CME course blends learning with improving quality of care

The trend of linking continuing medical education to performance improvement is gaining momentum. The American Academy of Family Physicians has launched a new online program called Measuring, Evaluating and Translating Research Into Care that's geared to help physicians improve patient care and meet maintenance-of-certification requirements.

Dale Moquist, MD, a Houston family physician and AAFP delegate, helped test the program. He was impressed with how easy it was to use.

"I see this program as a great opportunity for family physicians to not only measure the quality of work they're doing but to compare themselves to their peers," Dr. Moquist said.

Developed by the American Academy of Family Physicians, the METRIC program consists of a series of quality improvement modules, focusing primarily on single disease conditions. The first two are being released in 2005.

Bruce Bagley, MD, medical director of quality improvement for the AAFP, said the online program is intended as a tool to raise quality of care in the office while teaching about a particular disease.

"We're allowing credit for practice improvement work in the office," he said. "We know that seat time [in a lecture hall] doesn't cause behavior change. We're trying to do CME that engages physicians and causes them to produce a product."

That product is better health care and ultimately, healthier patients, Dr. Bagley said.

Dr. Moquist agreed. "You are doing something good for your patients, and at the same time you're getting CME credit," he said. "If you go and listen to a talk on the treatment of hypertension, you want to take that back to your patients and use it. This is the same thing, but it's a different way of doing it."

Once doctors go over the text covering diabetes, they are asked to take 10 charts and review them using a number of nationally recognized measures, such as when the last hemoglobin A1c was done.

The physician then picks one or more interventions to do over the next six months, and resources such as flow sheets are provided to help do this. Six months later, another 10 charts are checked.

When comparing their results to their peers, physicians can break it down as far as specifics such as patient levels of hemoglobin A1c.

Dr. Moquist said he liked the flexibility of the module. Few of his diabetic patients smoke, so in creating an intervention program, he'd focus on other issues. Now that the program is officially open for business, he's planning to log in and get started.

"Heck yeah, I think I'm going to do that," he said. "I just got the e-mail that I can log in."

Doctors can expect each of such CME modules to include:

• A practice assessment survey;
• A chart audit of 10 patient records on evidence-based performance measures, using an online data collection form;
• A feedback report comparing the participant's survey results to peers and a baseline of their performance measurement data;
• An action plan, including education opportunities, interventions, tools and instruction for implementation;
• A second chart audit six months later of 10 records on the same performance measures to determine if improvements have been made; and
• A final report of the baseline performance that compares measurement data before and after implementation of the action plan.

After this final step, the ABFM will be notified of a participant's successful completion of part IV of maintenance of certification requirements, and the participant will receive 20 CME credits. The diabetes module costs $25 for AAFP members and $50 for nonmembers.

All of the funding for this project came from an educational grant from Merck & Co. Inc. The AAFP declined to say how much this was.

The first module, "Diabetes: Improving Patient Care," is available online (link).