11/15/2010

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TRANSITIONING FROM

NEEDS ASSESSMENT TO

PRACTICE GAPS

November 16, 2010

2:00 – 3:00 PM ET

PRESENTERS

Chris PrestaSenior Manager, Enduring MaterialsAmerican Academy of Dermatology

Rebecca DeVivo, MPH, MSWSenior Director, Professional EducationAmerican Society for Gastrointestinal Endoscopy

OBJECTIVES

Define the difference between needs

assessment and practice gap.

Identify evidence-based sources to

gather practice gap data.

Develop tools to collect practice gap

data from learners and experts.

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DISCLAIMER

• This is only our experience – We have not had any

direct feedback from the ACCME.

• All experiences are different depending on your

organization.

WHERE I STARTED:

NEEDS ASSESSMENT

Question: Why is this activity needed?

Typical answers:- Data says this is a topic of importance and

education is needed:- Published, peer-reviewed research- Practice Guidelines

- Members say they want education in this area - Evaluation data- Member surveys

WHERE I STARTED:

NEEDS ASSESSMENT

EXAMPLE 1: Capsule Endoscopy

Evidence Base: ASGE Guideline

States education requirements before competency can be assessed:

“Completion of a hands-on course with a minimum of 8 hours CME Credit, endorsed by a national or international GI or surgical society and review of first 10 capsule studies by a credentialed capsule endoscopist.”

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BUT, ALONG CAME NEW ACCME

CRITERIA and LABELS…

Activity Labels for Criterion 2 (for the November 2011 cohort):

#1: Verification that the activity is developed from a professional practice gap connected to your own learners.

(What do physicians need to be able to do?)

(What is the practice-based problem?)

BUT, ALONG CAME NEW ACCME

CRITERIA and LABELS…

Activity Labels for Criterion 2 (for the November 2011 cohort):

#2: Verification that educational needs(knowledge, competence or performance) underlying the professional practice gaps were identified.

(Why does the problem exist?)

(How can we close the practice gap?)

UPSHOT:

“NEEDS ASSESSMENT” NOT ENOUGH!

We had identified an educational need, but based on what professional practice gap?

However, our Practice Guideline also states the Endoscopists wishing to perform capsule endoscopy:

- Must be able to integrate capsule endoscopy into the overall clinical evaluation of appropriately selected patients.

- Must be familiar with the hardware and the softwarenecessary to perform and interpret the capsule endoscopy images

- Must be able to accurately identify and interpret capsule endoscopy findings

These are practice gaps!

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UPSHOT:

“NEEDS ASSESSMENT” NOT ENOUGH!

To be more specific:

Practice Gap (what do they need to be able to?): - Must be able to integrate capsule endoscopy into the

overall clinical evaluation of appropriately selected patients.

Educational Need (Why does the gap exist? How can we help them close the gap?):

- Knowledge: Evidence-based information on when it is appropriate to use capsule endoscopy in the treatment of a patient.

- Competence: Skills training with the equipment- Performance: Additional experience/confidence in

reading cases

= Hands-on CME Course

So, what are some examples of resources

we can use?

Practice Guidelines

Went through and picked out specific

recommendations related to practice.

Collated all “practice gap” information into one document that can be used for multiple activity files.

ACCME has indicated they are looking for an

overall analysis of practice gaps.

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EVALUATION DATA

Ask attendees to describe a clinical question in

practice encountered in the last year.

Dermatologists told us that they need strategies to:

Safely administer biologic treatments in pediatric

patients

Skills to use a dermoscope

Appropriate treatment for alopecia in women

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EXPERTS

The Epidemiology ERG serves as resource of “experts” to identify practice gaps. The practice gap evaluation was based on the ERG review of literature, informal surveys and interviews with course directors and speakers.

Specific gaps in practice and knowledge were proposed for the following: Reporting adverse events for drugs and/or other treatments

Patient compliance with recommended treatments and behaviors

Use of total body skin exam to screen for skin cancers

Identification of ocular symptoms in rosacea that might lead to corneal disease

Identification of psoriatic arthritis in psoriasis patients that might lead to morbidity and disability

JOURNALS

The sited article reports 8 pts (2 from a previous

study) responding well to UVA-1 therapy. Irradiation with UVA-1 increases the collagenase

production by cultured fibroblasts, which could be

the pathophysiologic mechanism that explains the

good effect of UVA-1. This form of phototherapy

may be a treatment option for patients with this disabling and often therapy-resistant disease.

Kroft EB, Jong EM. Scleredema diabeticorum case

series: successful treatment with UVA-1. Arch

Dermatol. Vol 144:(No7):947-948.

