PQI Summit Conference and Workshop Dallas, TX August 18, 2007

Part IV: Roles for Societies/Leaders: Education/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 …..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?

PQI Summit Conference and Workshop Dallas, TX August 18, 2007

Changes will occur!

PQI will evolve Programs will develop

“Getting Real with Practice Qualty Improvement”

Diversity of Practice; DR, RO, RP

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 Workshop Radiation Oncology Bruce 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 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 Workshop Radiology Physics Richard 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 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? 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 Certification Optional Entry MOC Yes Personal Commitment State Requirement Hospital Requirement Desires not to recertify Time-Limited Certification (11,000) MUST Entry MOC

ABR’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: 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? 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 Flaws Almost all improvable errors result from flawed systems Identify areas where breakdowns occur Create a feasible plan to fix these areas Institute plan Wait a suitable time—new system “up and running” Remeasure original metric

Part IV: Practice Quality 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 Safety

PQI 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 Tracking Diagnostic Radiology Diplomates Year 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 √ 2  Measure  Analyze the data Yes 3  Develop an improvement plan  Begin collecting data again Yes 4  Modify improvement plan  Implement plan  Begin collecting improvement plan data Yes

PQI 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 Privileging Plan: CCHMC

Part IV: Roles for Societies/Leaders: Education/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 leadership Give feedback to ABR members Participate in building the future Discuss value added for members Part IV: Roles for Leaders/ Professional Societies: Communication

Quality in what we do!

ABMS 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 Competencies Part I Professional Standing Part II Lifelong Learning and Self-assessment Part III Cognitive Expertise Part IV Practice 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 Safety  Double Reading  Practice Guidelines Patient CareState 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 Safety  Double Reading  Turnaround Time  Practice Guidelines  Referring Physician Survey Interpersonal & Communication Skills SAMs with emphasis on communications.  Patient Safety  Double Reading  Turnaround Time  Practice Guidelines  Referring Physician Survey ProfessionalismState board license requirements and actions SAMs content on professionalism. General questions about ethics and charter on professionalism  Practice Guidelines  Referring 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 Safety  Double Reading  Turnaround Time  Practice Guidelines  Referring Physician Survey Systems-based Practice Specific CME and SAMs developed for systems-based practice. General questions about CQI content.  Patient Safety  Double Reading  Turnaround Time  Practice Guidelines  Referring Physician Survey

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? Steps in the PQI process Select a practice area to be improved Determine the quality measurement(s) and collect baseline data in target area Analyze the practice processes that impact on the target area Devise an improvement plan Institute the plan and remeasure data Report your findings

For more information: Papers on ABR MOC published in all major radiology journals May

Project Selection Test of FIRE—projects should be Feasible Interesting Relevant Ethical

Project Selection Five areas defined by ABR Patient safety Accuracy of interpretation Report turnaround time Practice guidelines/technical standards Referring physician surveys

Project Selection Diplomates may choose any project Devised by a national society (must be qualified by ABR) Devised by a group practice Devised 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 Metric Should be a reliable indicator of quality Should be easy to measure Unambiguous Reproducible Should be measured enough times Appropriate to frequency in practice Target: 10 minimum, 100 maximum

what we are asking from …..Society PQI projects development..partnering with the ABR SAMS Courses on How to do PQI projects SAMS Course on How to reduce errors, improve safety and improve quality Website links to yours involving lectures, programs for all diplomates developed by your society

Analyzing the System Flaws Almost all improvable errors result from flawed systems Identify areas where breakdowns occur Create a feasible plan to fix these areas Institute plan Wait a suitable time—new system “up and running” Remeasure original metric

Accuracy of Interpretation National program, such as ACR RadPeer

ABR DIPLOMATES Life-Time Certification Optional Entry MOC Yes Personal Commitment State Requirement Hospital Requirement Desires not to recertify Time-Limited Certification (11,000) MUST Entry MOC

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 Entry MOC Recertify DR only Practice Profile Examination Desires not to recertify Time-Limited Certification in subspecialty in pediatrics Entry MOC Recertify Pediatric and DR Recertification Pediatric Radiology and DR

ABR Pediatric Radiology Subspecialty Certification (CAQ) MOC Life-Time Certification in DR Optional Entry MOC Yes Personal Commitment State Requirement Hospital Requirement Desires not to recertify Time-Limited Certification in subspecialty in pediatrics Entry MOC (CAQ) Recertification in pediatric radiology and DR

ABR Life-Time Certification Life-Time Certification Enrolled in MOC Life-Time Certification