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

PQI Summit Conference and WorkshopPQI Summit Conference and WorkshopDallas, TXDallas, TX

August 18, 2007August 18, 2007

Part IV: Roles for Societies/Leaders:Part IV: Roles for Societies/Leaders:Education/CommitmentEducation/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 what we are asking from …..Society…..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?Where do we go from here?







Changes will occur!Changes will occur!

PQI will evolvePQI will evolvePrograms will developPrograms will develop

““Getting Real with Practice Getting Real with Practice Qualty Improvement”Qualty Improvement”

Diversity of Practice; DR, Diversity of Practice; DR, RO, RPRO, RP

Overview Questions 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 WorkshopPQI Summit Conference Workshop Radiation Oncology Radiation Oncology

Bruce Haffty, M.D., ABR ModeratorBruce 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.




PQI Summit Conference WorkshopPQI Summit Conference WorkshopRadiology PhysicsRadiology Physics

Richard Morin, PhD, ABR ModeratorRichard 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




Why PQI?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 CertificationTime-Limited Certification

(11,000)

MUSTEntry MOC

Optional Entry MOC

Yes Desires not to recertify

Personal CommitmentState Requirement

Hospital Requirement

ABR’s Components of MOCABR’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: Why do we need Part IV: PQI?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?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 FlawsAnalyzing the System Flaws

Almost all improvable errors result from flawed systems

Identify areas where breakdowns occurCreate a feasible plan to fix these areasInstitute planWait a suitable time—new system “up

and running”Remeasure original metric

Part IV: Practice Quality Part IV: Practice Quality Improvement (PQI)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 SafetyPatient Safety

PQI ProcessPQI 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 TrackingPQI Timeline & Milestone TrackingDiagnostic Radiology

DiplomatesYear 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 √

2Measure Analyze the data Yes

3

Develop an improvement plan Begin collecting data again Yes

4

Modify improvement planImplement planBegin collecting improvement plan data

Yes

PQI Project TypePQI 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 Provider Performance Based Privileging Plan: CCHMCPrivileging Plan: CCHMC

DEPARTMENT OF RADIOLOGY Provider Performance Based Privileging Plan

JCAHO-ACGME-ABMS 2007-2008

Clinical Division

Standard Performance Measures

Division Director 1/1/07 thru 12/31/08

Professional Performance Behaviors reflecting a commitment to continuous professional development, ethical practice, cultural competence, and a responsible attitude toward patients, families, colleagues and care teams

PALS certification or Radiology Advanced

Life Support Certification CPR Certification (by end of FY2008 and then

each year forward) Meets CME requirements to maintain Ohio

license Zero violations of “Hold Point” Procedure for

invasive procedures Unapproved abbreviations: Mean of < 0.001%

for use of “CC” discovered via Radiology report monitoring system

Fellow evaluations of faculty performance in

category “Role Model for Professionalism” (Acceptable = score of 3 .0 or 4.0)

Meets CME requirements to maintain Ohio

license Completion of JCAHO Patient Safety test

Part IV: Roles for Societies/Leaders:Part IV: Roles for Societies/Leaders:Education/CommitmentEducation/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 leadershipGive feedback to ABR membersParticipate in building the futureDiscuss value added for members

Part IV: Roles for Leaders/ Professional Part IV: Roles for Leaders/ Professional Societies:Societies:

CommunicationCommunication

Quality in what we Quality in what we do! do!

ABMS General CompetenciesABMS 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 CompetenciesABR MOC: the 4 MOC Components & the 6 CompetenciesPart IProfessional Standing

Part IILifelong Learning and Self-assessment

Part IIICognitive Expertise

Part IVPractice 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 SafetyDouble ReadingPractice Guidelines

Patient Care State 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 SafetyDouble ReadingTurnaround TimePractice GuidelinesReferring Physician Survey

Interpersonal & Communication Skills

SAMs with emphasis on communications.


Professionalism State board license requirements and actions

SAMs content on professionalism.

General questions about ethics and charter on professionalism

Practice GuidelinesReferring 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.


Systems-based Practice

Specific CME and SAMs developed for systems-based practice.

General questions about CQI content.


DEPARTMENT OF RADIOLOGY Provider Performance Based Privileging Plan

JCAHO-ACGME-ABMS 2007-2008

Clinical Division

Standard Performance Measures

Interpersonal/Communication Skills Enable the establishment and maintenance of professional relationships with patients, families, colleagues, and care teams

Number of parent, patient & coworker

complaints to Radiologist in Chief concerning behavior, communication & professionalism (Acceptable < 1 per year)


category “Effective Communication Skills” (Acceptable = score of 3 .0 or 4.0)


category “Role Model for Interacting with Patients & Families” (Acceptable = score of 3 .0 or 4.0)

Completion of CARES customer service

standards test Zero violations of Policy for documentation

and communication of changes between final and preliminary reports

MD report sign off in 24 hours (Acceptable

compliance rate = 95%)

Medical/Clinical Knowledge

Assign & de-identify imaging studies for

Why PQI?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?How to Do PQI?Steps in the PQI process

Select a practice area to be improvedDetermine the quality

measurement(s) and collect baseline data in target area

Analyze the practice processes that impact on the target area

Devise an improvement planInstitute the plan and remeasure dataReport your findings

For more information:For more information:

Papers on ABR MOC published in all major radiology journals May 2007.

www.TheABR.org

Project SelectionProject Selection

Test of FIRE—projects should be

Feasible

Interesting

Relevant

Ethical


Five areas defined by ABRPatient safetyAccuracy of interpretationReport turnaround timePractice guidelines/technical

standardsReferring physician surveys


Diplomates may choose any projectDevised by a national society (must

be qualified by ABR)Devised by a group practiceDevised 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 MetricChoosing the Metric

Should be a reliable indicator of qualityShould be easy to measure

UnambiguousReproducible

Should be measured enough timesAppropriate to frequency in practiceTarget: 10 minimum, 100 maximum

what we are asking from what we are asking from …..Society…..Society

PQI projects development ..partnering with the ABR

SAMS Courses on How to do PQI projectsSAMS Course on How to reduce errors,

improve safety and improve qualityWebsite links to yours involving

lectures, programs for all diplomates developed by your society

Analyzing the System FlawsAnalyzing the System Flaws

Almost all improvable errors result from flawed systems

Identify areas where breakdowns occurCreate a feasible plan to fix these areasInstitute planWait a suitable time—new system “up

and running”Remeasure original metric

Accuracy of InterpretationAccuracy of Interpretation

National program, such as ACR RadPeer

ABR DIPLOMATES

Life-Time CertificationTime-Limited Certification

(11,000)

MUSTEntry MOC

Optional Entry MOC




Why Participate?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

Time-Limited Certification in subspecialty in pediatrics

Entry MOCRecertify

Pediatric and DR

Entry MOCRecertify DR only

Practice Profile Examination

Desires not to recertifyRecertification

Pediatric Radiology and DR

ABR Pediatric Radiology Subspecialty Certification

(CAQ) MOC

Life-Time Certification in DR

Time-Limited Certification in subspecialty in pediatrics

Entry MOC(CAQ)

Optional Entry MOC




Recertification in pediatric radiology and DR

ABR Life-Time Certification

Life-Time Certification Enrolled in MOC

Life-Time Certification

Documents

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