prevent adverse reactions.   component).                  than the national average.    patients by 7%.               transfusion.                     be measured.
                                                                                                                                                                           Page 1
                          Professional Practice Gap Analysis Form
                                                                                   Level(s) of
                                                                 Rationale for    Educational
                                                                   Selected        Outcome
Standardized                                        Proposed     Educational     Measurement to
  Measure      Current Practice   Resulting Gap   Intervention    Format(s)         Be Used




                                                                                           Page 2

								
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