CME as a Bridge
To Quality
ACCME at the Pennsylvania
Medical Society
April 24, 2008
Marcia K. Martin
Manager, Provider Education
Accreditation Council for
Continuing Medical Education
Objective
To have a shared
understanding of how
accredited CME can be a
bridge to quality health
care.
ACCME Recognizes…
US health care is at a crossroads and
Accredited CME is being asked to
provide solutions.
It is a critical time for CME to
address the competency and
performance gaps of physicians…
Gaps are Real
“All adults in the United
States are at risk for
receiving poor health
care, no matter where
they live; why, where,
and from whom they
seek care; or what their
race, gender, or financial
status is.”
Rand, 2006 National Report Card
2006
It’s a Critical Time
to view…
CME as a
Bridge to Quality
Accredited CME…
for physician accountability
1.
2.
3.
4.
5.
6.
Linked to practice and focused on quality gaps
Supports Maintenance of Certification®
Requirement of maintenance of licensure
Fostering collaboration to address QI
Addressing interdisciplinary teams
Independent of commercial interests
Education that matters to patient care
CME AS A BRIDGE
TO QUALITY
Accredited CME is linked to
practice and focused on
healthcare quality gaps.
© 2008 ACCME
Synonymous with Practice-Based
Learning and Improvement
• Activities are linked to practice - based needs
(Updated Criterion 2)
• Content of CME matches the scope of the
learner’s practice (Updated Criterion 4)
• Measurements of change in competence,
performance or patient outcomes will be
available (Updated Criterion 11)
CME AS A BRIDGE
TO QUALITY
Accredited CME supports
physicians’ maintenance of
certification.
© 2008 ACCME
ABMS MOC™ Process
Part I - Professional
Standing
Part III - Cognitive Expertise
Medical specialists must hold a
valid, unrestricted medical license
in at least one state or
jurisdiction in the United States,
its territories or Canada.
They demonstrate, through
formalized examination, that they
have the fundamental, practicerelated and practice environmentrelated knowledge to provide
quality care in their specialty.
Part II - Lifelong Learning
and Self-Assessment
Part IV - Practice
Performance Assessment
Physicians participate in
educational and self-assessment
programs that meet specialtyspecific standards that are set by
their member board.
They are evaluated in their
clinical practice according to
specialty-specific standards for
patient care. They are asked to
demonstrate that they can assess
the quality of care they provide
CME AS A BRIDGE
TO QUALITY
Accredited CME is an essential
requirement for Maintenance of
Licensure.
© 2008 ACCME
FSMB Draft Report 2007
“State medical boards have a responsibility to
the public to ensure the ongoing competence
of physicians seeking relicensure.”
Recommendations
A. The Board should require the following for license renewal and
require documentation thereof:
Participation in an ongoing process of reflective self-evaluation, self assessment and
practice assessment, with subsequent successful completion of
educational activities tailored to meet the needs or
deficiencies identified by the assessment.
Demonstration of continued competence in the following areas: [ACGME/ABMS
Competencies] and, if applicable, osteopathic philosophy and osteopathic manipulative
medicine; including the knowledge, skills and abilities to provide
safe, effective patient care within the scope of their
professional medical practice. This criterion must be met, in part, by
passage of a valid, secure, proctored examination in the physician’s current practice area.
Demonstration of accountability for performance in practice.
Guided by the Updated Criteria…
Accredited CME
providers are
perfectly positioned
to support physicians
as they navigate their
own, personalized
processes of MOC and
“MOL”
CME professionals will provide
value to their physician
community by,
– Helping to uncover, measure,
and address important
knowledge, competency, and
performance-based gaps in
practice
– Aligning educational
planning with their
physicians’ scope of practice
CME AS A BRIDGE
TO QUALITY
Accredited CME is fostering
collaboration to address quality
improvement.
© 2008 ACCME
ACCME Will Reward Providers That…
• Work towards understanding the
healthcare environment in which their
physicians practice
• Seek solutions beyond their own
boundaries
• Identify and remove obstacles that stand
between current care and best care for
patients.
CME AS A BRIDGE
TO QUALITY
Accredited CME is addressing
interdisciplinary team practice.
