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The value of practice-based learning and improvement to physician performance in procedure-based care.

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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.

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