PI CME Research Articles

Pictorial Interview of Children’s Metacognition and Executive Functions (PIC–ME): A Comparison Between Children With and Without Attention Deficit Hyperactivity Disorder

Abstract Date Presented 3/30/2017 The Pictorial Interview of Children’s Metacognition and Executive Functions (PIC–ME) was designed to evaluate self-perception of executive function challenges in daily life among children with attention deficit hyperactivity disorder and to promote their engagement in goal setting. Results support the initial reliability and validity of the PIC–ME. Primary Author and Speaker: Ruthie Traub Bar-Ilan Contributing Authors: Adina Maeir

PI CME: Improving the Recognition and Management of Osteoporosis Post‐Fracture

PI CME: Improving the Recognition and Management of Osteoporosis Post‐Fracture

PI CME driven interventions in an outpatient oncology practice to improve awareness and utilization of advanced care directives.

e20508 Background: The completion of advance directives (AD) and the discussion of a patient’s end of life goals result in a more patient-centered approach to care. The Adena Cancer Center develope...

Evaluation of the Performance Improvement CME Paradigm for Pain Management in the Long-Term Care Setting

A performance improvement continuing medical education (PI CME) activity was designed to assist clinicians with accurately identifying and appropriately managing persistent pain in long-term care facility (LTCF) residents. Volunteer LTCFs participated in a three-stage PI CME model consisting of: 1) baseline assessment, 2) implementation of practice improvement interventions, and 3) reassessment. Expert faculty chose performance measures and interventions for the activity. A champion was designated ateach LTCF to collect resident charts and enter data into an online database. Eight LTCFs located across the United States participated in the activity. Fifty resident charts were randomly selected by each LTCF champion (25 for stage 1 and 25 for stage 3); a total of 350 charts were reviewed. In addition to a toolkit containing numerous performance improvement resources, an in-service meeting led by an expert faculty member was conducted at each LTCF. Stage 3 data were collected 6 weeks after implementation of interventions and compared with stage 1 baseline data to measure change in performance. Aggregate data collected from seven LTCFs completing the PI CME activity through stage 3 revealed improvements from baseline in four of five performance measures. This CME activity allowed for collection of data demonstrating performance improvement in persistent pain management. The tools used as part of the intervention (available at http://www.achlpicme.org/LTC/toolkit) may help other clinicians enhance their management of LTCF residents with persistent pain.

Performance improvement CME in psychiatry: implementing black box warning informed consent

Objective. Performance improvement continuing medical education (PI CME) is a recent educational methodology designed better to link educational content and outcomes in the context of limitations in the effectiveness of traditional CME. This study examines the ease of use and effectiveness of psychiatric CME in a small hospital. Methods. All staff psychopharmacologists assessed their performance in providing informed consent of black box risks of prescribed psychiatric medications in a 3-month period. Staff were educated regarding black box risks of all commonly prescribed psychiatric medications, and their performance in the following quarter was reassessed. Significance of change following the educational intervention at 3 and 6 months was determined by Chi square analysis. Results. PI CME was clearly successful in supporting behaviour change, χ2(1, N=60) =20.86, p=0.000, far outstripping traditional CME efforts. Changes in behaviour persisted over time, χ2(1, N=61)=4.04, p=0.044. This PI CME event received the highest possible rating by CME participants, and took few staff resources to implement. Conclusions. PI CME is an educational technology that can be carried out, without significant burdens to participants or educators, in psychiatric departments of small hospitals. PI CME can be much more effective than traditional CME in bringing about desired behaviour change in psychiatrist behaviours. Hospital-based PI CME may have other benefits, such as meeting criteria for Maintenance of Certification.

