1. METRIC: A Quality Improvement Innovation Kim Kruger, M.D., Assistant Director Duluth Family Medicine Residency Program

2. Does the thought of quality improvement give you a headache? “I don’t have time.” “I don’t know anything about statistics.” “What kind of project would I do?” “How would I set it up?” “Why should I (or anyone else) care about this outcome?” “It’s way too much work.”

3. Kim, See if the folks in KC could add this slide onto the end of our talk, no? TD Dear Dr Kruger How can your residency program meet ACGME practice-based learning and improvement requirements more easily? METRIC is the answer. METRIC (Measuring, Evaluating, Translating Research into Care) is an innovative online performance improvement program recommended by RRC- FM. Let METRIC help you train residents and faculty by: Evaluating the Family Medicine Center's clinical performance Comparing compliance with evidence-based guidelines among peers Meeting local Quality Improvement requirements Providing necessary documentation for meeting the ACGME requirements And the best part, it's free to family medicine residency programs. Sign up by emailing us at metric@aafp.org. For more information on METRIC, visit www.aafp.org/metric.metric@aafp.org www.aafp.org/metric We look forward to hearing from you. Sincerely, Sandy Schoenemann AAFP Senior Program Coordinator

4. METRIC “Measuring, Evaluating and Translating Research Into Care” www.aafp.org/METRIC AAFP on-line tool to incorporate quality improvement into physician practices Module guides users through a step-by-step process to assess practice and make improvements

5. METRIC Available modules: COPD, CAD, Asthma, Diabetes On-line tutorial about the basics of quality improvement Individual audit of 10 charts Group determines and applies an intervention for next 6 months Re-evaluate charts after 6 months

6. Teach the Competencies Put PRACTICE BASED LEARNING AND IMPROVEMENT into daily life by using relevant patient data to make changes, assess current methods, learn more about a specific population Demonstrate PROFESSIONALISM by showing a commitment to excellence and working with a team Learn SYSTEMS BASED PRACTICE through coordination of care and protocols

7. Teach Lifelong Habits AAFP: Performance Improvement in Practice ACGME: Practice Based Learning and Improvement RRC: Quality Improvement and Scholarly Investigation Future of Family Medicine: Life Long Learning ABFM: Part IV Maintenance of Certification CME: 20 hours

8. What are the benefits? A complete QI project available on- line Can be done with EMR or paper charts Statistics are calculated for you Top-notch technical support Structured process for residents to easily follow

9. What are the challenges? A team leader is necessary Faculty participation is recommended The timing can be challenging with residents in different places on different schedules The group must agree on only one or two interventions May be difficult to find 10 patients per resident for the given module

10. How does it fit in the curriculum? We put it into “Community Medicine” in years 2 and 3 Competency was achieved through completion of the module and printing the certificate for their files We used 3 noon conference slots over 6 months 30 minutes to complete the module and audit 10 charts

12. What do the residents say? Residents became more aware of quality documentation by auditing their own patients’ charts They felt more invested in their own patients’ outcomes They recognized where system weaknesses kept them from performing better

13. What do the residents say? They watched quality improvement processes work for them They saw how they can either lead a team or be a positive, supportive participant They had a better understanding of “pay for performance”

14. Why residency clinics do this best Faculty available to model and lead the team Team approach is used more frequently Innovative practice styles are often developed here Residents are looking for QI methods they can use in their future practices

15. What’s up next? CAD module for both R2 and R3, will alternate with Diabetes or COPD Different faculty joining us for Maintenance of Certification Hoping for a METRIC-R version for residencies (fewer patients required, improved access to the module for the team leader, different comparison graphs at the end to see their improvement as a resident group)

16. Give us your feedback or questions! Kim Kruger: kkruger@dfmrp.orgkkruger@dfmrp.org Duluth Family Medicine Residency Program 330 N. 8 th Avenue East, Duluth, MN 55805 Phone 218-529-9122 Fax 218-529-9120 Web site www.dfmrp.orgwww.dfmrp.org