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VERIFICATION THAT THE NEEDS UNDERLYING

THE GAP WERE IDENTIFIED?

Planning Documentation:

- Planning tools – Grids, templates, applications – may need updating.

Previously: Why is this activity needed?

Now:

GAP: What do physicians need to be able to do?

NEED: Why aren’t they able to do it? How can we help them do it? (i.e., knowledge, skills, etc.)

- Planning committee minutes/emails

- Board reports

OKAY, SO BACK TO WHERE I STARTED:

NEEDS ASSESSMENT

Question: Why is this activity needed?

Typical answers:- Data says this is a topic of importance and

education is needed:- Published, peer-reviewed research- Practice Guidelines

- Members say they want education in this area - Evaluation data

- Member surveys

AND NOW?

GAP ANALYSIS

New Question: What do our physicians need to be able to

do?

(that they’re not doing now…)

Typical answers (for ASGE):

- Integrate new technologies or procedures into practice

- Evaluate the latest research in the context of their own practice

- Efficiently and accurately process reimbursement

- Train their nursing staff/endoscopy team

THEN, what do we need to do to help them

do it?

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KEY POINTS

Gap Analysis identifies and documents the

objectives – what do physicians need to be able to do?

Needs Assessment defines the content – how can

we help them do it?

Sources can include:

Clinical Guidelines

Evaluations

Experts

Journals

Results of Performance Improvement Activities

SOME THINGS YOU CAN DO RELATIVELY

EASILY…

1. Look at your planning process:

Odds are, the answers are already there. You just need to tap into them.

A. How do you decide to do educational activities?

B. Who decides to do educational activities?

C. What are they basing their decision on?

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SOME THINGS YOU CAN DO RELATIVELY

EASILY…

2. Look at your data – does the data address practice gaps specifically?

A. Practice guidelines often specify practice gaps.

B. Evaluation/Survey Data: Should the questions be updated to assess practice gaps more specifically?

“What topics would interest you for future courses”

vs.

“What practice areas could you use additional training in to practice more effectively?”

SOME THINGS YOU CAN DO RELATIVELY

EASILY…

C. If you’re using published research, how does it

relate to physician practice?

D. Other sources?

• Public Adverse Events

• New technologies approved by FDA

SOME THINGS YOU CAN DO RELATIVELY

EASILY…3. Look at your planning and evaluation tools:

Do they document the process of planning the activity based on a practice gap?

Do your learning objectives focus on what participants will be able to do?

Does your evaluation assess the practice gaps you identified?

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SOME EASY EVALUATION

QUESTIONS THAT MAY HELP…

My ability to [insert Learning Objective #1] is:

Example:

My ability to define the difference between needs assessment and practice gaps is:

- Significantly increased

- Somewhat increased

- About the same

My ability to identify evidence-based sources to gather practice gap data is:- Significantly increased

- Somewhat increased

- About the same

What will you change in your practice as a result of attending this session?

AUDIENCE RESPONSE

My ability to define the difference between needs assessment and practice gaps is:

- Significantly increased

- Somewhat increased

- About the same

AUDIENCE RESPONSE

My ability to identify evidence-based sources to gather practice gap data is:

- Significantly increased

- Somewhat increased

- About the same

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SOME THINGS YOU CAN DO RELATIVELY

EASILY…

4. Everything should line up:

Practice Gaps: What physicians need to be able to do…

Learning Objectives: What physicians will be able to do as a result of the activity…

Evaluation: What physicians indicate they are able to do as a result of the activity

Follow-up Evaluation: What physicians did as a result of the activity.

TAKE HOME MESSAGES

The most important thing is to shift how you are thinking about “needs assessment” to focus on “practice gaps.”

In most cases, the data and information you need is already there or from the same resource – it’s all in how you identify and document it.

You can use the same tools you have been, but you may want to update the language to ease documentation needs. Better to start now!

ADDITIONAL RESOURCES

National Quality Forum:

http://www.qualityforum.org/

National Guideline Clearinghouse: http://www.guideline.gov/

ACCME tutorials: www.accme.org

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FINAL THOUGHTS…

Thank you

Questions?

QUESTIONS

We welcome your questions and comments.

Please use the chat box on the left side of your screen to submit a question.

THANK YOU!

Please take a moment to complete the brief

evaluation.

We appreciate your feedback!

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THANK YOU!

Join us for the Alliance’s next Takeout Tuesday webinar!

Engaging Physicians in Quality Improvement by

Teaching a Fair Culture: Partnering of CME, Medical Staff, and QI Leaders

Tuesday, December 14, 2010

2:00 – 3:00 PM ET

www.acme-assn.org