Impact of Performance Improvement Continuing Medical Education on Cardiometabolic Risk Factor Control: The COSEHC Initiative

The Consortium for Southeastern Hypertension Control (COSEHC) implemented a study to assess benefits of a performance improvement continuing medical education (PI CME) activity focused on cardiometabolic risk factor management in primary care patients. Using the plan-do-study-act (PDSA) model as the foundation, this PI CME activity aimed at improving practice gaps by integrating evidence-based clinical interventions, physician-patient education, processes of care, performance metrics, and patient outcomes. The PI CME intervention was implemented in a group of South Carolina physician practices, while a comparable physician practice group served as a control. Performance outcomes at 6 months included changes in patients' cardiometabolic risk factor values and control rates from baseline. We also compared changes in diabetic, African American, the elderly (> 65 years), and female patient subpopulations and in patients with uncontrolled risk factors at baseline. Only women receiving health care by intervention physicians showed a statistical improvement in their cardiometabolic risk factors as evidenced by a -3.0 mg/dL and a -3.5 mg/dL decrease in mean LDL cholesterol and non-HDL cholesterol, respectively, and a -7.0 mg/dL decrease in LDL cholesterol among females with uncontrolled baseline LDL cholesterol values. No other statistical differences were found. These data demonstrate that our PI CME activity is a useful strategy in assisting physicians to improve their management of cardiometabolic control rates in female patients with abnormal cholesterol control. Other studies that extend across longer PI CME PDSA periods may be needed to demonstrate statistical improvements in overall cardiometabolic treatment goals in men, women, and various subpopulations.

Constructing an adaptive care model for the management of disease-related symptoms throughout the course of multiple sclerosis—performance improvement CME

Background: Symptom management remains a challenging clinical aspect of MS. Objective: To design a performance improvement continuing medical education (PI CME) activity for better clinical management of multiple sclerosis (MS)-related depression, fatigue, mobility impairment/falls, and spasticity. Methods: Ten volunteer MS centers participated in a three-stage PI CME model: A) baseline assessment; B) practice improvement CME intervention; C) reassessment. Expert faculty developed performance measures and activity intervention tools. Designated MS center champions reviewed patient charts and entered data into an online database. Stage C data were collected eight weeks after implementation of the intervention and compared with Stage A baseline data to measure change in performance. Results: Aggregate data from the 10 participating MS centers (405 patient charts) revealed performance improvements in the assessment of all four MS-related symptoms. Statistically significant improvements were found in the documented assessment of mobility impairment/falls (p=0.003) and spasticity (p<0.001). For documentation of care plans, statistically significant improvements were reported for fatigue (p=0.007) and mobility impairment/falls (p=0.040); non-significant changes were noted for depression and spasticity. Conclusions: Our PI CME interventions demonstrated performance improvement in the management of MS-related symptoms. This PI CME model (available at www.achlpicme.org/ms/toolkit) offers a new perspective on enhancing symptom management in patients with MS.

The Long-Term Impact of a Performance Improvement Continuing Medical Education Intervention on Osteoporosis Screening

The purpose of this study is to determine whether a performance improvement continuing medical education (PI CME) initiative that utilizes quality improvement (QI) principles is effective in producing sustainable change in practice to improve the screening of patients at risk for osteoporosis. A health care center participated in a PI CME program designed to increase appropriate osteoporosis screening. There were eight 1-hour educational sessions for this activity over a 9-month period. Thirteen providers completed all 3 stages of the PI CME program. A variety of other clinicians, in addition to the 13 providers, participated in the educational sessions. Data were collected at the beginning and end of the PI CME activity and at three intervals during the 5 years after the completion of the activity. The percentage of tests for osteoporosis ordered and performed increased significantly from Stage A to Stage C of the PI CME activity and continued to increase after the completion of the PI CME activity. Follow-up data at 4 and 40 months (for ordering and performing osteoporosis screening) and 49 months (for performing the screening only) reflect the impact of the PI CME activity plus the continuing QI interventions. The percentage of BMD tests ordered continued to increase substantially over the post-PI CME periods: 4 and 40 months (F(3,46) = 4.04, p < .05). Similarly, the percentage of BMD tests performed continued to increase at 4, 40, and 49 months after the conclusion of the PI CME activity (F(4,55) = 12.55, p < .0001). The data indicate that PI CME utilizing QI principles can be effective in producing sustainable change in practice to improve the screening of patients at risk for osteoporosis. Further research is needed to determine the extent to which such changes can be directly attributed to this type of intervention.

