The Foundation for Developing Better Care
The ABMS Research and Education Foundation is engaged in a number of dynamic and interesting programs that go to the heart of improving physician performance, protecting patient safety and setting higher standards to achieve better care. The Foundation funds its programs through grants it receives, some limited grant-making as well as sponsored research agreements.
Improving Performance in Practice (IPIP)
Started in 2006, IPIP is a state-based, nationally led quality improvement initiative. It is sponsored in part by the Robert Wood Johnson Foundation and organized by the primary care certifying boards and physician specialty societies and allows primary care physicians and their practice teams to assess and improve the quality of chronic illness and preventive care and to share information and provide benchmarks to improve everyone’s care. By harnessing the power of its collaborative network of state-based programs and national professional organizations, IPIP is a unique innovation platform that provides a mechanism for rapid transmission of information about what is working and what isn’t.
Seven states have joined the IPIP - North Carolina, Colorado, Michigan, Pennsylvania, Wisconsin, Minnesota and Washington – amounting to 350 practices and 1,400 physicians caring for over 350,000 patients. IPIP states have over 75 quality improvement coaches working with the practices and more than 18 ongoing collaborative learning networks.
Ultimately, IPIP strives to improve outcomes for patients with diabetes, asthma and other chronic conditions. Through the use of Quality Improvement (QI) methods, such as the PDSA cycle, practices engage in redesign activities that create efficiencies and improve care. It seeks to align with other national QI initiatives and measures, such as the Medical Home Projects, NCQA’s Physician Practice Connection, the Robert Wood Johnson Foundation Aligning Forces for Quality Initiative, and others. Participation in IPIP will help physicians to complete the requirements for Part IV of ABMS Maintenance of Certification®. It also positions them well to take part in Pay-for-Performance programs offered by insurers.
A key feature of IPIP is the use of quality improvement coaches (QICs) who go into physicians’ offices and work closely with the entire practice team on improvement efforts. The QICs focus on four key areas that help practices provide better care for patients with chronic conditions:
- Use of a registry to identify patients with diabetes/asthma prior to the visit
- Use of condition-specific decision support tool (e.g., a visit planner)
- Creation of a customized flow diagram and protocols to standardize the care process:
Educate patients in self-management and support their efforts
- Use nursing standing orders to increase reliable execution
- Use a standard protocol
- Assign specific care team roles (who does what in the protocol)
- Conduct frequent monitoring of protocol use
IPIP includes the Learning Collaborative model developed at the Institute for Healthcare Improvement (IHI). This model brings care teams from physician practices together in a series of learning sessions to review data, share best practices and plan action steps. The Collaborative features pre-work and post-work to integrate the learning into practice, resulting in improved process and outcomes.
The national IPIP team, led by Sheldon D. Horowitz, MD, Special Advisor to the President of ABMS and Peter Margolis, MD, PhD, Director of the National Center for Design, Development and Evaluation at Cincinnati Children’s Hospital and Medical Center, provides project management as well as data aggregation and analysis to support the collaboratives in each state.
Characterizing Episodes and Costs of Care
ABMS Research and Education Foundation is working with a broad-based group of clinical and performance measurement quality experts on the High Value Healthcare Project: Characterizing episodes and Costs of Care. The goal is to advance the development of a national set of episode-based cost of care measures for a set of common acute and chronic healthcare conditions to understand how different providers use resources and compare to national benchmarks.
The project is part of a larger initiative funded by Robert Wood Johnson Foundation aimed at increasing awareness and improving effectiveness to achieve better quality of care.
So far, 22 separate measures have been outlined including one or more measures for each of the following conditions:
|Acute Myocardial Infarction
||Congestive Heart Failure
|| GERD/Hiatal Hernia
||Low Back Pain
|Chronic Obstructive Pulmonary Disease
The measure development process addresses episode definition, duration, identification of clinically relevant services, risk adjustment and attribution. A standard pricing approach will be used for the cost assignment. The measures will be pilot tested on both commercial and public datasets prior to submission to the National Quality Forum for endorsement.
Ultimately, the measures will be made available for public use, including use by local/regional multistakeholder collaboratives in an effort to increase awareness and improve the effectiveness of achieving better quality care.
For more information about this program, contact Sheila Lazier, Program Director.
Patient Safety Improvement Program Focuses on Safety and Quality Improvement
The ABMS Patient Safety Improvement Program is a Web-based tool for Physicians to learn essential patient safety skills and quality improvement fundamentals. The program includes four key components:
- Engaging patient safety scenarios every physician can relate to and use
- Comprehensive patient safety curriculum covering the core topics of epidemiology of patient safety and medical error
- Quality improvement fundamentals for applying methods and techniques to improve patient safety
- Patient safety improvement activities introducing changes that can be incorporated into practice
By integrating this module with local patient safety efforts, physicians will be able to demonstrate to the public, their patients and their colleagues — as well as their Member Boards — that they are deeply committed to assessing the safety of the care they deliver, and taking critical steps to improve it further.
The ABMS Patient Safety Improvement Program was guided by an advisory committee of nationally recognized subject matter experts in patient safety and quality improvement.
Development of CAHPS Surveys Underway
To assist physicians in becoming more cognizant of their communication skills, ABMS and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Consortium are developing a method to deliver the CAHPS Clinician-Groups Survey to the 24 ABMS Member Boards as a way to fulfill some of the Part IV Practice Performance Assessment requirements of ABMS Maintenance of Certification.
The survey is the primary collection instrument of CAHPS data which will be submitted to the National CAHPS Benchmarking Database for warehousing and analysis. Survey results will be reported to the Member Boards and their certified physicians to help them improve communication with patients in their practice.
This initiative is an important step toward fulfilling the ABMS strategic goals and further demonstrates the commitment to improving the quality of care.