Hess BJ, Lynn LA, Lipner RS, Holmboe ES. — American Board of Internal Medicine
Presented: American Association of Medical Colleges Conference, November 2009
Purpose: Practice-based learning and improvement is considered a core physician competency. The American Board of Internal Medicine (ABIM) introduced the Web-based Colonoscopy Practice Improvement Module (PIM) to enable physicians to measure their colonoscopy performance and implement a quality improvement (QI) plan. We examined results from this module to determine which measures physicians most frequently targeted for improvement and if positive changes were achieved in targeted measures.
Methodology: 147 gastroenterologists completed the Colonoscopy PIM in 2008. Summary data from chart audit of outcome and process measures and from a practice system survey were reported to the physician, highlighting areas for improvement. Physicians targeted one measure in a QI plan and then reported the results to ABIM.
Results: Notable performance results, reported as the mean percent of patients, aggregated at the physician level, include: adverse event during colonoscopy –<1%, complete informed consent documented –58%, measurement of colonoscope withdrawal time –53%, colonoscope withdrawal time >6 minutes –51%, and notification of pathology results within one week –73%. Based on an average follow-up sample of 36 patients per physician, average post-intervention performance was >88% for all measures.
Conclusion: When provided with a tool that facilitates quality measurement in their practices, physicians can identify areas to improve their performance in procedure-based care. Evaluating physician training in practice-based learning and improvement should include a quality of procedure component. Whether a single QI exercise leads to sustained effects or if these results apply to other procedures is not known. No audit was performed and results may be inflated.
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