tag:blogger.com,1999:blog-33981423110113289362024-02-19T03:49:53.110-05:00What Is Full Circle Clinical Education? The "Back to School" Tweet Fest Twitter service campaign (#CMEtf) highlights clinical education initiatives where the outcomes data and quality improvement findings have been published in peer-reviewed journals. Topics of interest are educational research where assessments and outcomes data show which instructional designs would be most appropriate to address clinicians' knowledge, competence, and performance gaps.Anonymoushttp://www.blogger.com/profile/02329067552426761393noreply@blogger.comBlogger17125tag:blogger.com,1999:blog-3398142311011328936.post-10169967671398404962015-10-06T15:09:00.000-04:002015-10-06T15:09:02.585-04:00Conversation-starter: SQUIRE tool standards as a connection between medical communication organization: ACEhp and AMWA<div class="MsoNormal">
<span lang="EN"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">There are many synergies and resources between the Alliance for Continuing
Education in the Health Professions (ACEhp) and the American Medical Writers
Association (AMWA), because medical educators and medical writers are all
communicators ... which explains why so many of us are members of both. In
today's ACEhp webinar (see <a href="http://www.acehp.org/p/cm/ld/fid=367" target="_blank">www.acehp.org/p/cm/ld/fid=367</a>), Jann Balmer
replied to a question asking about the role of medical writers in publishing
educational outcomes in the quality improvement reporting tool, SQUIRE (as
customized by ACEhp), saying that outcomes manuscripts can be enhanced by
medical writers and editors because QIE project managers may not be good
writers. My colleague, Donald Harting, and I have been discussing potential
organizational synergies between AMWA and ACEhp in this regard for over a year.
<o:p></o:p></span></span></div>
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<span lang="EN"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">This is an opportune moment for our memberships to work together: AMWA
celebrated 75 years with last week's Annual Conference, which started the very
day on which ACEhp launched its custom SQUIRE reporting tool for clinical
educational research at the annual Alliance Quality Symposium. This begs the
question: What role will professional medical writers and communicators in AMWA
play in publishing standardized, SQUIRE-compliant educational outcomes research
in the Alliance for CE in the Health Professions custom tool? <o:p></o:p></span></span></div>
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<span lang="EN"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">Conversation-starter: ACEhp identified a top goal of 2015's Phase II of the
Quality Improvement Education (QIE) Initiative as the "Assessment of
SQUIRE to generate Case Studies that demonstrate successful integration of
Education into QI." Professionals with capabilities in medical education
and writing will ideally combine their skills in writing these case studies.
Wouldn't you like to author a study that is eligible for later meta-analyses
because the study was SQUIRE-compliant? <o:p></o:p></span></span></div>
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<span lang="EN"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">Extension: There is an inaugural meeting on writing research in the SQUIRE
tool at Dartmouth this November 2015. MedBiquitous members, as experts in
standardization in medical education technology and reporting, what can you
contribute to this conversation? Members of the American Educational Research
Association LinkedIn group, what are your thoughts for connecting health
education research reporting to more global research agendas? <o:p></o:p></span></span></div>
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<span lang="EN"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">I am promoting the SQUIRE tool because of my roles as Co-Leader of the
ACEhp QIE Initiative's Building Block on "Nomenclature and Its
Adoption" and Research Track faculty. In these roles, I see the needs for
developing consistent wording and reporting standards for medical education
research. After all, how will we report our achievements and deliberate our
challenges in developing and researching CE in the Health Professions if we do
not have consistent language to use in the SQUIRE reporting tool? Let's not
delay a start in COMMUNICATING among health communicators. Join the discussion!
