The American Board of Pediatrics:
Efforts in Patient Safety and
Maintenance of Certification
Wednesday, December 5, 2007
12:00 – 1:00 p.m. EST
Moderator:
Marlene R. Miller, MD, MSc, FAAP
Vice President, Quality
National Association of Children’s Hospitals and
Related Institutions (NACHRI)
Alexandria, Virginia
This activity was funded through an
educational grant from the Physicians’
Foundation for Health Systems
Excellence.
Disclosure of Financial Relationships and
Resolution of Conflicts of Interest for AAP CME Activities Grid
The AAP CME program aims to develop, maintain, and increase the competency, skills, and
professional performance of pediatric healthcare professionals by providing high quality,
relevant, accessible and cost-effective educational experiences. The AAP CME program
provides activities to meet the participants’ identified education needs and to support their
lifelong learning towards a goal of improving care for children and families (AAP CME
Program Mission Statement, August 2004).
The AAP recognizes that there are a variety of financial relationships between individuals and
commercial interests that require review to identify possible conflicts of interest in a CME
activity. The “AAP Policy on Disclosure of Financial Relationships and Resolution of Conflicts
of Interest for AAP CME Activities” is designed to ensure quality, objective, balanced, and
scientifically rigorous AAP CME activities by identifying and resolving all potential conflicts of
interest prior to the confirmation of service of those in a position to influence and/or control
CME content. The AAP has taken steps to resolve any potential conflicts of interest.
All AAP CME activities will strictly adhere to the 2004 Updated Accreditation Council for
Continuing Medical Education (ACCME) Standards for Commercial Support: Standards to
Ensure the Independence of CME Activities. In accordance with these Standards, the
following decisions will be made free of the control of a commercial interest: identification
of CME needs, determination of educational objectives, selection and presentation of
content, selection of all persons and organizations that will be in a position to control the
content, selection of educational methods, and evaluation of the CME activity.
The purpose of this policy is to ensure all potential conflicts of interest are identified and
mechanisms to resolve them prior to the CME activity are implemented in ways that are
consistent with the public good. The AAP is committed to providing learners with
commercially unbiased CME activities.
DISCLOSURES
Activity Title:
Safer Health Care for Kids - Webinar
The American Board of Pediatrics: Efforts in Patient Safety
and Maintenance of Certification
Activity Date:
December 5, 2007
DISCLOSURE OF FINANCIAL RELATIONSHIPS
All individuals in a position to influence and/or control the content of AAP
CME activities are required to disclose to the AAP and subsequently to
learners that the individual either has no relevant financial relationships or
any financial relationships with the manufacturer(s) of any commercial
product(s) and/or provider of commercial services discussed in CME
activities.
Name
Paul V. Miles,
MD, FAAP
Name of
Nature of
Commerci
Relevant
al
Financial
Interest(s)* Relationship(s)
(*Entity
(If yes, please
producing
list:
health care Research Grant,
goods
Speaker’s
or services)
Bureau,
Stock/Bonds
excluding
mutual funds,
Consultant,
Other - identify)
CME Content
Will Include
Discussion/
Reference to
Commercial
Products/Servi
ces
Disclosure of Off-Label
(Unapproved)/Investigational Uses of
Products
AAP CME faculty are required to disclose to
the AAP and to learners when they plan to
discuss or demonstrate pharmaceuticals
and/or medical devices that are not approved
No
Yes
No
No
DISCLOSURES
SAFER HEALTH CARE FOR KIDS - PROJECT ADVISORY COMMITTEE AND STAFF
DISCLOSURE OF FINANCIAL RELATIONSHIPS
All individuals in a position to influence and/or control the content of AAP CME activities are required to
disclose to the AAP and subsequently to learners that the individual either has no relevant financial
relationships or any financial relationships with the manufacturer(s) of any commercial product(s) and/or
provider of commercial services discussed in CME activities.
Name
Name of
Commercial
Interest(s)*
(*Entity producing
health care goods
or services)
Nature of Relevant
Financial Relationship(s)
(If yes, please list:
Research Grant, Speaker’s
Bureau, Stock/Bonds
excluding mutual funds,
Consultant, Other - identify)
CME Content Will Include
Discussion/
Reference to Commercial
Products/Services
Disclosure of Off-Label
(Unapproved)/Investigational Uses
of Products
AAP CME faculty are required to
disclose to the AAP and to learners
when they plan to discuss or
demonstrate pharmaceuticals and/or
medical devices that are not approved
Karen Frush, MD, FAAP
(PAC Member)
No
No
No
No
Uma Kotagal, MD, MBBS,
MSc, FAAP (PAC Member)
No
No
No
No
Christopher Landrigan, MD,
MPH, FAAP (PAC Member)
No
No
No
Not sure
Marlene R. Miller, MD, MSc,
FAAP (PAC Chair)
No
No
No
No
Paul Sharek, MD, MPH.
