American College of Physicians: Internal Medicine — Doctors for Adults ®

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ACP programs provide best practices to ensure the best care

From the January ACP Internist, copyright 2009 by the American College of Physicians

By Jeffrey P. Harris

The goal of all of the College's quality improvement programs is to address the variability in patient care, to complement experience and judgment with evidence-based knowledge, to utilize programs to narrow the gaps between evidence and practice, and to try to improve translation of guidelines into practice.

Given the national focus on improving quality care, there's no better time to address this issue. If your goal is to enhance the care you provide to your patients, then you need to know where you stand and how you're doing. In order to improve, sometimes we need to change the way we care for patients and our practice behaviors. Changes do not have to be monumental to be effective. Small increments of change can add up to large-scale improvements.

A number of quality improvement programs available from the College can help internists gather practice data, identify practice gaps and patterns, and address practice barriers. These programs and tools promote team-based care and can help you enhance and improve your patient care.

ACPNet, the College's free Web-based quality improvement program, teaches clinical quality improvement techniques and educates office-based internists on evidence-based best practices. Launched in 1997, it now includes 1,000 practices. The program assesses practice patterns by collecting clinical outcomes data on patients and uses Web-based educational programs and toolkits to help physicians improve the quality of care of their patients.

ACPNet helps physicians analyze their practice patterns, evaluate their practice data to identify gaps and make necessary changes in their practices. To improve the effectiveness of the program, ACPNet provides coaching through conference calls and e-mail exchanges. Participating physicians may receive up to 38 category 1 CME credits and ABIM's Part 4 MOC credit. Participation is currently open for ACPNet's quality improvement projects on pain management and COPD.

Closing the Gap is another team-oriented, online program the College offers that helps physicians and their staffs create practice-wide systems change to improve patient care. Since its debut in 2002, the program has increased awareness of the gap between current practice and acceptable standards of care for many diseases. The program incorporates the Chronic Care Model for systems change and the Plan-Do-Study-Act cycle for quality improvement.

This team-based approach has resulted in statistically significant improvements in many clinical measures, such as a 40% increase in annual urine albumin testing, a 62% increase in annual dilated eye exams, and a 100% increase in influenza vaccinations. Participants receive up to 38 category 1 CME credits and Part 4 MOC credit. More than 350 practices have improved the care they deliver by participating in ACP Quality Improvement educational programs. Enrollment is currently open for Closing the Gap: Diabetes Care. For more information go online.

The Center for Practice Improvement & Innovation (CPII) enhances practice-based activities by providing tools, consultation and programs for ACP members. The CPII is dedicated to assisting small- to medium-sized practices better meet a broad array of challenges and improve outcomes and efficiencies. Members of the CPII staff, with grant funding from the Physicians' Foundation for Health Systems Excellence, worked with 30 small internal medicine practices. Key findings from the two-year project are being used to develop a variety of resources to help achieve workflow efficiencies, improve quality, and increase the satisfaction of patients, staff and physicians. The resources developed and used for the project are online in the Running a Practice section of the ACP Web site alongside a recently revised health information technology section that includes guidance for electronic health records and e-prescribing.

At the national level, the College continues to be a leader in developing policies that ensure that quality measures used to evaluate physician performance are evidence-based, relevant, valid and clearly defined. College policies have also addressed the inherent conflicts in pay-for-performance programs if physicians are held to achieving certain thresholds, rather than focusing on what is best for the patient. The degree of improvement in a metric, not simply whether any absolute number is achieved, should be considered when payments are linked to performance. Such a policy would ensure that physicians caring for more difficult populations would be rewarded for their achievements.

Additionally, the College works collaboratively with others to ensure that an internist's perspective is heard when decisions about pay-for-performance are made. ACP is a founding member of the AQA, (previously known as the Ambulatory Care Quality Alliance) to determine how to most effectively and efficiently improve performance measurement, data aggregation and reporting in the ambulatory care setting. Similarly, we are involved in the National Quality Forum which is developing and implementing a national strategy for health care quality measurement and reporting.

With the development of the patient-centered medical home model of care, providing the best quality of care to our patients will continue to be critical to the practice of primary care medicine. I encourage you to take advantage of the College resources available to you to improve efficiencies in your offices and enhance the care you provide your patients.

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