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A structured assessment of physicians' ability to apply quality improvement methods.


Hess BJ, Holmboe ES, Lipner RS, Lynn LA, Duffy DF. — American Board of Internal Medicine

Presented: Association of Medical Education in Europe Conference, September 2008

Background: Quality improvement (QI) is a core competency required of all physicians in the U.S. Developing methods to assess physicians’ ability to effectively implement QI methods is essential for helping physicians improve processes of care.

Work Done: Practice improvement modules are Web-based tools that use chart abstraction, patient surveys, and a practice-system survey to help internal medicine physicians use performance data to develop a QI plan, followed by a guided narrative self-report on the results of their plan. We developed a qualitative assessment method to determine the specific types of practice changes made and how well physicians implemented them. Three independent QI experts applied the methodology to assess improvement plans from 92 physicians who completed a preventive cardiology PIM.

Conclusion: Physicians implemented different types of practice-system changes; for example, 33% made information-management changes, 23% utilized patient education materials, and 18% changed how they managed care. However, most physicians provided weak evidence that changes were effectively implemented and that changes designed to impact a process of care would be sustained over time.

Take-Home Message: Few physicians use evidence-based approaches to improve quality of care in their practice. There are meaningful gaps in physician knowledge and skill about QI methods.

For more information about this presentation, please contact Research@abim.org.