CNMC Runds: Can CME save lives? Dave Davis, MD Senir Directr, Cntinuing Educatin & Perfrmance Imprvement (with Nancy Davis, PhD) 1
Dave Davis, MD Nthing t disclse (srt f sad, huh?) What d yu think f when yu think f CME? 2
Other framing questins 1. Des CME wrk? A different way f framing CME: the clinical care gap 2. What d we knw abut effective CME? 3. What are the frces changing CME? Natinal and lcal frces Changing healthcare 4. AAMC s ae4q prject 5. S what? Implicatins fr Children s Referrals revenue FRAMING CME and the Clinical Care gap: reputatin registratins 1977: Des CME wrk? 3
Des CME wrk? Des CME change physician behaviur? Health care utcmes? Size, scpe f CME (US data, ACCME, 2011) 13,700,000 physician participatins 9,500,000 aliied health participatins 953,000 hurs f instructin 133,000 activities 4
*The size, scpe and effect f CME vs the clinical care gap 13,700,000 physician participants The clinical care gap 9,500,000 aliied health participants 953,000 hurs f instructin 133,000 activities 5
And fr this expenditure, what d we get? Other framing questins 1. Des CME wrk? A different way f framing CME: the clinical care gap 2. What d we knw abut effective CME? 3. What are the frces changing CME? Natinal and lcal frces Changing healthcare 4. AAMC s ae4q prject 5. S what? Implicatins fr Children s 6
PAYING ATTENTION TO THE RESEARCH Physicians and thers nt self-aware: bjective needs assessment, perfrmance feedback imprtant Knwledge necessary but nt sufficient fr change; didactics lusy at changing perfrmance What wrks? Interactivity; sequencing; predispsing, enabling and reinfrcing strategies CME > cnferences; = practice-based tls (reminders, audit-feedback, prtcls & training) Dcs pass thrugh stages f learning: awareness, agreement, adptin t adherence Cchrane reviews, AHRQ/EB reviews, thers Effective CME: what d the studies f CE say? The effect f interventins n perfrmance and health care utcmes JAMA 1995;274:700-705 Audt and feedback Reminders Pt mediated Opinin leaders +PP interv# Academic detailing cnferences print, AV +PP refers the number f studies that shwed psitive effects Interv# refers t the number f studies with the particular interventins 0 10 20 30 40 7
Des frmal CME wrk?: graphic representatin f effect f variables (JAMA 1999; 282:867-874) Multiple sessins Single Mixed +PP interv# Interactive Didactic Interv# refers t the number f studies with the particular interventins +PP refers the number f studies that shwed psitive effects 0 5 10 15 Reaching all learners implicatins f the CME research agenda FROM Frmal CME: lectures, curses, educatinal materials TO Outreach visits Small grup learning Opinin leaders Academic detailing Interactivity: Patient-mediated strategies Q&A, case discussin, Audit/feedback reflectin, Reminders MCQs, (cmputerized, audience etc) respnse systems, Cmprehensive, thinkpair-share practice-based interventins QI- r Other ICT-enabled tls (web-based, videcnferencing, PDAs, etc) 8
Other framing questins 1. Des CME wrk? A different way f framing CME: the clinical care gap 2. What d we knw abut effective CME? 3. What are the frces changing CME? Natinal and lcal frces Changing healthcare 4. AAMC s ae4q prject 5. S what? Implicatins fr Children s 9
CHANGING CME 1) Reprts n healthcare 2011 2000 IOM: Redesigning CE in the Health Prfessins: a call fr a CPD Institute Macy-AAMC/AACN lifelng learning Unmet Needs : quality & safety Evidence-based medicine, guidelines Cmparative effectiveness Health Prfessinal Educatin Quality Chasm There s a crack in it that s hw the light gets in Lenard Chen 10
2) Other frces The New CME = Frces fr change x Visin x First Steps Resistance (inertia + barriers) CHANGING CME/CPD, ONE STEP AT A TIME: LESSONS FROM THE AAMC S AE4Q PROJECT. 11
