Engaging Physicians
  in Quality Improvement

Putting Quality into Practice (PQIP)

Although physician participation in quality improvement is essential to national efforts to "cross the quality chasm," rates of participation are still far from 100%. There are special challenges to participation in small practices—which is where most of health care is delivered.

To better understand the experience of those who have begun to introduce quality measurement and improvement techniques into small practices—and to understand how those practices may be different from those that have not—the ABIM Foundation sponsored and led a collaborative study that comprised interviews with 39 physicians from small practices that had implemented quality improvement strategies, and a smaller group of physicians from practices that had not. The findings suggested that those who had implemented quality improvement had benefited both economically and psychologically—that those practices not only ran more efficiently, but that physicians had rediscovered (through their efforts to measure and improve outcomes) the feeling that they were making a positive difference in their patients' lives.

More information on the PQIP project is available on a DVD, available from this website. To view an excerpt from that DVD, or to order a free copy visit Quality > Putting Quality into Practice (PQIP).

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Macy (CoVE)

Improving Quality of Care for Elderly Patients in the Educational Setting

This study is supported by grants from the Josiah Macy, Jr. Foundation and the ABIM Foundation. This research will evaluate the efficacy of the American Board of Internal Medicine's (ABIM) Care of the Vulnerable Elderly PIM sm Practice Improvement Module (CoVE PIM) in improving the teaching and quality of care for elderly patients in internal medicine and family medicine training programs.

The primary study objectives will assess the impact of the CoVE PIM on:

1. The knowledge, skills, and attitudes of trainees in the care of specific geriatric conditions
2. The quality of care received by elderly patients in the training ambulatory setting
3. Trainees' knowledge of and attitudes about practice-based learning and improvement, systems-based practice, and geriatric care guidelines, compared to the impact of a traditional educational intervention

Forty-six training programs in Internal and Family Medicine were selected from a pool of over 100 applicants. The study is currently in the data collection phase and boasts 1,455 participating trainees.

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Residency and Faculty Practicum in Quality Improvement

The Practicum study - begun in June of 2004 and completed in December 2005—was designed to evaluate the feasibility of using the ABIM's Preventive Cardiology PIM sm Practice Improvement Module (PC-PIM) as a tool to teach and evaluate competence in practice-based learning and improvement and systems-based practice in residency training. Data analysis for this project is in progress. The study is intended to determine how completing ABIM's PC-PIM impacts the practice, knowledge and attitudes of the residents in the training program about quality improvement science and guidelines for preventing future heart attacks and strokes. Fifteen residency programs across the U.S. participated in the Practicum Study.

Various publications are pending. Please click here to access a white paper about the findings based on early use of PIMs in the training setting.

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Survey of ABIM Diplomates on Maintenance of Certification (MOC)

Results from a national mail survey of internists' perceptions about the forces driving them to maintain certification and the value of the process showed that although 91 percent of all participants reported that they were still working in internal medicine or its subspecialties, this percent was notably lower among internists, 79 percent. Of those still working in the field of internal medicine or its subspecialties, about half reported being required to maintain their specialty certificate by at least one employer, but only about one-third of those completed or enrolled in the Maintenance of Certification program report this requirement as a reason for participating. Physicians who have actually participated, however, perceive the program more positively.

Phase II of this survey is a follow-up study to determine why 21 percent of the general internists reported to have left the field of internal medicine and to assess whether attitudes toward Maintenance of Certification and performance assessment have changed over time.

The findings from the original survey can be obtained from: Lipner RS, Byslma WH, Arnold GK, Fortna GS, Tooker J, Cassel CK. "Who is Maintaining Certification in Internal Medicine - and Why? A National Survey 10 Years After Initial Certification." Annals of Internal Medicine. (2006) Vol.144, pp. 29-36.

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Evaluation of Practice Improvement Modules in Medical Groups

This project is a collaborative effort with the Henry Ford Health System to assess whether ABIM PIM ^sm Practice Improvement Modules affect practice performance and result in improved clinical performance.

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Impact of the Self-Directed Practice Improvement Module Method to Change Physician Behavior in Quality Improvement

This study will determine whether ABIM’s Self-Directed Practice Improvement Module leads to evidence-based changes in physician practices and will determine the role of the practice systems survey in this change.

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