Better Collaboration, Better Care: improving the value of ... · Better Care: improving the value of CME in the health care setting Dave Davis, MD, FCFP Senior Director, Continuing

Better Collaboration,

Better Care: improving

the value of CME in the

health care setting

Dave Davis, MD, FCFPSenior Director, Continuing Education & Performance Improvement

Forest Plourde-ColeResearch and Development Specialist, Continuing Education and Improvement

© 2015 AAMC. May not be reproduced without permission.

• Introduction/overview (Dave)

• Force for change in the clinical environment

• Aligning & Educating for Quality (ae4Q)

• Outputs and outcomes

• Size, scope and impact of the ae4Q community (Forest)

• Drilling Down: some case examples of change (Dave/Forest)

• Looking ahead: marrying staff & faculty development and ae4Q – Educating for Quality in the academic medical center and hospital setting

Agenda


Our Task: Provide Care That Is…

Safe

Effective

Efficient

Timely

Personalized

Equitable

IOM, 2002

• Better care for

patients

• Better health for

communities

• Lower cost for

both


..in this sort of environment

• Increasing uncertainty in the system

• Accelerating rate of change

• Shifting professional roles

• Decreasing resources; increasing expectations

• Expectations of transparency; increased workload

• Diminished joy

4

Spiegelman and Berrett, Patients Come Second, 2014.


Quality improvement: the patient’s perspective

The clinical care gap


Forces for change in the system

Aligned CE/GME/

QI/PS

Research about effective CME,

QI, implementation

Regionalization; population

health management

QI/PS initiatives

Cost transparency and sensitivity

HIT, EHR, quality dataPractice model

evolution

ACA

Alignment of clinical and academic

enterprises

ACGME/CLERACCME

Outcomes-based

education, recertification,

MOC


Two worldsThe “magic” happens here

ae4Q (and

Te4Q)


ae4q: aligning and educating for qualitythe consultative process

Alignment: Organizational Alignment of CME and GME, QI/PI initiatives, practice plans, electronic health records, faculty/staff development, credentials…

Education: Tools

• Use of quality metrics in planning and assessment

• Use of evidence based CME/CPD interventions (including HIT, team training, interactivity, other methods)

Support: On-line Resources, Community of Practice




• What does ae4Q do?

• Outputs and outcomes (Forest)

• Size, scope and impact of the ae4Q community

• Drilling Down: some case examples of change (Dave)

• Looking ahead: marrying faculty development and ae4Q – Educating for Quality in the academic medical center and hospital setting (Forest and Dave)

Agenda


Outputs – Current State

In 2012, 11 pilot sites

launched

34 ae4Q sites, as of

August 2015

Across all four regions

of the USA, with four

sites in Canada

Active community that

engages through

webinars, newsletters,

and networking


Outputs – Our Goal

All health systems,

AMCs specifically,

have adopted the ae4Q

approach, either

through direct AAMC

engagement or

through self-direction

How do we share and

proliferate the

learnings from ae4Q

across the country?


Outcomes – Current State

Two surveys over the last two years have served as proxies for ae4Q outcomes

Two publications have explored ae4Q outputs and outcomes in more detail

Davis NL, Davis DA, Johnson NM, et al. Aligning Academic Continuing

Medical Education With Quality Improvement: A Model for the 21st Century.

Academic Medicine. 2013;88(10):1437-1441.



2015 survey solicited perceptions of outcomes attributable

to ae4Q intervention (n=23)

Organizational improvements cited included:

New champions or stakeholders for CME/QI alignment

and integration (60.8%)

New roles for the CME/CPD office, staff, and leadership

(78.2%)

Organizational/administrative changes or re-alignment

(34.7%)

Improvement in QI/PS culture (47.8 %)



What quality improvement activities has your institution

undertaken as a result of ae4Q?


Outcomes – Our Goal

How do you validate this?

Clinician behavior or practice improvement was reported in 13%

of sites and improvement in clinical outcomes was reported in

17.3% of sites.







