>> SINGER: Hello, my name is Steve Singer. I’m the Director of Education & Outreach at the Accreditation Council for Continuing Medical Education.
>> D’ALESSANDRO: Hi, my name is Jennifer D’Alessandro. I’m a Program Manager in the Education unit with the National Committee for Quality Assurance.
>> SINGER: Hello Jennifer.
>> D’ALESSANDRO: Hello Steve.
>> SINGER: Thanks for joining us today.
>> D’ALESSANDRO: You’re welcome. Thank you.
>> SINGER: Tell me about the organization you work with.
>> D’ALESSANDRO: I work for the National Committee for Quality Assurance, NCQA. We’re a private not-for-profit company and our vision and passion is to improve the quality of healthcare. And we do by developing quality standards and measures known as HEDIS, the Healthcare Effectiveness Data and Information Set for healthcare organizations to compare their performance against each other and continuously improve. So, our goal is to improve the quality of healthcare.
>> SINGER: So, that’s a lot.
>> D’ALESSANDRO: It is a lot.
>> SINGER: And you’re an accredited CME provider as well.
>> D’ALESSANDRO: We are.
>> SINGER: OK. So, tell me about the role of CME within NCQA.
>> D’ALESSANDRO: So, most recently we have successfully completed five performance improvement activities, which were collaborations with other organizations and they really spoke to improving the quality of care at the practice level. And involving the entire healthcare team, in that approach. So, we base many of our performance improvement initiatives on our HEDIS measures. We have data to support how clinicians are performing in these areas and we know that professional practice gaps exist. We publish on an annual basis The State of Healthcare Quality report. It’s free, available to download from our Web site and it’s a terrific resource for anyone to start a PI initiative or quality improvement initiative, because our HEDIS measures are so rigorous and scientifically based and tested and validated that it really is an apples to apples comparison among organizations at the health plan level, or at the physician practice level. So, a lot of our PI activities start with that. We know that there is a professional practice gap that exists. We have numbers to support that only 33 percent of children who’ve been diagnosed with ADHD are coming back into the physician for that critical follow up appointment in 30 days. So, we know there’s an educational need there to have the clinician educate the family about the importance of that. Have the healthcare team perhaps address the barriers that might exist to have the family bring the child back in. So, any PI initiative that we do in the planning and development of it we try to involve everybody at the practice level and what resources and efforts we can make embedded in the activity to assist the entire healthcare team to bring value for the activity.
>> SINGER: OK. So, you mentioned collaboration. Can you describe an example of the kind of collaboration that you’ve taken. Like how did you decide that you needed collaboration? Or what did you see in the potential for collaboration? And then what did you do?
>> D’ALESSANDRO: I think, when you assemble a group of very experienced, seasoned professionals that can bring a lot to the table, from their perspective and their experience, I think, our products and activity are better off. We seek to collaborate with other organizations, because we value their experience at the practice level, at the teaching facility level, the professional affiliation level, whatever it might be we enjoy seeking out those collaborations. And we value the experience everybody brings to the table. One of the other things that I think is really import in a PI activity is involving your target audience in your planning and development, ensuring that as you structure an activity to address professional practice gaps you’re really, you’re field testing it, if you will. You’re ensuring you have some validity and reliability built into your actual activity to reach those expected outcomes you want to achieve.
>> SINGER: It’s interesting what you said about involving the target audience. And I can, I can certainly see the value of that for engaging them in practice improvement modules, performance improvement modules around a particular gap. Something I’m interested in hearing your perspective about is sort of, if we swivel that around the axis of your measures the, you may be in the unique situation in your organization that the value, the validity of the measures that you have are already a something of importance to the target audience that you have.
>> D’ALESSANDRO: Sure.
>> SINGER: What can you suggest or what have you found are positive ways to engage physicians or to engage I’m mean you know I’m even thinking of a level higher, the C Suite, the executive leadership of healthcare institutions around education to improve quality.
>> D’ALESSANDRO: I think leadership at the health plan level or healthcare organization level have a particular priority or focus based on their patient population or demographics, whatever the needs are of their community or the consumer. There’s probably forces that influence that strategic direction of what clinical area they wish to focus on, but that’s the beauty of our HEDIS measures is they can select any out of those 77 measures across five care domains and choose what’s right for their patient population. And then the leadership at that health organization can dedicate and invest resources and initiatives towards improving a particular area, whether it’s diabetes, or congestive heart failure, or preventive screenings for children for immunizations. So, that healthcare organization can choose which area they want to focus their quality improvement efforts on. They can look at the data we publish; we have report cards that are available on our Web site. They can look at organizations across their state or across the country and see how organizations are doing and then focus their performance improvement efforts or their quality improvement activities on their own particular patient population. And I think, one of the, one of the challenges health plans or health care organizations may have is engaging that provider network that audience to engage in those quality activities. So, there has to be a concerted effort to place value on the importance of quality improvement effort, the value of that effort. And so, what would the expected result be for the patient population, what value would it be for that network provider.
>> SINGER: Let’s spend a couple minutes talking more specifically about the development of these performance improvement programs.
>> D’ALESSANDRO: OK.
>> SINGER: We had talked earlier about some insights or some advise you may be able to provide folks that are going to look at these measures and look to develop practice improvement programs in this way. Also, pitfalls to avoid or some challenges to address.
>> D’ALESSANDRO: OK. So, I think, one of the key pieces that we have used in the development of any performance improvement initiative is to create some sort of tool that will assess what the physician perceives to be their current level of performance. So, in many of our activities implement a case based vignette self-assessment survey. And that’s offered to the physician ahead of time the day they begin the actual PI activity, assessing , What’s going on in your current practice? How would you respond in this particular situation? We establish a little case situation for them to respond to. And then have them reflect as to what the barriers are in their practice. What’s going on that’s preventing them from achieving that optimal care for that patient, that individual. So, that’s one key piece that we’ve built into our performance initiatives to help providers reflect on current performance and consider what measures they would select towards improvement.
>> SINGER: And that’s part of the adult learning paradigm or predisposing your audience to learning So that you’re engaging them around that improvement process early so that they’re more engaged in in in what their, the target of what they’re trying to do.
>> D’ALESSANDRO: Absolutely. And we hope that snags and pulls them in to and gets them invested in the activity; has them reflect thinking maybe I’m doing OK.; maybe this is an area I’d like to focus on; knowing they probably need the support of their entire healthcare team to reach a particular level of improvement.
>> SINGER: You mentioned that you’ve been, that you’ve conducted five of these activities recently, performance improvement activities, what are you, as you sort of review the program and sort of look to the future, are there trends in which you’re seeing in the way that what your learners are looking for and how this evolving?
>> D’ALESSANDRO: Absolutely. Absolutely. I think with limited budgets, limited time, with busy provider office busy practice we’re seeing a lot of our providers prefer an online format either a Webinar or something that’s self-paced that they can progress through. So, when we develop CME courses we have to keep that in mind and make sure we offer formats that are appropriate for our learner, but can still offer value and still achieves some desired results. So, we’re seeing that definitely change.
>> SINGER: So, as you sort of look to those other formats, your challenge the opportunity for you is to ensure that they have just as much impact or the desired impact
>> D’ALESSANDRO: Yes.
>> SINGER: that you want them to have, have in that way.
>> D’ALESSANDRO: Yes, yes.
>> SINGER: Thank you very much, Jennifer.
>> D’ALESSANDRO: Thank you, Steve, for having me.
This is a transcript of Improving the Quality of Care at the Practice Level.
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