>>SINGER: I’m Steve Singer, I’m the director of Education and Outreach at the Accreditation Council for Continuing Medical Education.
>>MENCIA: Hello, I’m William Mencia I’m Vice-President of Education and Medical Affairs at Med-IQ.
>>SINGER: William it’s nice to have you here, thank you for coming.
>>MENCIA: Well, thank you Steve. It’s an honor to be here.
>>SINGER: So, what we’re going to do today is we’re going to talk about a business case for accredited CME to address care, to address improvement in care while lowering costs. And we’re going to align this; we’re going to connect this directly in the context of the Affordable Care Act. Very timely, and the Affordable Care Act’s sort of key goals are access to care, improvement of the delivery of care and care outcomes and the lowering of costs. And we’re going to talk about the latter two in the context of the work that you’ve done as an accredited provider and a medical education company, a for profit company in which you have chosen to address a clinical problem and to address it by engaging the leadership of several hospitals. And we’ll talk about the path that you took to sort of identify the problem and engage this leadership and understand all the dynamics of how you go about improving care and lowering costs. And, and we’ll see if we can pull out of that the value that, that you as an accredited provider can provide in this context and hopefully give some insights to other providers other stakeholders who are watching this to see that this is a possibility. This is something that they can do. So let’s start, just tell me about the organization that you work with.
>>MENCIA: Sure, I work with Med-IQ we are a medical education company based out of Baltimore, Maryland. And we have taken a focus over the last four or five years to developing more quality-based and performance improvement programs as a way of advocating for the value of continuing medical education as part of that push for quality that you spoke of.
>>SINGER: So, let’s start with the problem. You know our Criteria sort of stated simply are the Plan, Do, Study, Act model where you say, what’s the problem we want to solve and, and how are the people we serve as our customers our learners the targets the physicians we’re teaching and the health care teams that we’re teaching how are they involved? What is it that we are trying to change? How will we know when we are effective in creating change? And then lastly, were we effective in solving the problem? So, let’s start with the problem, what was the problem that you chose to address in this example?
>>MENCIA: We had developed a performance improvement activity about four years ago in acute coronary syndromes looking at physicians’ approaches to quality of care within the emergency department in the hospital system. And from that we were able to gather a series of gaps that were occurring within the systems. So, that was a performance based activity within the constructs of the AMA performance improvement model.
>>SINGER: And, it’s interesting, so you used this performance improvement activity really as a needs assessment to gather performance data about individual participant and then sort of seek to understand the broader picture of a system issue, system quality improvement issue.
>>MENCIA: That’s correct, Steve.
>>SINGER: So, going from that, you’ve now identified quality issue to address, ok and you wanted to do this and sort of test this, test this program in hospitals. So, let’s talk about the path you took to do this and you had some partners involved, some, some collaborators?
>>MENCIA: That’s correct, Steve. Unfortunately we didn’t really go into the ACSPI activity thinking of it as a needs assessment opportunity. We were really trying to develop and educational intervention. But, that’s a very interesting point, because the outcomes data that we were able to elicit showed some genuine gaps within the systems. Unfortunately as a medical education company we really don’t have access to systems of care. So, that’s why we had to reach out to groups that we had collaborated with in the past such as Johns Hopkins University and a group called EMCREG, the Emergency Medicine Cardiac Research and Education Group that’s based out of the University of Cincinnati. Now what’s interesting about EMCREG that it is a group of emergency department directors and physicians who, both in the United States and internationally, who have collaborated together to create research and education specific to those departments. So, it was through those two collaborative partners and their contacts that we were able to start reaching out to different hospitals to see which systems may have a need in this area and how open they would be to bring this type of initiative into their hospital.
>>SINGER: OK. So, here’s where the, where your value proposition as an accredited provider sort of began. Like, you know, we’ll sort of leave the performance improvement project behind and now you understand that there’s a problem you’re trying to solve, a quality problem, a system problem, and, and again the, the accredited CME provider’s requirement, the ACCME’s requirements support you in recognizing that collaboration with others can be a valued part of our, what we require of you. The integrating yourself into performance improvement, integrating yourself into quality improvement are all part of our requirements. So, as you did that, now you have this audience and how did you , how did you approach the, the, how did you approach the argument to say, we have a program and we’d like to, we’d like to work with you , we’d like to work with, like how did you get to the hospital?
