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PQI Summit Conference and WorkshopPQI Summit Conference and WorkshopDallas, TXDallas, TX
August 18, 2007August 18, 2007
Part IV: Roles for Societies/Leaders:Part IV: Roles for Societies/Leaders:Education/CommitmentEducation/Commitment
Educational courses, SAMs on Part IV Workshops on subtopics of PQI Identify key PQI focus areas New/additional guidelines, metrics Provide PQI tools, project templates Work with other societies on database
development Sharing with other societies
what we are asking from what we are asking from …..Society…..Society
PQI projects development ..partnering with the ABR
Emphasize safety, error reductions, opportunity to improve quality
SAMS Course on how to reduce errors, improve safety and improve quality
Website links to yours involving lectures, programs for all diplomates
Where do we go from here?Where do we go from here?
PQI Summit Conference and WorkshopPQI Summit Conference and WorkshopDallas, TXDallas, TX
August 18, 2007August 18, 2007
PQI Summit Conference and WorkshopPQI Summit Conference and WorkshopDallas, TXDallas, TX
August 18, 2007August 18, 2007
PQI Summit Conference and WorkshopPQI Summit Conference and WorkshopDallas, TXDallas, TX
August 18, 2007August 18, 2007
Changes will occur!Changes will occur!
PQI will evolvePQI will evolvePrograms will developPrograms will develop
““Getting Real with Practice Getting Real with Practice Qualty Improvement”Qualty Improvement”
Diversity of Practice; DR, Diversity of Practice; DR, RO, RPRO, RP
Overview Questions Overview Questions
Why did you choose the project? How did you decide on the metric? How will your Society sponsor it?
– Is it a template? How will data be collected and recorded? Do you anticipate multiple projects? Action ideas Insights/issues
PQI Summit Conference WorkshopPQI Summit Conference Workshop Radiation Oncology Radiation Oncology
Bruce Haffty, M.D., ABR ModeratorBruce Haffty, M.D., ABR Moderator
American Society for Therapeutic Radiology and Oncology: Performance Assessment
– Kathy Thomas, M.D.American Brachytherapy Society Project
– W. Robert Lee, M.D.Type I Project
– Peter Johnstone, M.D.– Jonathan Beitler, M.D.
Overview Questions Overview Questions
Why did you choose the project? How did you decide on the metric? How will your Society sponsor it?
– Is it a template? How will data be collected and recorded? Do you anticipate multiple projects? Action ideas Insights/issues
PQI Summit Conference WorkshopPQI Summit Conference WorkshopRadiology PhysicsRadiology Physics
Richard Morin, PhD, ABR ModeratorRichard Morin, PhD, ABR Moderator
American Association of Physicists in Medicine– Michael Yester, PhD
ABR Trustees: Templates for Type I Projects– Richard Morin, PhD– Geoff Ibbott, PhD– Donald Frey, PhD
Overview Questions Overview Questions
Why did you choose the project? How did you decide on the metric? How will your Society sponsor it?
– Is it a template? How will data be collected and recorded? Do you anticipate multiple projects? Action ideas Insights/issues
Why PQI?Why PQI?To demonstrate that radiologists use
measures of quality in their practice
To continuously improve the quality of radiologic practice in the U.S.
To respond to public outcry for better patient safety standards and to improve the quality of care in all of medicine
ABR DIPLOMATES
Life-Time CertificationTime-Limited Certification
(11,000)
MUSTEntry MOC
Optional Entry MOC
Yes Desires not to recertify
Personal CommitmentState Requirement
Hospital Requirement
ABR’s Components of MOCABR’s Components of MOC
Part I: Professional Standing
Part II: Lifelong Learning and Periodic Self-assessment
Part III: Cognitive Expertise
Part IV: Practice Quality Improvement
Why do we need Part IV: Why do we need Part IV: PQI?PQI?
Huge variations in care at local, regional and national levels
Regional differences in cost/outcomes
Lack of evidence based practice Reduce errors, improve patient
safety
Why do we need database?Why do we need database?