One step at a time Other framing questins 1. Des CME wrk? A different way f framing CME: the clinical care gap 2. What d we knw abut effective CME? 3. What are the frces changing CME? Natinal and lcal frces Changing healthcare 4. AAMC s ae4q prject 5. S what? Implicatins fr Children s 12
addressing sils What des ae4q d? Cnsultatin/advice/mentrship n. Educatinal Prcess Use f quality metrics in planning and assessment Use f evidence based interventins (including HIT, team training, staff develpment) Organizatinal Alignment f CME and GME, UME QI/PI initiatives (hspitals and practice plans) HIT, electrnic health recrds Faculty, Staff Develpment prgrams Resurces (references, funding surces, templates) 13
The Typical * AMC EHR Staff develpment QI/PI prgrams Teaching Hspital Health system data UME/ GME Cmmunity *there s n such thing Faculty Devel t Accreditatin, ther input The ae4q Cycle f Imprvement Data Surces: quality, utilizatin, CER results, OPPE/PQRS data Educatinal Resurces: grand runds, team/staff/rganizatinal develpment, internal and external CME prgrams, faculty develpment ae4q Prcess - Alignment and Educatin: resurce and interventin develpment, deplyment, mentring Evaluatin/Feedback t system and t ae4q prcess 14
Where were the pilt sites? Pilts selected based n : Interest Readiness Champin stakehlders Resurces needed Capacity Desired metrics Academic Medical centers f University f Kansas University f Oklahma Nrth Shre LIJ/Hfstra University f Iwa University f Clrad University f Oregn Health Sciences Center Duke University University Missuri-Clumbia Wayne State University Virginia Cmmnwealth University University f New Mexic 15
2012 sites ae4q sites phase 1 phase 2 Pilt sites Were they successful? AMC utcmes Patient care and prcess imprvements Re-alignment f CME with ther entities Champins, recgnitin f value f CME AAMC metrics/learning What utcmes are desirable, achievable and cmmn acrss AMCs? What resurces help the prcess? Our jint prducts Markers f rganizatinal readiness: alignment? educatinal effectiveness? champins? timing? drivers and barriers? New resurces t facilitate the integratin Sharing f Best Practices Cmmunities f Practice Disseminatin f results; publicatins; presentatins 16
Using CME as an interventin.. The clinical educatinal /health care initiatives, e.g., enterprise: fcus n runds quality develped metrics frm quality measures, care gaps team training mrbidity, mrtality and imprvement The CME enterprise: sessins fcused n curses and cnferences, related t cmmercial interests n, r nly self-assessment e.g. regular runds Glf game this aft Diabetic ketacidsis? patient n 5A Charts verdue Preeclampsia patient in ER Teenage kids 17
bjective assessments, e.g., quality runds Our department's perfrmance in XX management What s the rle f ther team members in making this better? What s the evidence? Hw d we cmpare with? Hw culd we d better? Imprving perfrmance: the Pathman-PROCEED mdel Methds/ Stages Awareness Agreement Adptin Adherence Predispsing Enabling Reinfrcing 18
Other framing questins 1. Des CME wrk? A different way f framing CME: the clinical care gap 2. What d we knw abut effective CME? 3. What are the frces changing CME? Natinal and lcal frces Changing healthcare 4. AAMC s ae4q prject 5. S what? Implicatins fr Children s S it s prbably a gd idea t change ur name but t what? Cntinuing Prfessinal Develpment??? Cntinuus Perfrmance Imprvement? Cntinuing Educatin/CPD & Imprvement Practice-based learning and imprvement anything s better than 19
Putting it tgether: Pathman, PROCEED and a CME-based implementatin planning guide Davis et al, BMJ, 2003 Methds/ Stages Awareness Agreement Adptin Adherence Predispsing Newsletter General runds Depart l runds meetings Enabling Small grup (team) discussin champins Wrkshps simulatins Reinfrcing Remindersg Audit/ feedback Reminders Audit/ feedback Thinking that lectures will change utcmes? Just plain dumb. 20
And finally, in summary Mre infrmatin: E-mail Web ddavis@aamc.rg www.aamc.rg/initiatives/cei www.mededprtal.rg 21