• Drilling Down: some case examples of change (Dave/Forest)

• Looking ahead: marrying faculty development and ae4Q – Educating for Quality in the academic medical center and hospital setting

Agenda


M&M/Improvement Conferences


M&M/Improvement Conferences: Key Considerations

Current

• Based on a single case

• Little attention to pre-determined objectives

• Interested in finding ‘fault’

• Setting often confrontational, blaming

• No framework for discussion

• No follow-up

The M&M/Improvement Conference

• Often based on multiple similar cases

• Objectives clear: systems-based

• Open setting, avoiding blame and shame

• Provide framework for analyzing systems, e.g. Fishbone diagram

• Require follow-up

© 2015 AAMC. May not be reproduced without permission.19

PRACTICE-BASED LEARNING AND IMPROVEMENT

(What have we learned, what will we improve)

Improvement

SYSTEM-BASED PRACTICE

(What is the Process?On whom do we depend and

who depends on us)

PROFESSIONALISM(How must we act)

INTERPERSONAL AND COMMUNICATION SKILLS

(What must we say)

MEDICAL KNOWLEDGE(What must we know)

PATIENT CARE(Overall Assessment)

Yes/No

Assessment

PATIENT-CENTERED

EQUITABLEEFFICIENTEFFECTIVETIMELYSAFEAims

Competencies

Healthcare Matrix: Care of Patient(s) with….

© 2004 Bingham, Quinn Vanderbilt University


Fishbone (Cause & Effect) Diagram

Why has room

turnover

time increased?

People Place

Policies Processes

Cause

WhyEFFECT

CAUSES

• Structured team brainstorming

• Represents relationship between some effect and all of the possible causes influencing it


Quality Grand Rounds


Quality Rounds

Current approach

Case presentation –resident’s case of the week, say

Review and critically appraise the evidence

Leave <25% time for Q&A

Quality Round approach

Start with a system problem

Use & present local data

Introduce QI methodology

Engage participants in discussion about how to address QI problem, >25% of the time


Planning:change rounds planning from this…

Isn’t ID always

the third

Tuesday?

I heard Jane XXX at a

recent meeting; she

was GREAT!

Don’t you have a friend at

Pfizer who could support

this?

Isn’t it Joe’s

turn to speak

this month?

What are we doing

here? I thought the

AA planned rounds..


….to thisWhat are the

clinical

problems

we’re trying to

solve here?

How do we know it’s

a problem? What do

the data show?

What are the barriers to

solving them? What about

a systems-based

approach? We’ve had

enough of the one-offs

How can we

use education

to solve it?

What types of education? How

could we deploy them? What

else could we do?


Embedding the Promotion of QI in Educational Activities

1. Highlight clinical areas with quality problems in a traditional educational activity

2. Explicitly add QI content to education on specific clinical topics

3. Embed educational activities in larger QI initiatives; use quality metrics to plan and assess learning activities

4. Supplement education with post-event deliverables

Ann Intern Med 2012;156:305


System-wide changes



The 2013 publication, Reduction of

Venous Thromboembolism (VTE) in

Hospitalized Patients: Aligning

Continuing Education With

Interprofessional Team-Based

Quality Improvement in an Academic

Medical Center, concluded that

aligning continuing education

with quality improvement through

an interprofessional,

multidisciplinary team approach

was associated with a decrease in

VTE.



Committee constructed of

quality experts, clinicians and

CME office

Investigated charts to determine

where to focus intervention

(80/20 rule applied)

Used Pathman/PRECEDE model

to deliver educational

intervention

VTE rates dropped from 12.68

per 1,000 patients in December

2010 to 6.10 per 1,000 patients







• Drilling Down: some case examples of change

• Looking ahead: marrying staff & faculty development and ae4Q in the academic medical center and hospital setting (Forest and Dave)

Agenda


Aligning Education with Quality

Ann Intern Med 2012;156:305


Consultative

engagement to

align education

enterprise

(UME, GME,

CME) with

health system

and patient care

needs

Development of

customized

initiatives and

organizational

changes to

leverage

education to

support QI work

OPTION 2:

Delivery of

Te4Q Faculty

Development

Program Part 1

to train clinical

faculty in QI

basics

Continued

support to

implement

recommendation

s from initial

consultation

Delivery of

TE4Q

workshop,

training faulty

how to teach

QI across the

educational

continuum

Aligning Educational and

Clinical Elements

OPTION 1:

Basic

quality/safety

training for

faculty, site-

driven

Delivery of Quality and Safety Training Across the System

The Educating for Quality suite of services

©Website: www.aamc.org/ae4qEmails:

[email protected]@[email protected]@aamc.org

Karyn Baum, MD, MEd, senior consultant, Quality Educational Initiatives, AAMC

Professor of Medicine, University of Minnesota

mailto:[email protected]




Documents

Better Collaboration, Better Care: improving the value of ... · Better Care: improving the value of CME in the health care setting Dave Davis, MD, FCFP Senior Director, Continuing