Doctors use CME, quality efforts to boost results

To cut medical errors and improve outcomes, a growing number of physicians are combining continuous quality improvement projects with directed continuing medical education activities.

By Jay Greene, amednews staff. Dec. 17, 2001.

Over a year ago, Barbara Mierzwa asked 200 physicians affiliated with the State University of New York at Buffalo School of Medicine and Biomedical Sciences if they would be interested in practice-based, outcomes-oriented research projects with their patients.

In exchange for collecting data from chart reviews, learning cutting-edge clinical practices and participating in educational activities, SUNY-Buffalo's Office of Continuing Medical Education offered to grant the physicians continuing medical education credits for specific parts of their projects, said Mierzwa, the medical school's CME director.

See related content

"Our CME office just stepped up and said we can partner with you in addition to helping you improve outcomes for your patients," Mierzwa said. "Whatever you choose to do, we can offer frosting on the cake in terms of credit."

Thomas Foels, MD, associate medical director of Independent Health, a 360,000-member HMO in Buffalo, took the university up on its offer. Dr. Foels had devised two quality management initiatives that he felt could have CME components. The first was an asthma management chart review initiative. The second was a project to improve accessibility of physicians by conducting more effective triage of telephone calls.

Not only does each project award CME credits, but Dr. Foels said the HMO also offers monetary awards to physicians who participate in the initiatives by including the exercise in the health plan's existing Quality Management Initiative Award program. Under QMIA, physicians earn about 10% of their overall office revenue, Dr. Foels said.

"We thought it was an added incentive to attach the CME credit powers to it," said Dr. Foels, who is clinical assistant professor of pediatrics at SUNY-Buffalo. "The credit lent an air of academic virtue and resonance to it. We felt if we could get this certified with the medical school and have faculty speak on the topic that it would lend credibility to the projects."

Dr. Foels also said he thought patient outcomes would be improved through the chart review process, peer interaction and CME activities. "We hope to see a corresponding decrease in office visits, and in a perfect world, elimination of hospitalizations and emergency visits," he said.

CME offered for the asthma project consists of 2.5 hours for two grand round lectures, one hour credit for developing a clinic action plan and one hour for chart reviews and a test on how to provide best care for patients.

"Ongoing learning using CME is more effective than a one-time CME course," Mierzwa said. "CME that is organized to improve patient care is successful CME. When physicians earn that credit, it is more than just saying, 'Oh, that was an interesting lecture.' They actually have helped their patients."

Improved outcomes, fewer errors

Using practice-based CME to improve patient outcomes is another way to enhance continuous quality initiatives, said Barbara Barnes, MD, president of the Society for Academic Continuing Medical Education.

"This is a way of merging education with practice and continuous quality improvement," Dr. Barnes said. "Traditionally we looked at education as being separate."

One barrier for many CME providers is how to structure the projects to meet accreditation standards of the Accreditation Council for Continuing Medical Education, she said.

"CME providers in smaller institutions are closer to their delivery systems and have a better opportunity to develop these programs," Dr. Barnes said. "Academic medical centers can be so large that it is hard to get data and be aware of what is going on."

But stimulated by new accreditation standards from the ACCME and reports issued the past two years from the Institute of Medicine on medical errors, an increasing number of CME providers and participating medical groups are designing similar tools to measure CME effectiveness, Dr. Barnes said.

CME providers also can earn an "exemplary compliance" accreditation from the ACCME by designing programs that evaluate outcomes of educational activities.

Asthma study results

With asthma on the rise, therapeutic options can confuse patients and physicians. In the majority of instances, national asthma care guidelines are not followed, Dr. Foels said.

During the first stage of Independent Health's 18-month study, more than 35 pediatricians and family physicians reviewed 277 charts. At an average 2.5 asthma visits per year, physicians rated the visits at 70% mild-intermittent, 26% mild-persistent, 4% moderate-persistent, and 1% severe-persistent.

But 23% of charts reviewed had no documented history of school or work absenteeism, a clear indicator that physicians were missing important data. In addition, 29% of intermittently symptomatic asthmatics were under an allergist's care -- a high referral rate, Dr. Foels said.

The data indicated there was room for improvement through CME and other educational interventions, he said.

"Once the doctors had the complete histories, they knew exactly what to do with treatment," Dr. Foels said. "The incomplete histories were a real problem. This past September we did another chart review. We expect the next round of data collection to be much better. We will talk with the doctors individually and have our final CME [grand rounds] in March" of 2002.

RELATED CONTENT
» CME success stories translate into better patient care, results Oct. 2, 2000