Need to know our baseline at a national level
Public disclosure of quality measurement data lead to improvements in quality of care
Analyzing the System FlawsAnalyzing the System Flaws
Almost all improvable errors result from flawed systems
Identify areas where breakdowns occurCreate a feasible plan to fix these areasInstitute planWait a suitable time—new system “up
and running”Remeasure original metric
Part IV: Practice Quality Part IV: Practice Quality Improvement (PQI)Improvement (PQI)
Focus on practice improvement
Potential areas (select ONE):
Patient safety
Accuracy of interpretation
Referring physician surveys
Report turnaround time
Compliance with established Practice Guidelines and Technical Standards
National Patient Safety Goals - Hand-hygiene - Medication error prevention- Universal protocol- Patient identification- Improve communication between caregivers
Radiology specific error reduction programs- Radiation dose- MR safety
- Safe use of contrast material- Others
Patient SafetyPatient Safety
PQI ProcessPQI Process
Learn about PQI ….2007 year Select project appropriate for you, in your practice, or one from a national society Measure certain percent of cases Review and analyze data Create and implement improvement plan Re-measure and track Report participation to ABR
PQI Timeline & Milestone TrackingPQI Timeline & Milestone TrackingDiagnostic Radiology
DiplomatesYear of Cycle
What I must do each year of 10-year MOC cycle Submit report / attestation via the Personal Web Page
1
Learn about PQI Select a project Yes √
2Measure Analyze the data Yes
3
Develop an improvement plan Begin collecting data again Yes
4
Modify improvement planImplement planBegin collecting improvement plan data
Yes
PQI Project TypePQI Project Type
Local level/ group/department/individual
Physicians compare performance against own baseline
Some comparison among peers
Normative databases lacking
Sponsored by national specialty society or organization
Regional or national database participation
Benchmarking
Feedback
Provider Performance Based Provider Performance Based Privileging Plan: CCHMCPrivileging Plan: CCHMC
DEPARTMENT OF RADIOLOGY Provider Performance Based Privileging Plan
JCAHO-ACGME-ABMS 2007-2008
Clinical Division
Standard Performance Measures
Division Director 1/1/07 thru 12/31/08
Professional Performance Behaviors reflecting a commitment to continuous professional development, ethical practice, cultural competence, and a responsible attitude toward patients, families, colleagues and care teams
PALS certification or Radiology Advanced
Life Support Certification CPR Certification (by end of FY2008 and then
each year forward) Meets CME requirements to maintain Ohio
license Zero violations of “Hold Point” Procedure for
invasive procedures Unapproved abbreviations: Mean of < 0.001%
for use of “CC” discovered via Radiology report monitoring system
Fellow evaluations of faculty performance in
category “Role Model for Professionalism” (Acceptable = score of 3 .0 or 4.0)
Meets CME requirements to maintain Ohio
license Completion of JCAHO Patient Safety test
Part IV: Roles for Societies/Leaders:Part IV: Roles for Societies/Leaders:Education/CommitmentEducation/Commitment
Educational courses, SAMs on Part IV Workshops on subtopics of PQI Identify key PQI focus areas New/additional guidelines, metrics How-to workshops for diplomates Provide PQI tools, project templates Work with other societies on database
development
Share descriptions about MOC/PQI
PQI projects/project leadershipGive feedback to ABR membersParticipate in building the futureDiscuss value added for members
Part IV: Roles for Leaders/ Professional Part IV: Roles for Leaders/ Professional Societies:Societies:
CommunicationCommunication
Quality in what we Quality in what we do! do!
ABMS General CompetenciesABMS General Competencies
Medical knowledge
Patient care
Interpersonal and communication skills
Professionalism
Practice-based learning and improvement
Systems-based practice
ABR MOC: the 4 MOC Components & the 6 CompetenciesABR MOC: the 4 MOC Components & the 6 CompetenciesPart IProfessional Standing
Part IILifelong Learning and Self-assessment
Part IIICognitive Expertise
Part IVPractice Performance
Medical Knowledge
State board license requirements and actions
Documentation and completion of 500 CME credits. Minimum of 250 Category 1.
Achieve a passing score on the ABR cognitive exam.
Patient SafetyDouble ReadingPractice Guidelines
Patient Care State board license requirements and actions
Documentation: CME with review of new techniques and protocols.
Achieve a passing score on the ABR cognitive exam, which includes patient care content.
Patient SafetyDouble ReadingTurnaround TimePractice GuidelinesReferring Physician Survey
Interpersonal & Communication Skills
SAMs with emphasis on communications.
Patient SafetyDouble ReadingTurnaround TimePractice GuidelinesReferring Physician Survey
Professionalism State board license requirements and actions
SAMs content on professionalism.
General questions about ethics and charter on professionalism
Practice GuidelinesReferring Physician Survey
Practice-based Learning
& Improvement
Specific CME and SAMs developed for practice-based learning and improvement.
