Quality improvement CME gets thumbs up
After a pilot program that allowed physicians to earn CME credit for improving quality in a practice setting proved successful, the American Medical Association in September 2004 modified its standards so that accredited CME providers could offer practice-based performance improvement activities. As a result, doctors should start seeing more CME options that allow them to earn credit for integrating quality improvement into their clinical practices.
It’s the latest in a series of efforts to make CME more interactive and a part of physicians’ practices. For example, the AMA and American Academy of Family Physicians previously have supported CME credits for looking up answers to clinical questions in handheld computers.
The Centers for Medicare & Medicaid Services rolled out the performance improvement CME pilot in April 2003. To participate, physicians need to implement a quality improvement intervention in one of three areas — diabetes management, breast cancer screening, or influenza and pneumococcal immunization. Doctors then use performance measures to track the success of their care and adjust interventions if there is no improvement. Physicians earn up to 30 credits in the first year if they participate in all three interventions.
The AMA randomly surveyed 15% of the 4,000 doctors who participated in the pilot in 2003. About 82% of doctors found the CME materials at least somewhat helpful, 90% were satisfied or very satisfied with the program, and 95% found it to be a positive experience.
Recent studies (including this project) are bringing the education back into CME. Such studies avoid equating brilliant lectures with education. Teaching does not necessarily induce learning.
We (UAB CME) have spent that last several years trying to understand how to help physicians learn. Quality improvement projects represent one excellent example of a technique which works.
The future of CME must link education (and thus patient outcomes) with method. This study looks promising.
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2 Responses to The future of CME
David Toub, MD, MBA
April 4th, 2005 at 3:50 pm
Great post-I’ll have to blog about this as well (http://homepage.mac.com/dtoub/blog/index.html).
I’m Chief Medical Officer at MedCases, an ACCME-accredited provider of online CME, and the outcomes issue is a hard one to solve. For starters, how do you do a real controlled trial proving that the education in and of itself has really led to improvements in clinical outcomes? It’s also hard, if not problematic (HIPAA, etc) to get access to clinical data, and given so many variables involved in decision making, I’m not sure we can easily separate out the influence of a single CME program from many other ways physicians can learn to do the “right thing.”
RGL
April 5th, 2005 at 7:21 am
While still in practice and as one of the primary physicians in a managed care network in my community, a similar performance program was in place but on a more comprehensive scale. It was one of the ways the network employed to see if we were dispensing the type of care we were expected to give.
Strictly, it was not the type of CME as we understand this to be, and were never given credits since the time spent was considered part of our practices. It was also successful in the respect that it kept us on our toes, with our membership in the network partly dependent on how we adhered to the program.
Most of us still view CME as strictly didactic: attending meetings and seminars, listening to tapes, reviewing the latest medical literature with quizzes and passing grades to accumulate credits, taking computer courses, and so many other ways. After all, these are the types of activities we are required to document when applying for relicensure and for renewal of membership in hospital staffs.
CME remains a thriving business, and some of the best courses are offered by top-notch centers like Harvard, Johns Hopkins, Emory, UC-San Francisco, and the University of Miami.