The
American
Board of
Pediatrics
The Role of Maintenance of Certification
In Maintaining and Promoting Physician
Competency
Closing the Quality Gap
Paul V. Miles MD
Vice President, Director of Quality Improvement
And Assessment Performance in Practice
American Board of Pediatrics
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The
American
Board of
Pediatrics
What our patients see
• 54% of the time adults receive recommended
appropriate care (McGlynn)
• 42% of the time children receive recommended
appropriate care (Mangione-Smith)
• “With that much variation, they can’t all be right”
…..Jack Wennberg
• There is a gap between knowing and doing
(“every system……….”)
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The
American
Board of
Pediatrics
Maintenance
Of Certification
PMCP-G
PMCP-S
Part One: Professional Standing
Professionalism
Part Two: Lifelong Learning
Medical knowledge
QI knowledge
System knowledge
Part Three: Cognitive Expertise
Medical knowledge
QI knowledge (PBLI)
System knowledge (SBP)
Part Four: Performance in Practice
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Competencies
Patient Care
Medical knowledge
Communication
QI (PBLI)
System-based practice
The
American
Board of
Pediatrics
PMCP
• First cohort began in 2003
• Approximately 4500 pediatricians each year
• By 2010 this group must meet the requirements
for all four parts of MOC
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The
American
Board of
Pediatrics
Maintenance
Of Certification
PMCP-G
PMCP-S
Part One: Professional Standing
Valid license, no restrictions
Part Two: Lifelong Learning
ABP GP knowledge SA
AAP PREP (ABP approved)
Assessment ABP Decision Skills Assessment
Tools
ABP Knowledge SA (literature review)
AAP NeoReviews (ABP approved)
Other Subspecialty Prep programs
Part Three: Cognitive Expertise
Secure, proctored exam
Part Four: Performance in Practice
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Web-based modules and/or Established QI effort (ABP approved)
Patient/Peer Survey
The
American
Board of
Pediatrics
Part 1
• Valid, unrestricted license – Maintenance of
licensure (MOL)
• DANS national reporting system for physicians
with restrictions to their medical license
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The
American
Board of
Pediatrics
Part 2: Knowledge Self Assessment (Open
book, low stakes, requires passing score)
Existing
Year
ABP Knowledge self-assessment
2006
ABP Decision Skills
2006
AAP PREP (broad based general knowledge)
2003
Subspecialty modules (current best articles)
2006-9
Subspecialty prep programs (eg. Neoreviews)
2006-10
In Development
QI Self Assessment
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2008
The
American
Board of
Pediatrics
Part 3: Secure Cognitive Examination
• Cognitive simulation of practice
• Predominantly assesses higher-order intellectual
abilities—not recall
Clinical Judgment: >50%
Synthesis: 20 to 35%
Recall Knowledge: <15%
• Includes conditions that could present to any
practice, but doesn’t require knowledge that good
practitioners would normally “look up”
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The
American
Board of
Pediatrics
Part 4
Diplomate enrolls in MOC
On the ABP Web-site
Patient Survey
Part 4 Practice Assessment & Improvement
Option A
Web based modules
Such as eQIPP or ABMS
Patient Safety Module
Option B
Participate in Established
Improvement Project
(including attestation forms)
Complete QI Knowledge Self Assessment
(Required with Option B)
Credit for Part IV MOC
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The
American
Board of
Pediatrics
Pediatric CAHPS
• Developed for ambulatory care
• Provide feedback to pediatricians on how well
they communicate with patients and involve them
in care
• Built into an improvement model (physicians will
be given strategies to test to improve their
communication performance)
• Has the ability to discriminate at the individual or
the group level
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The
American
Board of
Pediatrics
Part 4
Diplomate enrolls in MOC
On the ABP Web-site
Patient Survey
Part 4 Practice Assessment & Improvement
Option A
Web based modules
Such as eQIPP or ABMS
Patient Safety Module
Option B
Participate in Established
Improvement Project
(including attestation forms)
Complete QI Knowledge Self Assessment
(Required with Option B)
Credit for Part IV MOC
11
The
American
Board of
Pediatrics
ABP Focus on Quality Improvement
• The MOC process is focused on helping
pediatricians measure and improve quality of
care and their professional development
• The ABP is not interested in trying to measure
individual physician practice performance
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shape
The
American
Board of
Pediatrics
Looking for Bad Apples
(historic approach to physician quality)
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Brent James Patient Safety Reporting Systems and Applications IOM
The
American
Board of
Pediatrics
Improving Good Apples (ABP focus)
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Brent James Patient Safety Reporting Systems and Applications IOM
The
American
Board of
Pediatrics
Part 4: Self-Evaluation of
Performance in Practice
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• Understand the benefits of collecting data from
your own practice.
• Collect data on a specific disease entity or
problem from your patients’ charts.
• After collecting data, interpret and analyze it
so you can use it.
• Compare your care with peers and benchmarks
to be able to learn from others
• Based on your analysis, identify and test
opportunities for improvement within your
practice.
The
American
Board of
Pediatrics
Part 4A: Web Based QI Modules
ABP Approved Products:
– Education in Quality Improvement for Pediatric
Practice (AAP eQIPP)
– Patient Safety Improvement Program (ABMS)
– Performance Improvement Modules (being
developed with the AAP)
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The
American
Board of
Pediatrics
Performance Improvement Modules
Diplomate
Registers &
Chooses
Module
Diplomate
Measures
Practice
Quality
Clinical
Data
Survey
Data
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Rapid Cycle Improvement
Diplomate
Chooses
Change
Package
Change
Package
1
Change
Package
2
Change
Package
3
Diplomate
Re Measures
Quality
The
American
Board of
Pediatrics
Part 4B: Credit for Established QI
•
•
•
•
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Recognition of valid participation in an ABP
approved structured quality improvement program
Boards set standards for design, implementation,
and results of structured QI programs.
Boards set standards defining meaningful
participation in accredited programs.
Programs apply for accreditation.
Physicians supply attestation and documentation
of participation for Part 4 credit.
The
American
Board of
Pediatrics
Part 4
Existing – 4A Web based
Year
eQIPP modules (Asthma & ADHD)
2004
In Development – 4A Web based
ABMS Patient Safety Module
2007
eQIPP Nutrition & other modules
2007
Performance Improvement Modules (PIMs)
2007
In Development – 4B
Credit for ongoing projects
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2007
The
American
Board of
Pediatrics
Medical
Knowledge
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Quality
Improvement
Knowledge
Measurement
Improvement
Re Measurement
The
American
Board of
Pediatrics
eQIPP allows the learner to quickly
assess their practice online.
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The
American
Board of
Pediatrics
A real-time data analysis allows the
learner to begin to identify opportunities
for improvement.
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The
American
Board of
Pediatrics
eQIPP offers an
interactive learning
environment. The
program also
includes practical,
easy-to-use tools
that can be
implemented
quickly into the
office setting.
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The
American
Board of
Pediatrics
After completing the clinical
content, the learner uses the
Model for Improvement to
identify opportunities for
improvement in their
practice.
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The
American
Board of
Pediatrics
Within each step, the learner will
receive advice for identifying,
prioritizing, refining, and launching
new improvement cycles.
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The
American
Board of
Pediatrics
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eQIPP
subscribers
have access to
the modules
for three
years. You will
be able to
track your
progress, and
monitor your
successes over
time.
The
American
Board of
Pediatrics
The Challenge for Medical Education
• How do we integrate medical education with the
delivery of quality care so that students see and
participate in the ongoing assessment and
improvement of care that is safe, timely, effective,
efficient, patient centered and equitable?
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