PI CME – Easy as ABC? Maybe not.
The AMA three part approach to offering CME credit for involvement in performance improvement CME is deceptively simple. Three stages. Stage A requiring the physician to engage in some sort of data based assessment of his or her practice using identified performance measures through chart review or another appropriate mechanism. Stage B requiring the physician learns from an intervention based the performance measures used in the first step. Stage C requiring the physician to re-evaluate and reflect on performance in practice (Stage B) by comparing the outcomes achieved with the assessment done in Stage A. Then the physician summarizes any practice, process and/or outcome changes that resulted from their participation in the entire process.
ABC. Simple as can be. But is it? That may depend on how far the physician goes in an attempt to really understand the practices they are engaged in that show a disparity between their current practice and the recommended practice provided in the “identified performance measure”.
What does the physician really know when looking at his or her performance data compared to that of expected performance provided in an identified performance measure? They know one thing. How their performance stacks up against an identified performance measure. That’s it. Nothing more. That is not enough to develop an effective intervention to close the gap between their practice and the practice suggested in the identified performance measure. That requires a much deeper understanding of what is going on in his or her practice that is yielding the observed outcomes.
The temptation at this stage of a PI CME project is to assume we have an answer. We’ll throw some CME at it. Usually that answer is based on well intentioned opinions but not on valid or reliable information. Basing a PI CME intervention on well intentioned opinion(s) about how to “fix” something and not on data that lets you know exactly what is going on in the practice is likely to result in a short term fix but not a sustainable change in the practice setting. So what will surely happen? Things will gradually drift back toward where they were when the initial assessment was done. That is not performance improvement. That is treating symptoms and not causes. That should not be how the CME provider wants PI CME to be conducted in their setting.
Here is a serious question. How many CME professionals currently have the skill set required to facilitate PI CME efforts? My observation is a few but not nearly enough. With the changes in the CME environment making CME and performance improvement synonymous this will have to change. I have some ideas about the skill sets that CME professionals will have to acquire to be effective in PI CME. More on that in a later posting.
