Link research, science and education in a way that produces practical tools for family physicians to improve the quality of their care. This, says AAFP President Mary Frank, M.D., was the ultimate goal of the AAFP Task Force on Linkages to Practice Improvement. It met last year and early this year, recommending outcomes the AAFP Board of Directors endorsed in March.
AAFP Points Way to Linking Research, Science, Education, QI
By Jane Stoever & Cindy Borgmeyer
5/9/2005
See the table for a summary of the outcomes.
The recommendations will set up a continuous loop of work, says Frank, who chaired the task force. The loop:
The recommendations will set up a continuous loop of work, says Frank, who chaired the task force. The loop:
- Evidence-based clinical practice guidelines are developed based on research.
- Quality improvement experts put them into a form usable by physicians, with tools to guide implementation.
- The guidelines-made-practical are rolled out through CME to practicing physicians and through medical education to students and residents.
- Members use the guidelines in their practices, see what improves care in their offices, later remeasure their progress and then feed information back to the researchers.
- The cycle starts again.
"The idea is not only to develop new standards and quality improvement tools, but also to measure whether what we're doing works so we can change the things that don't give us the outcomes we need," says Frank.
Summary of Outcomes Proposed by Linkages Task Force
The AAFP Board of Directors in March adopted measurable outcomes (not in order of priority) recommended by the Task Force on Linkages to Practice Improvement:
A note on the term linkages: The "Future of Family Medicine Report" encouraged the fusion of concepts such as quality improvement and CME that previously had been the purview of separate areas within the Academy, the task force noted in its final report to the AAFP Board.
The task force members came from five AAFP commissions -- those on Clinical Policies and Research, Continuing Medical Education, Education, Health Care Services, and Quality and Scope of Practice. The task force met with representatives of entities including the Agency for Healthcare Quality and Research, CMS, National Committee for Quality Assurance, and American Board of Family Medicine. The commissions will issue reports on their progress toward implementing the six recommendations in 2005. Corresponding commissions established under the new AAFP governance structure will make progress reports in 2007 and 2010.
The task force members came from five AAFP commissions -- those on Clinical Policies and Research, Continuing Medical Education, Education, Health Care Services, and Quality and Scope of Practice. The task force met with representatives of entities including the Agency for Healthcare Quality and Research, CMS, National Committee for Quality Assurance, and American Board of Family Medicine. The commissions will issue reports on their progress toward implementing the six recommendations in 2005. Corresponding commissions established under the new AAFP governance structure will make progress reports in 2007 and 2010.
QI Example
Frank says she and her colleagues in three offices have adopted a uniform flow sheet for diabetes care. The physicians check glycohemoglobin levels to see how near their patients are to the target range and check on the frequency of testing. "Some feedback," says Frank, "went like this: 'I give everybody a form when they come for their diabetes visit to get their hemoglobin A1C measured by the next visit, but you know what? I don't know who actually goes to the hospital lab for the test.'"
To solve that problem, the offices are buying machines to do the test during office visits.
"One, we bring the care to the patient," says Frank. "Two, we do what they need in terms of their diabetes care at the point when they're in the office, whether it's for a diabetes visit or because of a cold. Three, it's a waived test, so it's not a lot of hassle for us, and it increases our income instead of having the hospital lab paid for the test. It's a win for the patient. It's a win for me -- I'm not frustrated, wondering where the results are for the lab test I asked the patient to get before this visit. And it economically benefits our office."
To solve that problem, the offices are buying machines to do the test during office visits.
"One, we bring the care to the patient," says Frank. "Two, we do what they need in terms of their diabetes care at the point when they're in the office, whether it's for a diabetes visit or because of a cold. Three, it's a waived test, so it's not a lot of hassle for us, and it increases our income instead of having the hospital lab paid for the test. It's a win for the patient. It's a win for me -- I'm not frustrated, wondering where the results are for the lab test I asked the patient to get before this visit. And it economically benefits our office."
New Face of CME
"The task force recommendations change the face of CME," says Norman Kahn, M.D., AAFP vice president for science and education. "The recommendations help us get to an era in which physicians will be continually measuring the outcomes of their practice behaviors, continually improving their practice behaviors based on constant, repeated evidence-based feedback. This is what CME was supposed to be all about to begin with -- giving physicians information that actually changes their behaviors in specific ways that are linked by the evidence to improved patient outcomes."
The Academy is looking forward to the time, says Kahn, when many FPs will enter an office-based quality improvement program and, for example, get 20 CME credits for improving their office procedures for managing patients with diabetes. One option already available is the Academy's project called "METRIC: Measuring, Evaluating and Translating Research Into Care."
"I encourage every Academy member to visit the METRIC site and try the process for improving care of patients with diabetes and -- coming this July -- the process for care of patients with coronary artery disease," says Frank. "The feedback so far is that METRIC produces immediate changes in practice."
In addition, there's progress on point-of-care resources: The Commission on Continuing Medical Education has approved criteria for point-of-care resources to obtain AAFP CME accreditation, and the Board has approved the criteria. So programs with point-of-care products (software to assist physicians in making diagnoses in the exam room or hospital room) can now submit requests for CME accreditation.
The Academy is looking forward to the time, says Kahn, when many FPs will enter an office-based quality improvement program and, for example, get 20 CME credits for improving their office procedures for managing patients with diabetes. One option already available is the Academy's project called "METRIC: Measuring, Evaluating and Translating Research Into Care."
"I encourage every Academy member to visit the METRIC site and try the process for improving care of patients with diabetes and -- coming this July -- the process for care of patients with coronary artery disease," says Frank. "The feedback so far is that METRIC produces immediate changes in practice."
In addition, there's progress on point-of-care resources: The Commission on Continuing Medical Education has approved criteria for point-of-care resources to obtain AAFP CME accreditation, and the Board has approved the criteria. So programs with point-of-care products (software to assist physicians in making diagnoses in the exam room or hospital room) can now submit requests for CME accreditation.
