Activity Requirements
ABIM approves two types of quality improvement (QI) activities through the AQI pathway:
- Web-based activities that guide physicians and/or practices through a QI cycle. A working prototype must be available for review prior to consideration of an application.
- QI projects/programs managed by coaches, administrators or leaders provided by the sponsor. These activities may include some Web-based elements. If so, a working prototype of the Web-based elements must be available for review.
QI activities approved through the AQI pathway must meet the requirements in the following six domains:
- Clinical Topic Requirements
- Goals and Objectives Requirements
- Measure and Data Collection Requirements
- Performance Analysis and Intervention Requirements
- Physician Participation Requirements
- Infrastructure and Resources Requirements
Clinical Topic Requirements
- Addresses a quality gap that is supported by a needs assessment or problem analysis.
- Relates to a national priority, regional initiative or local gap in patient care.
- Addresses a well-defined patient population.
- Is relevant to a sufficient number of ABIM Board Certified physicians.
Goals and Objectives Requirements
- Goals must be defined in an aim statement that includes time-specific objectives.
- Goals and objectives must be designed to improve patient care.
- Timeframe for the QI activity must be appropriate for meeting goals and objectives.
- QI activity must adequately address one or more IOM dimensions of quality (safety, timeliness, effectiveness, equity, efficiency, patient-centeredness).
Measure and Data Collection Requirements
- Includes outcome, process and/or balancing performance measures that are:
- Nationally endorsed by NQF
- Approved/developed or co-developed by PCPI, NCQA or the Joint Commission or
- Accepted into the Agency for Healthcare Research and Quality (AHRQ) National Quality Measures Clearinghouse (NQMC)
- Measures that are not nationally endorsed or professionally developed must be evidence-based. ABIM applies the Physician Consortium for Performance Improvement (PCPI) Position Statement (pdf) on evidence as our criteria.
- Self-developed measures will be accepted provisionally for two years. During that time, the measures must be submitted to the NQMC. Measures not accepted by NQMC may result in non-renewal of the AQI activity.
- Measures developed by another organization and adopted for use in the AQI activity are not required to be submitted to the NQMC. The AQI sponsor is encouraged to contact the measure developer regarding plans for submitting measures to the NQMC and will be asked to provide ABIM with an update on the status of the measures at the time of AQI renewal.
- Includes a sufficient number of performance measures to provide meaningful data about the quality of care related to the clinical topic. Includes an adequate data collection tool (i.e., chart abstraction, registry) for assessing performance on the identified measures. Data collection tools developed for this activity must be field-tested and applications must include results from this testing along with documentation highlighting how the results of the testing were incorporated into the measures and/or data collection tool. E-mail qualityimprovement@abim.org for field-testing types and criteria.
- Sampling strategy includes at least 25 patients per measure. (Exceptions are provided if the alternative sampling strategy is shown to be sufficient for generating useful performance data.)
- Data collection period for initial measurement and remeasurement (e.g., one month, three months, etc.) must be an appropriate length to assess performance on the identified measures.
- Data collection process complies with HIPAA regulations.
- Sponsor must have an adequate method for assuring the quality and completeness of the data collected for the activity.
Performance Analysis and Intervention Requirements
Performance data:
- Is provided at an appropriate level (e.g., physician, group, institution) to meet the activity's objectives.
- Is available for all measures identified in the activity.
- Is presented in a format (e.g., bar charts, scatter plots, etc.) that allows adequate analysis of the performance measures.
- Includes a comparison of results to clinical guidelines, peers or other available benchmarks when available.
Additionally, participants must identify one or more target improvement goals based on performance feedback.
Activity includes:
- Tools to assist participants in an analysis of the current practice system or process. This includes identification of the care team associated with the target measure.
- Development of an action plan that allows participants to identify the specific interventions and timeframe needed to achieve the target performance goals.
- Adequate quality improvement resources and tools related to the clinical topic, as well as the activity's goals and objectives.
Physician Participation Requirements
- Sponsor must require active participation by physicians in each component of the activity and for the entire length of the activity.
- Sponsor must have a process to adequately monitor physician participation in the activity.
- Sponsor must have a conflict management process in place for disputes related to MOC Part IV credit for physicians who do not meet participation requirements.
Physicians seeking MOC credit must have:
- Provided direct, consultative or administrative care to patients as part of the QI activity.
- Acted as physician lead or a member of the QI team.
- Implemented one or more test of change to improve patient care.
- Engaged in the QI activity for the minimum duration required by the sponsor.
- Participated in the QI activity within 24 months of requesting MOC points.
Infrastructure and Resources Requirements
- Adequate stakeholder (internal and external) support and input into the development and maintenance of the activity must be provided.
- Currency and relevance of the clinical content used in the activity must be maintained. This involves periodic review of relevant guidelines and other sources of clinical data and timely updates to content.
- Technology used for the activity (e.g., Web-based tools, registries, etc.) must be maintained and updated as needed.
- Telephone and/or online support must be provided to physicians during their participation in the activity, including online and personal technical support for any Web-based tool.
- Appropriate and sufficient funding to support the activity must be secured. If the activity is funded through commercial support, such funding must adhere to the Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support. ABIM reserves the right to request an additional external review by an expert of ABIM’s choice (at the applicant’s expense) to assure that the activity presents a balanced approach to diagnostic and therapeutic options.