Over 100 attendees from across the medical education community tuned in to hear MM&M's latest webcast. The online how-to session offered a trove of advice on creating quality-driven CME, or learning that impacts physician performance and patient outcomes.
With several factors influencing the quality movement in med ed, but a dearth of guidance available to providers, the webcast hit on a timely topic while seeking to address a real need.
“CME was…and still is remote from practice,” said Nancy Davis, PhD, executive director of the National Institute for Quality Improvement and Education (NIQIE), who was involved in early efforts to establish a credit system for performance improvement-based learning in her previous role directing education for the American Academy of Family Physicians (AAFP). That is, it's hard to know the relevance to the individual physician. Whereas the live event with a simple time metric was the central activity of the past, new learning emphasizes multiple formats, based on evidence-based practice, with an eye toward performance and quality improvement.
The American Medical Association established a PI-based CME credit system, which has been adopted by the American Osteopathic Association, and the AAFP has a parallel system. The ACCME also has emphasized QI-oriented CME in its updated compliance criteria. Overall there is a higher public expectation to improve care.
Providers are beginning to take the necessary shifts beyond simply didactic programs. Pri-Med, which sponsored the hour-long webcast to stimulate and advance efforts, is creating curricula that are clinically linked, moving toward longitudinal education and longitudinal outcomes to measure physician change and ultimately get at better patient outcomes. It conducted a pilot with an electronic medical record (EMR) company to determine what kind of practice data could be pulled from an EMR to further enhance its needs assessment.
“We're pleased with the depth of data we've been able to generate,” reported Marissa Seligman, PharmD, chief clinical and regulatory affairs officer, SVP, Pri-Med Institute. However, the database has limits. It's historically used as a reimbursement tool and does not capture data on lifecycle modifications or other criteria of patient care, she said.
While there's still room for traditional continuing professional development (CPD) activities, a range of methods are needed to begin to predispose an audience for evidence-based practice and improvement, and Pri-Med's EMR pilot is one example of a strategy that addresses clinical improvement. Collaboration with QI and safety professionals who are collecting such data regularly is needed, and CME providers need to develop the skills to get to the point where they can use inputs to measure the impact of their CME.
Funding is another hurdle.
“There will begin to be more grants…available from public [and] private sources, like foundations, to begin to assess the current climate for professional development,” said Bob Kristofco, MSW, director, medical education, US medical external affairs, Pfizer. In addition, “The pharmaceutical industry continues to have an expectation for more outcomes-oriented CME. There's not necessarily any prescription…but…the industry has begun to expect more from providers in terms of educational design, assessmemt of need and a legitimate way of looking at outcomes.”
One of the “best potential resources,” he added, are health systems, which are interested in improving quality of care.
As providers move from a didactic to a practice-oriented way of doing business, achieving better outcomes is key, but it will take work. Establishing an ROI for this type of CME is very different from what providers have done in the past.
Said Seligman: “We need everyone who has a stake in CME to innovate, take risks…and get outcomes to the level CME now requires.”