>>MENCIA: So, through the contacts at the two collaborators had already established we were invited in to a series of hospitals and we showed to them the outcomes of our performance improvement activity and we were able to demonstrate to them that there are specific gaps especially in the areas of risk assessment of patients who come into the emergency department with a potential cardiac arrest or myocardial infarction. That there are gaps in terms of providing guideline-based care within the emergency department and specific gaps in terms of reducing the time to treatment, or the time to transfer of these patients.
>>SINGER: OK. So, so, for those and you targeted a group of hospitals with this, you said you had meetings, but the, the EMCREG helped you to identify some to set up some meetings for you? How did that happen?
>>MENCIA: Correct. So, that’s correct. So, through the faculty that we asked to be a part of the program, they had some of those contacts and through those contacts we ended up speaking with C-Suite executives at those three institutions, two in the Detroit area and one in Greensboro, North Carolina.
>>SINGER: OK. And with those three hospitals you moved forward with the rest of the project?
>>MENCIA: That is correct.
>>SINGER: OK. Now, let’s, you and I talked on the phone and sort of identified that in as a way to implement the project, locally within these hospitals there’s sort of a range of interventions or sort of a range, the dynamics of the problem within the hospital and you know you talked about sort of work force issues or team issues, can you explore how you went about sort of going from this the performance improvement and sort of the gaps, starting with the problem to the way in which you analyzed the problem sort of in situ within those institutions to develop the strategies or the interventions that you would do in order to address the problem locally.
>>MENCIA: Sure, we had done a pilot program previously at a hospital in Florida looking at VT prophylaxis in major surgery, patients undergoing major surgery. And that afforded us to see the opportunity to see that most of the errors or the barriers within systems were not necessarily clinically based but are more based on human factor errors or lack of communication or lack of team work within the individuals in the system. So, when we approach those types of educational opportunities within these three hospitals for this program what we established was a multi-staged initiative, where the first stage was getting a baseline assessment of where that specific institution was in terms of meeting the gaps that we had established. But, then comes the education phase and that’s multi-tiered, because not only is clinical education required but then you also have to get into the aspects of creating a culture change within the institution a culture of quality among all of the , among all of the employees within the institution. From the physicians to the nurses to the pharmacists to the PAs, NPs, hospitalists you name it within the system all have to be invested in this. So, it, it create that environment of continuous learning where you come in and you do a, a specific type of workshop where you’re providing not only that clinical education, but also, that quality based education and then you reinforce that over a period of time.
>>SINGER: The folks listening to this video would listen to what you just said and would say, well that doesn’t sound like CME. That doesn’t sound like the same old CME, when in fact, what you’re doing is CME and it’s accredited CME and it sort of lights up a lot of our requirements. So that, you talked about you talked about non sort of educational strategies, clinical strategies, noneducational strategies, strategies around improving communication and team work, which are fully within our definition of professional practice of the physicians and health professionals that you are serving with education and you’re showing how you, as an accredited provider could really lead an effort to take a multi sort of a multi-tiered approach to solve the problem. So let’s, let’s, sort of can you talk more about the strategies that you used to turn your CME into a quality improvement process improvement approach?
>>MENCIA: Absolutely. You had mentioned earlier the Plan, Do, Study, Act method and we utilize that as providers in all of our activities. So, when you say that the listeners may not see this as CME, we approach this as we would any CME activity and it has all the elements of a typical CME activity. We did the baseline assessment certainly to see where the specific gaps were for that specific institution, but then the onsite education has all the elements of a live interactive workshop where we bring in the staff from the institution they hear both clinical education around the disease state area and the importance to adherence to guideline based care, but they also hear the education that serves the competencies that we address within CME around process improvement around checklists around identifying the roles of each person within the health care team how to communicate better. And that would all lead to reduction of errors within that institution.
>>SINGER: So, you found no barriers within the requirements of the accredited CME to engage with, with sort of the aspects or the elements of the problem you were trying to solve?
