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Performance Improvement in Practice
Overview
Performance improvement (PI) activities describe structured, long-term processes by which a physician or group of physicians can learn about specific performance measures1, retrospectively assess their practice, apply performance measures prospectively over a useful interval, and reevaluate their performance. To award AAFP Prescribed credit for PI activities, providers must:
- Establish an oversight mechanism that assures content integrity of the selected performance measures. These measures must be evidence-based2 and well-designed (e.g., required data elements are clearly specified, data collection is feasible). Improvement activities may address any facet (i.e., structure, process or outcome) of a physician’s practice with direct implications for patient care.
- Provide clear instructions to the learner that define the educational process of the PI activity (documentation, timelines, etc.) and establish how they can claim credit.
- Validate the depth of physician participation by a review of submitted PI activity documentation. When requested, supply specific documentation of such credit to participating physicians.
- Provide adequate background information so that physicians can identify and understand a) the performance measures that will guide their PI activity, and b) the evidence base behind those measures. Providers may deliver this education through live activities, enduring materials or other means.
- Have an AAFP Active or Life member involved in the planning/ review of the overall CME activity.
To develop a complete, structured performance improvement activity, providers must ensure that participating physicians integrate all three stages described below.
Stage A: Learning from current practice performance assessment
Assess current practice using identified performance measures, either through chart reviews or some other appropriate mechanism. Participating physicians should be actively involved in data collection and analysis.
Stage B: Learning from the application of performance improvement to patient care
Implement an intervention based on the performance measures selected in Stage A using suitable tracking tools (e.g., flow sheets). Participating physicians should receive guidance on appropriate parameters for applying an intervention and assessing performance change, specific to the performance measure and the physician’s patient base (e.g., how many patients with a given condition, seen for how long, will produce a valid assessment?).
Stage C: Learning from evaluation of the performance improvement effort
Reevaluate and reflect on performance in practice (Stage B) by comparing to the assessment done in Stage A. Summarize any practice, process and/or outcome changes that resulted from conducting the PI activity.
Stage A: Learning from current practice performance assessment
Assess current practice using identified performance measures, either through chart reviews or some other appropriate mechanism. Participating physicians should be actively involved in data collection and analysis.
Stage B: Learning from the application of performance improvement to patient care
Implement an intervention based on the performance measures selected in Stage A using suitable tracking tools (e.g., flow sheets). Participating physicians should receive guidance on appropriate parameters for applying an intervention and assessing performance change, specific to the performance measure and the physician’s patient base (e.g., how many patients with a given condition, seen for how long, will produce a valid assessment?).
Stage C: Learning from evaluation of the performance improvement effort
Reevaluate and reflect on performance in practice (Stage B) by comparing to the assessment done in Stage A. Summarize any practice, process and/or outcome changes that resulted from conducting the PI activity.
Review Fee
The review fee is $700 for a two-year accreditation term. The non-profit discounted fee is $500 for CME providers with a non-profit status. The fee is for review services rendered and is not refundable. Payment and supporting materials must accompany the application before the review process can begin.
Assigning Credit
Physicians may be awarded incremental AAFP Prescribed credit for completing each successive stage of a performance improvement activity. Incremental credit for PI activities should be awarded as follows:
- Five (5) AAFP Prescribed credits can be awarded for the completion of each of the three Stages (A, B and C). Completion of the full PI cycle is not required.
- Providers may design PI activities so that physicians can enter at any of the three Stages. Providers that do so must design a mechanism by which physicians who enter after Stage A can document their completion of work equivalent to that described for the earlier stages.
- Physicians completing, in sequence, all three Stages (A through C) of a structured PI activity may receive an additional five (5) AAFP Prescribed credits, for a maximum of twenty (20) credits per activity. This credit allocation acknowledges that the best learning is associated with completing a well-conceived PI activity.
References
- A clinical performance measure is a mechanism that enables the user to quantify the quality of a selected aspect of care by comparing it to a criterion. (Institute of Medicine, 2000)
- Evidence-based medicine is "the integration of best research evidence with clinical expertise and patient values." (Sackett DL, Strauss SE, Richardson WS, et al. Evidence-based medicine: How to practice and teach EBM. 2nd ed. London: Churchill Livingstone; 2000.)
