Promoting physicians' self-assessment and quality improvement: The ABIM diabetes practice improvement module

Holmboe, Eric S.; Meehan, Thomas P.; Lynn, Lorna A.; Doyle, Paula; Sherwin, Tierney; Duffy, F. Daniel

doi:10.1002/chp.59

Cited by 72 publications

(52 citation statements)

References 15 publications

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“…Second, there was no audit process to ensure that instructions for sampling and data extraction were followed. However, prior work confirmed the accuracy of physician-reported data in a quality improvement framework, 27 and physicians had no reason to provide false results as there were no consequences for low or …”

Section: Discussionmentioning

confidence: 95%

Assessing the Quality of Osteoporosis Care in Practice

Weng

Hess²,

Lynn

et al. 2015

J GEN INTERN MED

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BACKGROUND:Patients with osteoporosis can sustain fractures following falls or other minimal trauma. This risk of fracture can be reduced through appropriate diagnostic testing, pharmacologic therapy, and other readily measured standards of care. OBJECTIVES: Our aim was to develop a credible clinical performance assessment to measure physicians' quality of osteoporosis care, and determine reasonable performance standards for both competent and excellent care. DESIGN: This was a retrospective cohort study. PARTICIPANTS: Three hundred and eighty one general internists and subspecialists with time-limited board certification were included in the study. MAIN MEASURES: Performance rates on eight evidencebased measures were obtained from the American Board of Internal Medicine (ABIM) Osteoporosis Practice Improvement Module® (PIM), a web-based tool that uses medical chart reviews to help physicians assess and improve care. We applied a patented methodology, using an adaptation of the Angoff standard-setting method and the Dunn-Rankin method, with an expert panel skilled in osteoporosis care to form a composite and establish standards for both competent and excellent care. Physician and practice characteristics, including a practice infrastructure score based on the Physician Practice Connections Readiness Survey (PPC-RS), were used to examine the validity of the inferences made from the composite scores. KEY RESULTS: The mean composite score was 67.54 out of 100 maximum points with a reliability of 0.92. The standard for competent care was 46.87, and for excellent care it was 83.58. Both standards had high classification accuracies (0.95). Sixteen percent of physicians performed below the competent care standard, while 22 % met the excellent care standard. Specialists scored higher than generalists, and better practice infrastructure was associated with higher composite scores, providing some validity evidence. CONCLUSIONS: We developed a rigorous methodology for assessing physicians' osteoporosis care. Clinical performance feedback relative to absolute standards of care provides physicians with a meaningful approach to selfevaluation to improve patient care.

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Section: Discussionmentioning

confidence: 95%

Assessing the Quality of Osteoporosis Care in Practice

Weng

Hess²,

Lynn

et al. 2015

J GEN INTERN MED

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“…Prior work showed that practices can reliably and accurately abstract and report data from their medical records. 9 A potential limitation of our study is that physicians may have selectively chosen patients in an effort to boost their quality measures. Previous research, however, found that patient selection by physicians engaged in maintenance of certification projects was unbiased, as the primary goals were educational.…”

Section: Discussionmentioning

confidence: 99%

Family Physicians' Quality Interventions and Performance Improvement Through the ABFM Diabetes Performance in Practice Module

Peterson¹,

Blackburn²,

Puffer³

et al. 2014

The Annals of Family Medicine

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PURPOSE Practice performance assessment is the fourth requirement of Maintenance of Certification for Family Physicians (MC-FP). American Board of Family Medicine (ABFM) diplomates have many options for completing Part 4 requirements, including Web-based Performance in Practice Modules (PPMs) developed by the ABFM. Our objective was to describe the actions and outcomes of family physicians who completed the ABFM diabetes PPM. METHODSWe undertook a descriptive study of all diabetes PPMs completed by physicians in the 50 United States and Washington, DC, from 2005 to October 2012. Successful completion required quality measure abstraction from 10 patient charts before and after a plan-do-study-act cycle improvement effort. We used descriptive statistics to assess physician demographics and quality outcomes. RESULTSFamily physicians completed 7,924 diabetes qualitative improvement modules. Their mean age was 48.2 years, they had practiced a mean of 13.8 years, and three-fourths lived in urban areas (76.9%). Nearly one-half selected diabetic foot examination or eye examination as their quality improvement measure. Performance on all quality measures improved. Significant improvement was seen in rates of hemoglobin A 1c control (<7.0%; 57.4% to 61.3%), blood pressure control (<130/90 mm Hg; 53.3% to 56.3%), foot examinations (68.0% to 85.8%); and retina examinations (55.5% to 71.1%). The most common interventions were standing orders (51.6%) and patient education (37.1%).CONCLUSIONS Family physicians participating in MC-FP implemented improvement projects and showed quality improvements in caring for patients with diabetes. Emphasis on quality of care by payers will increasingly require physicians to embrace quality measurement and improvement.

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“…Fifth, the sampling strategy and accuracy of chart data were not audited (there was no penalty for poor performance on the PIM); however previous work has confirmed the accuracy of physicianreported data in the Diabetes PIM. 29 It is possible that some physicians may not have adhered to the sampling instructions and their performance on individual measures might be inflated.…”

Section: Discussionmentioning

confidence: 99%

Setting a Fair Performance Standard for Physicians’ Quality of Patient Care

et al. 2010

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BACKGROUND: Assessing physicians' clinical performance using statistically sound, evidence-based measures is challenging. Little research has focused on methodological approaches to setting performance standards to which physicians are being held accountable. OBJECTIVE: Determine if a rigorous approach for setting an objective, credible standard of minimally-acceptable performance could be used for practicing physicians caring for diabetic patients. DESIGN: Retrospective cohort study. PARTICIPANTS: Nine hundred and fifty-seven physicians from the United States with time-limited certification in internal medicine or a subspecialty. MAIN MEASURES: The ABIM Diabetes Practice Improvement Module was used to collect data on ten clinical and two patient experience measures. A panel of eight internists/subspecialists representing essential perspectives of clinical practice applied an adaptation of the Angoff method to judge how physicians who provide minimallyacceptable care would perform on individual measures to establish performance thresholds. Panelists then rated each measure's relative importance and the Dunn-Rankin method was applied to establish scoring weights for the composite measure. Physician characteristics were used to support the standard-setting outcome. KEY RESULTS: Physicians abstracted 20,131 patient charts and 18,974 patient surveys were completed. The panel established reasonable performance thresholds and importance weights, yielding a standard of 48.51 (out of 100 possible points) on the composite measure with high classification accuracy (0.98). The 38 (4%) outlier physicians who did not meet the standard had lower ratings of overall clinical competence and professional behavior/attitude from former residency program directors (p=0.01 and p=0.006, respectively), lower Internal Medicine certification and maintenance of certification examination scores (p= 0.005 and p< 0.001, respectively), and primarily worked as solo practitioners (p=0.02). CONCLUSIONS: The standard-setting method yielded a credible, defensible performance standard for diabetes care based on informed judgment that resulted in a reasonable, reproducible outcome. Our method represents one approach to identifying outlier physicians for intervention to protect patients.

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Promoting physicians' self-assessment and quality improvement: The ABIM diabetes practice improvement module

Cited by 72 publications

References 15 publications

Assessing the Quality of Osteoporosis Care in Practice

Assessing the Quality of Osteoporosis Care in Practice

Family Physicians' Quality Interventions and Performance Improvement Through the ABFM Diabetes Performance in Practice Module

Setting a Fair Performance Standard for Physicians’ Quality of Patient Care

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