© 2008 ACCME
Institute of Medicine Directive
• Health Professions
Education: A Bridge to
Quality (2002)
– A core-competency that
health professionals
“cooperate,
communicate, and
integrate care in teams
to ensure that care is
continuous and
reliable”
To Realize This Goal
• Long-term strategic
partnership
ACCME
ANCC
ACPE
• Three accrediting
organizations of three
professions
• Cooperating,
communicating - and are
integrating their systems of
accreditation
Since 1998/2005
• All three organizations have actively
collaborated to explore areas of synergy
• A statement of shared values and future
collaborative projects, accepted by the
leadership of all three organizations in
2006
Fruits of Our Collaboration
• Alignment of critical aspects of accreditation
Requirements and Processes for physicians,
nurses, and pharmacists
• Shared commitment to safeguard education from
commercial interests
• Both the ANCC and ACPE adopted the ACCME
Standards for Commercial Support™ in 2007
Committed to Future Collaboration
• More standardized terminology for
accreditation
• Common or shared approaches for
accreditation processes
• Creation of a special accreditation that
rewards providers who engage in
multidisciplinary education planned for
and by the entire healthcare team
CME AS A BRIDGE
TO QUALITY
Accredited CME is independent of
commercial interests.
© 2008 ACCME
An Endeavor For Medicine,
By Medicine
When CME fails to be exclusively oriented to
measured gaps in the delivery of care we
cease to be relevant to physicians-inpractice and we fail the needs of patient
care.
Face Validity
• Our most important stakeholder the American public - demands
that the CME system provide
demonstrable value without influence
from industry
Taking Action
• You have a story to tell
• Accredited CME is aligned to the current
and future needs of medicine
• It is a critical time for CME to make
absolutely sure that it is widely known
what CME
– is doing
– will be doing
– is capable of doing
ACCME Commitment
The ACCME is resolute in its efforts to
ensure that CME is,
– Provided through a valid and credible
accreditation system
– Independent of commercial interests
– Free of commercial bias in all CME topic
selection, planning decision, and presentation
content
A Look at ACCME’s
Updated
Accreditation
Criteria
Physician
Performance
Analysis
Synthesis
This is CPD
Judgment
Regnier et al, JCEHP, Fall 2005
Physician
Performance
Analysis
Synthesis
This is CME
Judgment
Regnier et al, JCEHP, Fall 2005
Physician
Performance
CME is entirely
about practice
based learning and
improvement
Analysis
Synthesis
Judgment
Regnier et al, JCEHP, Fall 2005
Physician
Performance
CME is about
facilitating
performance
improvement
Analysis
Synthesis
Judgment
Regnier et al, JCEHP, Fall 2005
What is the Professional
Practice Gap?
…and what need underlies that gap?
Is it knowledge ?
Is it competence ?
Is it performance ?
C2
“Female breast cancer
rates are falling
nationwide, but in
Chicago, black women
are 73% more likely than
white women to die from
the disease”
Fall 2007
C2: The provider incorporates into CME activities
the educational needs (knowledge, competence,
or performance) that underlie the professional
practice gaps of their own learners.
Ideal
Performance
Performance
• Individuals
• Communities
• Populations
C2: The provider incorporates into CME activities
the educational needs (knowledge, competence,
or performance) that underlie the professional
practice gaps of their own learners.
Regarding the diagnosis of breast cancer…
Gap
Need
K
“ I did not know that.”
C “ I have no clinical strategy.”
P “ I have no access to diagnostics!”
C2: The provider incorporates into CME activities
the educational needs (knowledge, competence,
or performance) that underlie the professional
practice gaps of their own learners.
C18
The provider identifies factors
outside the provider’s control that
impact on patient outcomes.
- Has data and information that explains
patient outcomes of learners …..beyond the
performance of physicians.
C2: The provider incorporates into CME activities
the educational needs (knowledge, competence,
or performance) that underlie the professional
practice gaps of their own learners.
C19
The provider implements educational
strategies to remove, overcome or
address barriers to physician change.
- Has data and information on barriers to
change applicable to own learners.
Incorporated into educational program as
activities, or modules
Discussion
Based on the NEED/GAP, what are the
desired results of the activity?
…what is the activity designed to change?
physicians’ competence ?
physicians’ performance ?
patient outcomes?
C3
C3: The provider generates activities / educational
interventions that are designed to change
competence, performance, or patient outcomes as
described in its mission statement.
C
Has questions for screening for risk
factors / signs in their own patients.
P
Asks high-yield questions; Examines for
relevant signs
PO
Increased number of patients diagnosed
or referred
C3: The provider generates activities / educational
interventions that are designed to change
competence, performance, or patient outcomes as
described in its mission statement.
C6
Is there an IOM, ACGME/ABMS or
other competency related to your
desired result?
- What application or connection to a
physician’s outside requirements for
continued practice will the activity have?