FAAP (PAC Member)
No
No
No
No
Erin Stucky, MD, FAAP (PAC
Member)
No
No
No
No
Nancy Nelson (AAP Staff)
No
No
No
No
Melissa Singleton, MEd
(Project Manager – AAP
Consultant)
No
No
No
No
Junelle Speller (AAP Staff)
No
No
No
No
Rev 9/2007
DISCLOSURES
AAP COMMITTEE ON CONTINUING MEDICAL EDUCATION (COCME)
DISCLOSURE OF FINANCIAL RELATIONSHIPS
All individuals in a position to influence and/or control the content of AAP CME ac tivities are required to disclose to the AAP and
subsequently to learners that the individual either has no relevant financial relationships or any financial relationships with the
manufacturer(s) of any commercial product(s) and/or provider of commercial services discussed in CME activities.
Name
Name of
Commercial
Interest(s)*
(*Entity producing
health care goods
or services)
Nature of Relevant
Financial Relationship(s)
(If yes, please list:
Research Grant, Speaker’s
Bureau, Stock/Bonds
excluding mutual funds,
Consultant, Other - identify)
CME Content Will Include
Discussion/
Reference to Commercial
Products/Services
Disclosure of Off-Label
(Unapproved)/Investigational Uses
of Products
AAP CME faculty are required to
disclose to the AAP and to learners
when they plan to discuss or
demonstrate pharmaceuticals and/or
medical devices that are not approved
Ellen Buerk, MD, FAAP
No
No
No
No
Meg Fisher, MD, FAAP
No
No
No
No
Robert A. Wiebe, MD, FAAP
No
No
Not sure
No
Jack Dolcourt, MD, FAAP
No
No
No
No
Thomas W. Pendergrass, MD,
FAAP
No
No
No
No
Beverly P. Wood, MD, FAAP
No
No
No
No
CME CREDIT
The American Academy of Pediatrics (AAP) is
accredited by the Accreditation Council for
Continuing Medical Education to provide continuing
medical education for physicians.
The AAP designates this educational activity for a
maximum of 1.0 AMA PRA Category 1 Credit™.
Physicians should only claim credit commensurate
with the extent of their participation in the activity.
This activity is acceptable for up to 1.0 AAP credit.
This credit can be applied toward the AAP CME/CPD
Award available to Fellows and Candidate Fellows of
the American Academy of Pediatrics.
OTHER CREDIT
This webinar is approved by the National Association of
Pediatric Nurse Practitioners (NAPNAP) for 1.2
NAPNAP contact hours of which 0.0 contain
pharmacology (Rx) content. The AAP is designated
as Agency #17. Upon completion of the program,
each participant desiring NAPNAP contact hours
should send a completed certificate of attendance,
along with the required recording fee ($10 for
NAPNAP members, $15 for nonmembers), to the
NAPNAP National Office at 20 Brace Road, Suite 200,
Cherry Hill, NJ 08034-2633.
The American Academy of Physician Assistants accepts
AMA PRA Category 1 Credit(s)TM from organizations
accredited by the ACCME.
Paul V. Miles, MD, FAAP
Vice President
Director of Quality and Practice Assessment
The American Board of Pediatrics
Chapel Hill, North Carolina
Learning Objectives
Upon completion of this activity, you will be
able to:
• Discuss the role of the American Board of
Pediatrics (ABP) in improving children’s health care
quality and safety.
• Apply the new Maintenance of Certification process
to your own individual situation.
• Describe the role of the ABP in specific projects to
improve knowledge and delivery of safe care to
children.
Patient Safety as a Professional
Competency
The American Board of Pediatrics: Efforts in
Patient Safety and Maintenance of Certification
Safer Health Care for Kids Webinar
Dec 5, 2007
Paul V. Miles MD
Vice President for Quality and Practice Assessment
American Board of Pediatrics
To Err is Human:
The IOM recommended that standards
for provider competence and knowledge
of patient safety be developed and
that assessment and reassessment on a
periodic basis be done.
P Miles ABP
13
“The ability to assess and systematically
improve the safety of medical practice is
an essential competency of every certified
physician.”
