The ABIM recently developed a series of Web‐based practice‐focused self‐evaluation instruments called Practice Improvement Modules (PIM) as a requirement of its maintenance of certification program. PIMs facilitate the implementation of quality improvement (QI) processes through medical record abstraction, patient surveys, and a review of physicians' clinical microsystems. The primary goal is to promote QI in physicians' practices, including those of hospitalists.
To report the initial experiences and demographics of the early users of the hospital‐based PIM.
The hospital‐based PIM is unique in that it allows physicians to utilize and reflect on hospital‐level outcomes data from 1 of 4 conditions using CMS‐endorsed performance measures: acute myocardial infarction (AMI), community‐acquired pneumonia (CAP), congestive heart failure (CHF), and ventilator‐associated pneumonia (VAP). The hospital PIM asks diplomates to describe their QI team (existing or proposed), complete a step‐by‐step work process for a single measure, and analyze their hospital‐level microsystems and environment in order to develop a new or report on an existing hospital QI plan.
The mean age of the hospital PIM completers (n = 771) was 45 years, 76.0% were male, and they came from a wide variety of disciplines and areas of expertise. Most physicians (64.1%) had never completed a medical record audit of their own practice. The most common approaches to developing QI plans and interventions included the creation of the plan from scratch internally (37.0%), the use of existing quality improvement organization (QIO) tools (29.6%), and the adoption of plans and interventions from the medical literature (21.1%). Diplomates reported using help from medical societies, consultants, or outside vendors infrequently (4.1%). Physicians reported working in interdisciplinary teams (77.5%), developing standing orders (63.4%), learning about existing pathway or standing orders (59.2%), and gaining new communication skills (59.2%) as the most frequently utilized methods of implementing QI plans. Few reported needing new equipment (8.4%), and one quarter reported specifically using electronic medical records (25.5%) to implement their QI plans. Finally, the majority of completers chose CAP (39.0%), followed by CHF (29.1%), VAP (16.9%), and AMI (15.0%). Interestingly, the measures chosen by physicians for improvement did not always correlate with conditions in which performance was reported as poor or lacking. Future work is warranted to explicate how and why decisions are made regarding targeted measures, as well as to continue to build knowledge regarding how the hospital PIM facilitates QI at the hospital and physician levels. Although preliminary, this work highlights the hospital PIM as a useful component of maintenance of certification.
K. Caverzagie, American Board of Internal Medicine, receives salary support from ABIM; E. Bernabeo, none; S. Reddy, none; E. Holmboe, none.