C3: The provider generates activities / educational
interventions that are designed to change
competence, performance, or patient outcomes as
described in its mission statement.
C17
Are there other initiatives within the
institution working on this issue?
and/or
C20
Are there other organizations we
could partner with that are working
on this issue?
C3: The provider generates activities / educational
interventions that are designed to change
competence, performance, or patient outcomes as
described in its mission statement.
C11
Based on your desired result, what
type(s) of evaluation methods will
you use to know if your activity was
effective at meeting the need and
creating change in competence,
performance, or patient outcomes?
Discussion
C4: The provider generates
activities /educational
interventions around content
that matches the learners’
current or potential scope of
professional activities.
C5: The provider chooses
educational formats for
activities / interventions that
are appropriate for the
setting, objectives and desired
results of the activity.
C6: The provider develops activities
/ educational interventions in
the context of desirable
physician attributes (e.g., IOM
competencies, ACGME
Competencies).
C4: The provider generates
activities /educational
interventions around content
that matches the learners’
current or potential scope of
professional activities.
C5: The provider chooses
educational formats for
activities / interventions that
are appropriate for the
setting, objectives and desired
results of the activity.
C6: The provider develops activities
/ educational interventions in
the context of desirable
physician attributes (e.g., IOM
competencies, ACGME
Competencies).
Are there
women in
your
practice ?
C4: The provider generates
activities /educational
interventions around content
that matches the learners’
current or potential scope of
professional activities.
C5: The provider chooses
educational formats for
activities / interventions that
are appropriate for the
setting, objectives and desired
results of the activity.
C6: The provider develops activities
/ educational interventions in
the context of desirable
physician attributes (e.g., IOM
competencies, ACGME
Competencies).
C4: The provider generates
activities /educational
interventions around content
that matches the learners’
current or potential scope of
professional activities.
C5: The provider chooses
educational formats for
activities / interventions that
are appropriate for the
setting, objectives and desired
results of the activity.
Example
C6: The provider develops activities
/ educational interventions in
the context of desirable
physician attributes (e.g., IOM
competencies, ACGME
Competencies).
 The nation should strive for “care that
does not vary in quality because of
personal characteristics such as
gender, ethnicity, geographic location
and socioeconomic status.”
Institute of Medicine-2001
 Equity is one of six essential
dimensions of quality of care
Discussion
C7: The provider develops
activities/educational
interventions independent of
commercial interests (SCS 1, 2
and 6).
C8: The provider appropriately
manages commercial support
(SCS3)
C9: The provider maintains a
separation of promotion from
education (SCS 4).
C10:The provider actively promotes
improvements in health care
and NOT proprietary interests
of a commercial interest (SCS
5).
The Concern
Through their implicit or
explicit, control of, or
influence on, CME content,
commercial interests can
create commercial bias in
CME (favoritism) that will
result in a learner’s
inclination towards, or
actual, use of a product or
service that is more than
is necessary.
First
 commercial bias
Second  A change in the learners.
Content bias: The content or format of a CME
activity, or its related materials,
is designed so as to promote a
specific proprietary business
interest of a commercial interest.
Topic bias:
CME is commercially supported.
Pre-ACCME Standards for
Commercial Support
Personal
COI
CS
Planners
Activity
Topic
Topic Content
Activity
Activity
CS
“use that is
more than
necessary”
“CME providers cannot receive
guidance either nuanced or direct, on the
content of the activity or on who should deliver
that content.”
CS
X X
Topic
Planners
Activity
Activity
ACCME Solution = Criterion 7
Personal
COI
X X X
Topic Content
X
Activity
CS
X
“use that is
more than
necessary”
SCS 1: Independence
SCS 2: Resolution of Personal Conflicts of Interest
SCS 6: Disclosure
Criterion 8:
SCS 3 - Appropriate Use of
Commercial Support
•
•
•
•
•
Written Agreement from Provider
For planned purpose
For education /educators
Not for learners
Accountable
Criterion 9:
SCS 4 - Management of Associated
Commercial Promotion
Standard 4.2
• Product-promotion material or product-specific
advertisement of any type is prohibited in or during
CME activities.
• The juxtaposition of editorial and advertising
material on the same products or subjects must be
avoided.
• Live (staffed exhibits, presentations) or enduring
(printed or electronic advertisements) promotional
activities must be kept separate from CME.
Criterion 10:
SCS 5 - Content and Format
without Commercial Bias
5.1 The content or format
of a CME activity or
its related materials
must promote
improvements or
quality in
healthcare and not
a specific proprietary
business
interest of a
commercial
interest.