…..ABMS-CMSS Joint Planning Committee,
December 2002
P Miles ABP
14
Six Core Physician Competencies
Applied to Patient Safety
• Patient care
• Medical knowledge
• Interpersonal and communication skills
• Professionalism
• Practice-based learning and improvement
• Systems-based practice
(Adopted by the ACGME and all twenty four ABMS specialty boards)
P Miles ABP
15
Person Approach vs. System Approach
“Naturally enough, the associated countermeasures are directed
mainly at reducing unwanted variability in human behavior.
These methods include poster campaigns that appeal to
people's sense of fear, writing another procedure (or adding to
existing ones), disciplinary measures, threat of litigation,
retraining, naming, blaming, and shaming. Followers of this
approach tend to treat errors as moral issues, assuming that bad
things happen to bad people what psychologists have called the
just world hypothesis.1”
Reason, J BMJ 2000;320:768-770 ( 18 March )
P Miles ABP
16
Person Approach vs. System Approach
“The basic premise in the system approach is that
humans are fallible and errors are to be expected, even
in the best organizations. Errors are seen as
consequences rather than causes, having their origins
not so much in the perversity of human nature as in
"upstream" systemic factors.”
Reason, J BMJ 2000;320:768-770 ( 18 March )
P Miles ABP
17
Dreyfus Model for Learning
•
•
•
•
•
Novice
Advanced beginner
Competent
Proficient
Expert
P Miles ABP
18
Medical Career Continuum
•
•
•
•
•
Novice………………………Medical student
Advanced beginner…….Beginning resident
Competent………..…………Senior resident
Proficient………….…7-10 years into career
Expert……...…....Senior faculty/practitioner
P Miles ABP
19
Number of Pediatricians
Improvement Focus
Educational System Improvement
Residents
Faculty
Standard
Novice – Competent - Expert
P Miles ABP
20
Team and System Competency
• The same progression from novice to expert applies to
teams and microsystems
• The ABP will accept team data for certification of
individuals
P Miles ABP
21
Personal Competency and Quality Care
IOM QUALITY
ACGME/ABMS
COMPETENCIES
SAFE
TIMELY
EFFECTIVE
EFFICIENT
PT
CENTERED
EQUITABLE
PT CARE
MEDICAL
KNOWLEDGE
COMMUNICATION
PROFESSIONALISM
PRACTICE BASED
LEARNING AND
IMPROVEMENT
SYSTEM BASED
PRACTICE
J. Bingham & D. Quinn Vanderbilt
P Miles ABP
22
Personal Competency and Patient Safety
ACGME/ABMS
Competencies
Patient care
Safety
Clinical and procedural skills
Medical Knowledge Knowledge about best practices, potential complications
Communication
Closed loop communication, negotiated narratives
Professionalism
Commitment to safety, transparency, a different view of autonomy
Practice based
learning &
improvement
Improvement science, measurement and reporting of errors, a
commitment to telling the truth
System based
practice
Team knowledge skills and attitudes, root cause analysis, process flow
diagrams, microsystem and macrosystem knowledge, crew resource
management
P Miles ABP
23
Competency in Teamwork
• Team Knowledge:
– Knowledge about components of teamwork
– Shared models
– Knowledge of teammate characteristics
– Knowledge of team mission, norms, objectives, and
resources
– Task-specific responsibilities
Baker et al J Comm J Qual Patient Saf 31:185-202, Apr. 2005
P Miles ABP
24
Competency in Teamwork
• Skills:
– Closed-loop communication
– Team leadership
– Mutual performance monitoring
– Backup behavior
– Adaptability
• Attitudes:
– Belief in the importance of teamwork
– Mutual trust
– Team orientation
Baker et al J Comm J Qual Patient Saf 31:185-202, Apr. 2005
P Miles ABP
25
Measurement of Team Performance
• Must be grounded in team theory
• Must account for individual and team-level
performance
• Must capture team process and outcomes
• Must adhere to accepted standards for reliability and
validity
• Must address and real or perceived barriers to
measurement
Baker et al J Comm J Qual Patient Saf 31:185-202, Apr. 2005
P Miles ABP
26
ABP Maintenance of Certification
Version 1.1: Requirements
Part 1: License
Part 2: Knowledge & Decision Skills SA
Part 3: Secure examination
Part 4: Component A – Patient Survey
Component B – Approved activity
P Miles ABP
27
Version 1.1: How much time?