Performance Improvement CME

Web Activity Posting Date: November 2011 Performance Improvement CME: Diagnosing and Treating Bipolar Disorder Alan Podawiltz, DO, MS, FAPA Performance Improvement CME (PI CME) is an educational activity in which clinicians retrospectively assess their current clinical practice, choose areas for improvement, and implement interventions based on treatment guidelines and health care standards and then re-evaluate their clinical practice to assess the improvements made. This PI CME focuses on the treatment of bipolar disorder in primary care settings and addresses the topics of accurately diagnosing the disorder, selecting appropriate treatments, encouraging patient adherence to medication, monitoring the efficacy and safety of pharmacotherapy, and knowing when to refer patients to a consultant or hospital. (J Clin Psychiatry 2012;73[05]:e18) From the Department of Psychiatry, University of North Texas Health Science Center, Fort Worth. doi:10.4088/JCP.10060pi5cc

Performance Improvement CME: Adult ADHD

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent psychiatric disorders and is now understood to be a lifelong condition for most individuals. Unfortunately, many adults with ADHD are not being diagnosed, possibly due to insufficient diagnostic criteria, the complex presentation of the disorder, and a reluctance by physicians to diagnose the disorder in adults. Additionally, many of those who have been diagnosed with ADHD do not receive adequate treatment despite the availability of established and effective agents. Performance Improvement CME (PI CME) is an educational activity in which clinicians retrospectively assess their current clinical practice, choose areas for improvement and implement interventions based on treatment guidelines and health care standards, and then re-evaluate their clinical practice to assess the improvements made. This PI CME activity focuses on improving the diagnosis and treatment of adult ADHD.

Performance Improvement CME: Long-Term Treatment of Bipolar Disorder

Bipolar disorder is a chronic, multidimensional syndrome that, if present in childhood, is likely to persist into adulthood. Currently, this condition is 1 of the 10 leading causes of disability among adults. Patients with bipolar disorder present with predominantly depressive symptoms, have a high risk for suicidality, and have considerable physical, social, and occupational/academic impairments, signaling an exigent need for the proper acute and long-term management of the disorder. Performance Improvement CME (PI CME) is an educational activity in which clinicians retrospectively assess their current clinical practice, choose areas for improvement and implement interventions based on treatment guidelines and health care standards, and then re-evaluate their clinical practice to assess the improvements made. This PI CME focuses on improving the overall treatment of bipolar disorder in order to prevent relapse and promote optimal outcomes for children and adults with this condition.

Sharing Collaborative Designs of Tobacco Cessation Performance Improvement CME Projects

Performance Improvement Continuing Medical Education (PI CME) provides an important opportunity for CME providers to combine educational and quality health care improvement methodologies. Very few CME providers take on the challenges of planning this type of intervention because it is still a new practice and there are limited examples from which to model. This article offers case examples of educational design, results, and lessons learned from 4 tobacco cessation PI CME activities. To share with the CME community different cases of PI CME educational design and results so that CME providers may have examples to draw from and develop more PI CME activities. This is a case report. Four of 9 partners of the Cease Smoking Today (CS2day) initiative developed the 4 tobacco cessation PI CME activities. Each project was designed and implemented using a common planning framework and clinical performance measures but with varying operational and educational design components depending on the strengths and resources of the leading partner. Three projects that are completed show improvements in aggregated practitioner performance and smoking quit rates. One project is currently under way. These cases highlight the value of collaboration, identify influences of operational and educational designs on variation in compliance with performance measures, and lead to a discussion of similarities in barriers, successes, and lessons for future practice.

Performance Improvement CME: Managing Chronic Pain

Performance Improvement CME (PI CME) is an educational activity in which clinicians retrospectively assess their current clinical practice, choose areas for improvement and implement interventions based on treatment guidelines and health care standards, and then re-evaluate their clinical practice to assess the improvements made. This PI CME activity focuses on improving the safety and efficacy of treating chronic pain with opioid medications.

Performance Improvement CME: Improving Outcomes in Depression

Performance Improvement CME (PI CME) is an educational activity in which clinicians retrospectively assess their current clinical practice, choose areas for improvement and implement interventions based on treatment guidelines and health care standards, and then re-evaluate their clinical practice to assess the improvements made. This PI CME focuses on improving the detection and initial treatment of depression, enhancing patients' treatment response, and preventing relapse and recurrence.