5.2 Presentations must give a
balanced view of therapeutic
options. Use of generic
names will contribute to this
impartiality. If the CME
educational material or
content includes trade
names, where available trade
names from several
companies should be used,
not just trade names from a
single company
Discussion
Criterion 11 -12:
Evaluation
C11: The provider analyzes changes in learners
(competence, performance, or patient outcomes)
achieved as a result of the overall program’s
activities /educational interventions.
C12: The provider gathers data or information and
conducts a program-based analysis on the
degree to which the CME mission of the provider
has been met through the conduct of CME
activities/educational interventions
CME Mission Statement:
C1
•
5 basic components (CME purpose, content areas,
target audience, types of activities, and expected results
• expected results stated as change in competence OR
performance OR patient outcomes.
Criterion 13 -15:
Improvement
C13: The provider identifies, plans and implements the
needed or desired changes in the overall
program (e.g., planners, teachers,
infrastructure, methods, resources, facilities,
interventions) that are required to improve on
ability to meet the CME mission.
C14: The provider demonstrates that identified
program changes or improvements, that are
required to improve on the provider’s ability to
meet the CME mission, are underway or
completed.
C15: The provider demonstrates that the impacts of
program improvements, that are required to
improve on the provider’s ability to meet the CME
mission, are measured.
Criterion 13 -15:
Improvement
Aligns Learner and Provider
Mission
Purpose, content,
target, type and
expected results in
terms of
▲ in competence or
▲ in performance or
▲ in patient outcomes
Interventions
Needs
Objectives
Planning
Standards for
Commercial
Support
Program Impact
Purpose, content, target,
type and expected
results in terms of
▲ in competence or
▲ in performance or
▲ in patient outcomes
Activity
Impact
Program Improvement
Criterion 13 -15:
Improvement
Aligns Learner and Provider
MissionC14
Purpose, content,
target, type and
expected results in
terms of
▲ in competence or
▲ in performance or
▲ in patient outcomes
C12
Program Impact
Interventions
Needs
Objectives
C11
Planning
Standards for
Commercial
Support
Purpose, content, target,
type and expected
results in terms of
▲ in competence or
▲ in performance or
▲ in patient outcomes
C15
Activity
Impact
Program Improvement
C13
Criterion 13 -15:
Improvement
Aligns Learner and Provider
Study
Plan
Mission
Purpose, content,
target, type and
expected results in
terms of
▲ in competence or
▲ in performance or
▲ in patient outcomes
Interventions
Needs
Objectives
Do
Planning
Standards for
Commercial
Support
Program Impact
Purpose, content, target,
type and expected
results in terms of
▲ in competence or
▲ in performance or
▲ in patient outcomes
Activity
Impact
Program Improvement
Act
Discussion
C16: The provider operates in a manner that
integrates CME into the process for improving
professional practice.
• Evidence that CME supports practice
based learning and improvement.
• Provides opportunities for
investigation and evaluation of their
own patient care, appraisal and
assimilation of scientific evidence, and
improvements in patient care
C17: The provider utilizes non-education strategies to
enhance change as an adjunct to its activities /
educational interventions (e.g., reminders,
patient feedback).
• Evidence of use of rewards, process
redesign, peer review, audit
feedback, monitoring, reminders,
decision report systems,
encouragement
- (adapted from Grol, Wensing and Eccles,
Improving Patient Care, publ. Elsiver,
Butterworth, Heineman, 2005)
C18: The provider identifies factors outside the
provider’s control that impact on patient
outcomes.
C19: The provider implements educational strategies
to remove, overcome or address barriers to
physician change.
C20: The provider builds bridges with other
stakeholders through collaboration and
cooperation.
• Evidence of alliances with other organizations
that has a demonstrable impact on the program
of CME.
• Other organizations participate in C2-10 with
the accredited provider.
• Incorporated into elements of measurement in
C11-12.
• Other organizations part of solutions in C1415.
C21: The provider participates within an institutional
or system framework for quality improvement.
• Evidence of the integration of, and
contribution by, the CME provider
to quality improvement initiatives.
C22: The provider is positioned to influence the scope
and content of activities /educational
interventions.
• Evidence of provider’s control of the
development of CME activities from
inception of idea to evaluation.
ACCME Recognizes…
US health care is at a crossroads and
Accredited CME is being asked to
provide solutions.
It is a critical time for CME to
address the competency and
performance gaps of physicians…
CME that matters to patient care
Thank you