General questions about essential core knowledge and practice improvement principles.
Patient SafetyDouble ReadingTurnaround TimePractice GuidelinesReferring Physician Survey
Systems-based Practice
Specific CME and SAMs developed for systems-based practice.
General questions about CQI content.
Patient SafetyDouble ReadingTurnaround TimePractice GuidelinesReferring Physician Survey
DEPARTMENT OF RADIOLOGY Provider Performance Based Privileging Plan
JCAHO-ACGME-ABMS 2007-2008
Clinical Division
Standard Performance Measures
Interpersonal/Communication Skills Enable the establishment and maintenance of professional relationships with patients, families, colleagues, and care teams
Number of parent, patient & coworker
complaints to Radiologist in Chief concerning behavior, communication & professionalism (Acceptable < 1 per year)
Fellow evaluations of faculty performance in
category “Effective Communication Skills” (Acceptable = score of 3 .0 or 4.0)
Fellow evaluations of faculty performance in
category “Role Model for Interacting with Patients & Families” (Acceptable = score of 3 .0 or 4.0)
Completion of CARES customer service
standards test Zero violations of Policy for documentation
and communication of changes between final and preliminary reports
MD report sign off in 24 hours (Acceptable
compliance rate = 95%)
Medical/Clinical Knowledge
Assign & de-identify imaging studies for
Why PQI?Why PQI?To demonstrate that radiologists use
measures of quality in their practice
To continuously improve the quality of radiologic practice in the U.S.
To respond to public outcry for better patient safety standards and to improve the quality of care in all of medicine
How to Do PQI?How to Do PQI?Steps in the PQI process
Select a practice area to be improvedDetermine the quality
measurement(s) and collect baseline data in target area
Analyze the practice processes that impact on the target area
Devise an improvement planInstitute the plan and remeasure dataReport your findings
For more information:For more information:
Papers on ABR MOC published in all major radiology journals May 2007.
www.TheABR.org
Project SelectionProject Selection
Test of FIRE—projects should be
Feasible
Interesting
Relevant
Ethical
Project SelectionProject Selection
Five areas defined by ABRPatient safetyAccuracy of interpretationReport turnaround timePractice guidelines/technical
standardsReferring physician surveys
Project SelectionProject Selection
Diplomates may choose any projectDevised by a national society (must
be qualified by ABR)Devised by a group practiceDevised by the practitioner
Like SAMs, CME, and the cognitive exam, PQI projects are the responsibility of the individual whether collaborating with a larger group or not
Choosing the MetricChoosing the Metric
Should be a reliable indicator of qualityShould be easy to measure
UnambiguousReproducible
Should be measured enough timesAppropriate to frequency in practiceTarget: 10 minimum, 100 maximum
what we are asking from what we are asking from …..Society…..Society
PQI projects development ..partnering with the ABR
SAMS Courses on How to do PQI projectsSAMS Course on How to reduce errors,
improve safety and improve qualityWebsite links to yours involving
lectures, programs for all diplomates developed by your society
Analyzing the System FlawsAnalyzing the System Flaws
Almost all improvable errors result from flawed systems
Identify areas where breakdowns occurCreate a feasible plan to fix these areasInstitute planWait a suitable time—new system “up
and running”Remeasure original metric
Accuracy of InterpretationAccuracy of Interpretation
National program, such as ACR RadPeer
ABR DIPLOMATES
Life-Time CertificationTime-Limited Certification
(11,000)
MUSTEntry MOC
Optional Entry MOC
Yes Desires not to recertify
Personal CommitmentState Requirement
Hospital Requirement
Why Participate?Why Participate?
May be required by- Health system- Payers- State medical license
Pay for performance
To improve your practice
It’s the right thing to do
ABR Pediatric Subspecialty Certification
(CAQ)
Time-Limited Certification in DR
Time-Limited Certification in subspecialty in pediatrics
Entry MOCRecertify
Pediatric and DR
Entry MOCRecertify DR only
Practice Profile Examination
Desires not to recertifyRecertification
Pediatric Radiology and DR
ABR Pediatric Radiology Subspecialty Certification
(CAQ) MOC
Life-Time Certification in DR
Time-Limited Certification in subspecialty in pediatrics
Entry MOC(CAQ)
Optional Entry MOC
Yes Desires not to recertify
Personal CommitmentState Requirement
Hospital Requirement
Recertification in pediatric radiology and DR
ABR Life-Time Certification
Life-Time Certification Enrolled in MOC
Life-Time Certification