The performance improvement process	December 2008

Rick Kennison, president and general manager, PeerPoint Medical Education Institute (peerpt.com), walks through the major steps of how a performance improvement CME program is run.

Rick Kennison: It’s actually a very long process. Generally, like all CME, it starts with a needs assessment. It starts with understanding what the clinical and performance gaps are. And from that a determination is made whether or not performance improvement is actually good in this arena. There are arenas that probably are not the best thing. Maybe there is very little provider interest in a particular therapeutic area, so it may not have any real benefit. Like allergic rhinitis.

But once it’s determined that there is a need for it, what we’ll do is we’ll generally use something called the Keystone Method. The Keystone Method is a four-step process that we trademarked to create a program. In the first Keystone area is a content development meeting. What we do is we pull in experts in the field. We bring in quality improvement experts. We bring in anybody who can help us address some of the barriers to high quality care delivery, and we invite them to a meeting. What we do is we vet strategies and we talk about a whole bunch of different techniques and opportunities that may surface to try to improve the quality of care.

Next, what we do is take the learnings from the first step and we create some type of training mechanism for the participants. For instance, it may be a live meeting. We recently kicked off a performance improvement program at the ACG meeting. Other things could be Web conferencing, live and enduring Web conferencing. Other modalities that bring the issues front and center and train the participant as to what the quality improvement program consists of, why it’s important, and the best ways to work within their own care setting to improve the quality of care they deliver.

Phase three is the QI phase or the PI phase. For every initiative and every gap that we uncover, we come up with specific tools that are guideline based to help do two things. Number one, determine where a practice is at the beginning period. A snapshot into their current practice patterns, if you will. That can be a few weeks, a few months.

Then what we do is go to step two, which is an implementation phase. We go back to the guidelines we’ve been talking about, and we create tools that make the process easy, digestible, and valuable to the participants. For instance, we may take a 70-page set of guidelines and create an easy-to-follow algorithm regarding steps that should be taken in this particular patient, and we give it to them. And we ask them to record specific data that is part of the implementation tools, and they submit all this data back to us. So, what we’re able to do is we’re able to see trends over time. Once they had the tools in front of them, did the quality of the care that was delivered to the patient improve over these periods of time? Over these snapshots? And in most cases, the answer is yes. There are cases where the answer is no, and that may be because of other barriers existing within their practice or it may just be from a lack of still not doing it right.

The next and final phase is the reporting period. Our goal is not just to write a nice little white paper or send somebody an email saying this is what we found. What we do is we are preparing to write peer-review publications, abstracts, posters, in medical journals saying look, we did this educational initiative, we found by changing or by providing providers with the right questions and the right answers, we were able to improve the quality of care in patients that were suffering from disease state X.

That’s what the process looks like. It’s a hybrid between CME, adult learning, practice management, maintenance and certification, concepts and theories associated with performance improvement. It’s taking multiple things that have been in existence and putting them into a digestible format that takes the strengths from each of them and couples them.

Who else has an interest in this? We’ve been talking to major insurers. I’m talking about medical insurance carriers. Physician groups. Hospital systems have been interested in what we’re talking about here. We’ve been talking with the federal government, in terms of some of these initiatives. And so the days of solely pharma supported CME may be dwindling. Even more so with the inception of performance improvement because other companies and other organizations are interested in these types of results too.