Purpose: Health care systems and their physicians continuously strive to improve care to patients through QI initiatives. Yet participating in these activities, particularly for residency program physicians, may seem like one more “to do” along with all the other things to be checked off including those related to specialty board (re) certification, state licensure requirements, and ACGME requirements. ACCME President and CEO Graham McMahon argues that eliminated administrative burden by combining quality efforts and education in our organization can create alignment in continuing education and support physician resilience. Our project sought to utilize a single QI initiative to meet multiple system, accreditation and provider needs and seamlessly complete associated “check box” requirements.
Methods: Family medicine residents and faculty are required to participate in quality improvement initiatives, to learn how to manage patients and populations including those with disparities, meet specialty board certification requirements and engage in scholarly activities. We cross-walked these requirements at the start of a single health care disparities project to assure that we were meeting the elements for each requirement through the unifying lens of improving patient care quality metrics. Colorectal Cancer (CRC) screening is a system quality metric with records monitored for patients > 50 years of age. Analysis of clinic site data revealed that the largest CRC screening disparity was age (not race or gender). Patients aged 5054 had the largest disparity gaps ranging from 13-15% compared to those > 65 age. Team members at two residency clinic practice sites approached project using the IHI Model for Improvement with participation. Interventions included caregiver/provider education on available/approved CRC tests at standing resident/faculty meeting, clinic scripts for how to approach CRC screening with patients, and workflow refinements occurring as part of iterative PDSA cycles. Project leaders successfully applied for Part IV MOC through the system’s Continuing Professional Development Portfolio Program.
Results: Our clinical quality disparities quality improvement projected targeting 50-54 yo patients for CRC screening demonstrated an increase in CRC screening with improvements of 1% and 6% at two clinical sites during project period. As a result, we decreased the age disparity gap by 5% for CRC screening in our family medicine residency clinics. 23 participants (11 residents and 12 faculty) completed 2 PDSA cycles with three data points to obtain Part IV MOC credit. Core project team members have presented their project process and results at peer reviewed system wide forums and at regional/national specialty meetings thereby meeting the ACGME’s accreditation requirements for scholarly activities and disparities.
Conclusion/Discussion: As educational leaders, our project followed McMahon’s recommendation that QI – MOC Part IV activities be designed and implemented across the continuum of education using a team-based approach aligned with the ACGME CLER process. Our results are exciting! We improved patient care. We decreased administrative burden by using a single project to check off multiple ACGME requirements. And our physicians completed their Part IV board (re)certification requirements. Collaboration between project team and leaders from clinical quality, continuing medical education and graduate education can have multiplier effects!
Lehmann W, Simpson D, Ouweneel K, Frederick T, Nichols C, Blaza J, Wiley, J. Achieving the Multiplier Effect Using Part IV MOC. Peer Reviewed Poster Presentation. American Board of Medical Specialties (ABMS) Conference. September 25, 2017. Chicago, IL.