>>MENCIA: That’s a great question, because it’s, the barriers are not necessarily in the construct of how to develop the activity. The typical barriers are within the health care providers within the institution, because the see this as another class that they have to go to. But once they’re in there especially through the type of quality system of education that we use which is called Crew Resource Management it’s based on a program that was developed by NASA and the FAA in the late Seventies early Eighties looked at what were the factors that lead to a series of accidents that that industry faced. And they realized that is was all around human factors. It was all around communication and identification of barriers among the different members of the team. And there are parallels in that system to the health care team. The pilot can be seen as the surgeon or the director of a emergency department in this case and then the crew, different members of the crew different members of the health care team that are addressing a specific patient. So, within this construct of the CRM while at first you do get the crossed arms once the physicians and the other health care professionals start seeing the connection of the dots and an airplane crash I tell you gets everybody’s attention right away and that’s how the program starts. They show a simulation of an actual airline accident
>>SINGER: This is a part of your activity
>>MENCIA: part of the education
>>SINGER: you didn’t put everybody in that
>>SINGER: in an airplane, OK.
>>MENCIA: No, no, no, this is a part of the education. They’re watching an actual simulation and then the pilots break down what’s happened and then start paralleling that to break downs within the health care system. And that’s where you see all those arms get uncrossed, people start leaning forward and immediately they’re engaged and recognizing that yes, there is opportunity to improve within the hospital.
>>SINGER: So, that’s great. So, now what’s next, you’ve done the project in three hospitals and sort of what’s the status of this project going forward?
>>MENCIA: It’s still an ongoing project. We do have some preliminary data. We were, we just presented some of that information at the American Academy of Managed Care annual meeting or meeting on quality earlier this summer. We will be submitting the manuscript for publication in September after the final analysis of the data is done. But, we’ve already been able to see a statistical improvement across the three areas of the gaps that I mentioned earlier.
>>SINGER: OK. And have you at this point been able to sort of bring back validation to the argument about improving care and lowering cost, is that, how do you right now sort of at a midpoint how do you assess your success with regard to that?
>>MENCIA: Great question. So, the body of evidence now exists going back to that PI activity and now the QI initiative within the hospital to demonstrate how CME has played a role in actually improving care. We were able to see statistical improvements in terms of the utilization of risk assessments scores in all patients that come into the hospital. We were able to see reduction in times to treatment, and times to transfer patients out of the institution. So, what we’ve seen through this activity is that CME played an active role in being able to improve quality of care, improve patient care within this institution, within these three institutions.
>>SINGER: So, in showing improved use of risk assessments scores and decreasing the time to treat, sort of effectiveness in the, in the with respect to the quality improvement goals, how do you interpret data or what does that tell you in terms of the other goal of lowering cost?
>>MENCIA: So those two factors that I mentioned plus other variables that we’ve been able to improve all would suggest that we have created more efficiencies in terms of patient care within the emergency department. And that ultimately would also suggest that there is going to be a decrease in health care utilization costs within the system.
>>SINGER: OK. So, in terms of lowering costs you have evidence that’s suggestive that you’re improving efficiency, but that might be an area for sort of future study as this project sort of evolves And if as you have the opportunity to sort of expand the project into other places.
>>MENCIA: That is correct. Our intent was to create a scalable model, look at a few gaps that we could specifically address within the institution but also to be able to gather more data more information about how to do deeper level studies within these types of institutions.
>>SINGER: Ok. And as part of this values proposition I would expect that having done this, this pilot project there’s a , there’s a point at which you’re going to have to go back to those stakeholders and say here’s what we’ve accomplished and are you willing to continue supporting this? Are we able to continue this? Right?
>>MENCIA: That is correct, in fact that is also the intent is to be able to scale this up to other hospitals across the country. One goal of hopefully getting this information published and appear in a peer review journal is to demonstrate that value of these types of educational activities to other institutions across the country so that when we approach them they’ve already seen that this model can work. And how it could be applied within their own institution.
>>SINGER: Great. Great. Thanks for clarifying. So, I wish you luck as you continue this project and hope that you have success and continuing to sort of scale into other institutions. And this video is sort of one of two parts so, in fact, we’re going to talk in the second video about how you did sort of a similar kind of project focused on improvement with a managed care organization also with published results. And we’ll talk more about sort of the research focus of how of what you learn in terms of gathering data and being able to publish the evidence basis for the value that you are bringing as an accredited provider. So thank you very much.
>>MENCIA: Thank you, Steve.
This is a transcript of How CME Can Improve Health Care Quality While Reducing Costs: A Medical Education Company/Hospital Collaboration
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