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Training programs can use Web-based tools to identify quality gaps and improve performance.

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Hess BJ, Lynn LA, Hood SC, Bernabeo EC, Holmboe ES. — American Board of Internal Medicine

Presented: Association of American Medical Colleges Conference, November 2013

Purpose: Practice-based learning and improvement (PBLI) is a core physician competency. The American Board of Internal Medicine (ABIM) developed Practice Improvement Modules (PIMs) for specific chronic conditions and communication skills to enable physicians to measure their practice performance and implement a quality improvement (QI) plan. This study examined how training programs use PIMs for QI and the results achieved.

Method: Twenty-six internal medicine residency programs and 12 subspecialty fellowship programs across the United States completed an ABIM PIM between 2010 and 2012. Mean number of participating trainees per program was 9 (range 2 to 27). PIMs are Web-based, self-evaluation tools that use medical chart reviews and/or patient surveys with a practice system survey to create a comprehensive performance assessment. Each program examined their trainees' performance data, and worked as a team that included faculty and staff to implement a QI plan for targeted measures. Programs re-measured performance on targeted measures. The types of measures chosen for QI were identified, and baseline and follow-up performance rates on these measures were compared.

Results: Programs most frequently completed PIMs focused on cancer screening and hypertension. Programs targeted different types of measures for QI; 21 targeted process measures (e.g., cervical cancer screening), 9 chose intermediate outcome measures (e.g., blood pressure at goal), and 8 chose patient experience measures (e.g., doctor knows patient as a person). On average, programs demonstrated the largest change from baseline to follow-up in process measures (34% to 62%, P<0.001), compared to outcomes (39% to 52%, P<0.001), and the patient experience measures (41% to 50%, P<0.01). Thirty-two programs (84%) indicated that changes made using the PIM had a positive impact on their clinic's practice.

Conclusion: Training programs can effectively use the ABIM PIMs to identify and minimize quality gaps. PIMs can provide experiential learning in PBLI that benefits patients through improving the care provided.

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