Part Activity
Approx. Time
Commitment
1
Licensure
0 hr
2
A - Knowledge Self-assessment
B - Decision Skills
5 hr
5 hr
3
Examination
5 hr
4
A - Patient Survey
B - eQIPP (or similar)
- Credit for participating in approved QI
2 hr
10+ hr
10+ hr
NOTE: Approximate times are actual “seat” time and do not include
preparation time
P Miles ABP
7-year
certificate
27+ hours
3.9+ hr/yr
28
What is Part 4?
Component A
• Patient Survey
Component B
+
Option 1: Approved web-based
module
•
AAP eQIPP modules
•
Patient Safety module
•
PIM module + selfassessment combination
package
 eg. Asthma PIM + QI
Self-assessment
Note: Activities listed under the Component B
options are for example purposes only; other
activities exist.
Option 2: Approved collaborative
•
P Miles ABP
eg. VON project + QI Selfassessment
29
A Proposal to Design, Develop, and
Deploy a
Web-based Patient Safety Education and
Improvement Module
That Will Meet the Requirements for
Part 4 Maintenance of Certification TM
A Collaborative Effort
•
•
•
•
•
•
•
ABMS – lead organization
ABP/AAP
ABFP/AAFP
ABIM/ACP
Surgery, anesthesiology, other specialties
VA, DoD, AHRQ,
National experts on patient safety
P Miles ABP
31
Features
• Designed to work for all 650,000+ board certified
physicians across 24 specialties
• Designed to work for non practicing physicians
• Before and after knowledge self assessment
• Quality improvement approach
• Designed to work with local improvement efforts
• Hot Links to key Patient Safety Web sites
P Miles ABP
32
www.abms.org
P Miles ABP
33
www.abms.org
P Miles ABP
34
ABMS Patient Safety Improvement Program
www.abms.org
P Miles ABP
35
Other ABP Safety Initiatives
• Patient safety content in certifying exams and other
parts of the certifying process
• ABP approval of patient safety improvement projects
to meet the requirements for MOC Part 4
• Alliance for Pediatric Quality has selected patient
safety as one of the three initial Improve First
initiatives
P Miles ABP
36
Eliminating Bloodstream Infections
NACHRI CA-BSI Collaborative
In the first 6 months,
29 children’s hospitals
reduced infection rates
in the PICU by nearly
70 percent by adhering to
a rigid set of evidencebased practices shown
to prevent infections
in children.
Monthly Aggregate PICU CA-BSI Rate
BSI Collaborative
Began Oct 2006
8
7
BSI Rate per 1,000 Line Days
6
5
4
3
2
1
Notes:
1) Prior to October 2006, the aggregate monthly collaborative rate is the average of the rates
from all PICUs due to unavailability of line days data. Beginning in October 2006 the
aggregate rate is calculated by dividing the total number of infections for the entire
collaborative by the total number of line days.
2) Begining November 2006 control limits have been recalculated to illustrate the apparent
change in the process of care. The new control limits are variable, taking into account the
number of line days for each month (u-chart) while the previous control limits were constant,
only taking into account the change in average BSI rate from month to month (XmR chart)
03/07 n=28
04/07 n=28
01/07 n=28
02/07 n=28
11/06 n=29
12/06 n=29
09/06 n=22
10/06 n=29
07/06 n=23
08/06 n=22
05/06 n=27
06/06 n=27
03/06 n=29
04/06 n=27
01/06 n=29
02/06 n=29
11/05 n=28
Center Line
12/05 n=28
09/05 n=28
10/05 n=28
07/05 n=28
08/05 n=28
05/05 n=28
06/05 n=28
03/05 n=28
04/05 n=28
01/05 n=27
02/05 n=27
11/04 n=26
12/04 n=26
09/04 n=27
Monthly BSI Rate
10/04 n=27
07/04 n=27
08/04 n=27
05/04 n=23
06/04 n=25
03/04 n=23
04/04 n=25
01/04 n=23
02/04 n=23
0
Control Limits
70% improvement: estimated 20 lives saved, 160 infections prevented,
$6.4 million not spent in the first 6 months
P Miles ABP
37
Resources for Patient Safety
•
•
•
•
•
AHRQ Web M&M site www.ahrq.gov
To Error is Human IOM
Creating systems of safe care IOM
To Do No Harm – Julie Morath
ABMS Web-based patient safety module
P Miles ABP
38
Now What?!?
Some take-away points from the Webinar:
• The ABMS Patient Safety Program is valuable for all
physicians
• Participate in a local, regional or national safety
improvement project
• Engage in the AAP Safer Health Care for Kids effort
• Create a culture of safety in your practice
• Maintain board certification