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Improving the quality of clinical care through practice-based learning and improvement.

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Hess BJ, Johnston M, Iobst W, Lipner RS. — American Board of Internal Medicine

Presented: American Educational Research Association Meeting, April 2011

Background: Osteoporosis is a chronic, progressive disease and a major public health threat. Little is known about individual physicians’ ability to engage in practice-based learning to improve their performance on important quality indicators for patients with or at risk for osteoporosis. The impact of practice systems (e.g., use of electronic health records) on osteoporosis care is also not well understood.

Objective: We examined how well a national sample of physicians performed on 22 quality indicators of osteoporosis care; we specifically examined if type of internist (general internists versus subspecialists) and specific practice system capabilities were associated with performance on the measures. We also determined which measures physicians most frequently targeted for improvement and assessed the degree to which performance improved on these measures.

Participants: 855 physicians from the United States with time-limited certification in general internal medicine enrolled in the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) program.

Measures: We used data from the ABIM Osteoporosis Practice Improvement Module, a Web-based self-assessment module comprised of a medical chart review and a practice system survey that includes seven broad practice system domains. Physicians reviewed their chart and practice system summary and developed a quality improvement plan to increase performance on one targeted measure. Physicians then re-measured performance on their targeted measures by conducting another medical chart review.

Key Results: Variability in performance on the measures was found, with some observed differences between general internists, geriatricians and rheumatologists. Some practice system elements were significantly (but modestly) associated with performance on the measures, particularly for estimation and counseling about calcium intake and vitamin D (rs between 0.20 and 0.28, ps<.002). Across all practice types, the most commonly selected measure targeted for improvement was documentation of vitamin D level (about 38% of physicians targeted this measure); on average, physicians reported significant and large increases in performance on measures targeted for improvement.

Conclusion: Our study demonstrated that physicians can successfully engage in practice-based learning by measuring their clinical performance and then take action to improve the quality of patient care.

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