1. The ABIM Practice Improvement Module (PIM) for Residency Programs

2. Implement and Test Change Collect Data Develop Improvement Plan Functional Anatomy of a PIM Data Synthesized and Returned Develop Practice Improvement Plan Survey Patients Analyze Practice Review Charts P D S A Impact

3. ABIM PIM Topics Asthma Diabetes Preventive Cardiology Clinical Preventive Services Hypertension Care of the Vulnerable Elderly Hospital Care (JCAHO measures) Subspecialty PIMs (2006) –May be especially good for fellows

4. Learning (Improvement) Cycle Deliver Care Measure Care Reflect on Feedback Make a Change

5. Practice Improvement Module – Step 1 Deliver Care Measure Care Reflect on Feedback Make a Change Chart Audit Patient Survey Practice Survey

6. Practice Improvement Module – Step 2 Deliver Care Measure Care Reflect on Feedback Make a Change Chart Audit Patient Survey Practice Survey Performance Report Guided Reflection

7. Practice Improvement Module – Step 3 Deliver Care Measure Care Reflect on Feedback Make a Change Chart Audit Patient Survey Practice Survey Ideas to Change System Performance Report Guided Reflection

8. Practice Improvement Module – Step 4 Deliver Care Measure Care Reflect on Feedback Make a Change Chart Audit Patient Survey Practice Survey Ideas to Change System New Process to Deliver Care Performance Report Guided Reflection

9. Purpose of PIM Chart Audit Physician self assessment Competence in practice-based learning and improvement Systematic analysis of care processes under physician’s control Experience with data collection and management for population-based medicine

10. 9.What was the date and results of the most recent lipid profile? (Enter 0 if unavailable) Month Year Total cholesterolmg dL LDL cholesterol mm Hg HDL cholesterol mm Hg Triglycerides mm Hg 10.Has a screening test for type 2 diabetes been done? Yes No 11.What is the patient's 10-year risk of developing myocardial infarction or coronary death? <10%10-20%>20% DEC2002 230 105 43 98

11. Patient Survey Invite patients to complete a questionnaire –Automated telephone or web –Confidential and anonymous Provides valuable and specific information about specific aspects of care Logistically most difficult in residency clinic setting

12. Examine Practice Systems Builds awareness of systems-based practice –Residents often unaware of what “systems” exist in clinic Identifies level of health information technology Identifies practice staff organization and teamwork Stimulates ideas for improvement

13. 1.Patient medical records contain …Yes+/-No … a problem list that is regularly reviewed and updated. … a medication list that is reviewed and updated at every visit. … a display of key lab results that shows trends, goals, and variation over time. … a display of key clinical findings that shows trends, goals, and variation over time. … an integrated treatment plan that documents and guides treatment decisions of the team. INFORMATION MANAGEMENT

14. Review Report and Develop a Plan Download practice performance analysis compared to guidelines Select opportunities for improvement Develop a plan for improvement Report the impact of the test through re-measurement

15. Patient Characteristics Chart Review (n= 20) Patient Survey (n= 31) DemographicsN%N% Male 1050723 Female10502477 Very good to excellent health723 Fair to poor health1032 Risk factors for CHD N%N% Prior MI210413 Other clinical CHD15 Symptomatic carotid artery disease15 Peripheral artery disease001135 Abdominal aortic aneurysm00 Diabetes mellitus420619

16. Outcomes of Care Chart Review (n= 20) Patient Survey (n= 31) Clinical outcomes N%N% Systolic BP <130 mm Hg 9 45 Diastolic BP <85 mm Hg 19 95 LDL cholesterol at goal 7 35 HDL Cholesterol >40 mg dL 10 50 Triglycerides <150 mg dL 12 60 Functional outcomes and behaviors N%N% Good fitness level 2 6 Physical activity > 4 days/week 4 12 Patient satisfactionN%N% Patients rate practice of preventive care excellent 5 19

17. Assessment of 10-year risk for coronary death or MI 10-year risk Your Assessment No. correctly identified No. with risk overestimated No. with risk underestimated Insufficient information to calculate risk <10% 10 3 7 0 10– 20% 5 1 0 4 0 >20% 4 2 2 0 PROCESSES OF CARE

18. Patient Self-Care Support Patient Survey (n= 31) Patient knows…N% …blood pressure level as measured within past year 30 97 …cholesterol level as measured within past 5 years 27 87 Doctor or practice is very good or excellent at… …encouraging questions 20 64 …providing information on preventing heart attacks 29 93 …providing information on side effects of medications 14 45

19. PRACTICE IMPROVEMENT PLAN Enter your goals for improvement: Outcome Measures From % To % Increase patients with LDL cholesterol at goal 35 Increase patients rating preventive care excellent 19 Process Measures From % To % Screening for diabetes done in high-risk patients 20 Improve use of aspirin, antiplatelet or anticoagulant 33 50 60 80

20. Availability PIMs available now –Web-based $100 registration plus $25 dollars per resident 5 medical record audits/resident with a minimum of 25 5 patient surveys/resident –Will score at 25 regardless of total number of residents One practice assessment