I believe that this is a great opportunity for all health educators, education
researchers, and writers to collaborate! <o:p></o:p></span></span></div>
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<span lang="EN"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">For additional information on these organizations, topics, and events,
check out these links (some may have membership firewalls): <o:p></o:p></span></span></div>
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<span lang="EN"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">- SQUIRE (Standards for Quality Improvement Reporting Excellence) inaugural
conference: <a href="http://squire-statement.org/news_events/squire_international_writing_conference/" target="_blank">squire-statement.org/news_events/squire_international_writing_conference/</a><o:p></o:p></span></span></div>
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<span lang="EN"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">- ACEhp Quality Symposium: <a href="http://www.acehp.org/p/cm/ld/fid=20" target="_blank">www.acehp.org/p/cm/ld/fid=20</a> (see also
the August 2015 issue of the Almanac: <a href="http://www.acehp.org/p/cm/ld/fid=52" target="_blank">www.acehp.org/p/cm/ld/fid=52</a>, p.
15)<o:p></o:p></span></span></div>
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<span lang="EN"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">- ACEhp Foundation QIE Initiative: <a href="http://www.acehp.org/p/cm/ld/fid=43" target="_blank">www.acehp.org/p/cm/ld/fid=43</a><o:p></o:p></span></span></div>
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<span lang="EN"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">- ACEhp Foundation QIE Initiative's custom SQUIRE tool: <o:p></o:p></span></span></div>
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<span lang="EN"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">---See Slides 17 - 19 of
<a href="http://www.acehp.org/p/do/sd/sid=864&fid=1212&req=direct" target="_blank">www.acehp.org/p/do/sd/sid=864&fid=1212&req=direct</a><o:p></o:p></span></span></div>
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<span lang="EN"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">---See Webinars at <a href="http://www.acehp.org/p/cm/ld/fid=367" target="_blank">www.acehp.org/p/cm/ld/fid=367</a><o:p></o:p></span></span></div>
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<span lang="EN"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">- AMWA 75th Anniversary: <a href="http://www.amwa.org/amwa_anniversary" target="_blank">www.amwa.org/amwa_anniversary</a><o:p></o:p></span></span></div>
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<span lang="EN"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">- MedBiquitous: http://www.medbiq.org/ and new Performance Standard:
<a href="http://www.medbiq.org/node/1001" target="_blank">www.medbiq.org/node/1001</a><o:p></o:p></span></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">Connect with me! SHBinford@FullCircleClinicalEducation.com or
<a href="http://www.linkedin.com/company/full-circle-clinical-education-inc" target="_blank">www.linkedin.com/company/full-circle-clinical-education-inc</a></span></div>
Anonymoushttp://www.blogger.com/profile/02329067552426761393noreply@blogger.comtag:blogger.com,1999:blog-3398142311011328936.post-35839838255110150942015-09-18T04:03:00.000-04:002015-09-18T04:14:06.638-04:00CS2day: Award-Winning, 9-Collaborator, Performance-Improvement CME With an Outcomes-Based Evaluation Model<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">I saved the best for the last
entry in the Back to School Tweet Fest. The <b>Cease Smoking Today (CS2day) initiative cannot be ignored</b> in a
series about effective educational interventions in changing practice and improving
quality of health care. An <a href="http://www.ncbi.nlm.nih.gov/pubmed/22190095">entire
2011 supplement of the <i>Journal of
Continuing Education in the Health Professions</i> (<i>JCEHP</i>) reports the complex CS2day educational program</a> and its
findings, with six research articles [1-6] and three forum articles [7-9] written
by multi-institutional teams among the nine initiative partners. This study was
awarded the Alliance for CME (now ACEhp) Award for Outstanding CME
Collaboration in 2009 (see PDF pages 15-18 of <a href="http://www.acehp.org/d/do/150">www.acehp.org/d/do/150</a>), and was
presented in a 2012 CME Congress poster (P50: <a href="http://www.cmecongress.org/wp-content/uploads/2012/05/CME-Congress-2012-Abstracts.pdf">http://www.cmecongress.org/wp-content/uploads/2012/05/CME-Congress-2012-Abstracts.pdf</a>).
The study boasts collaboration among universities, professional societies,
accredited CME providers, ACEhp presidents and conference chairs, CME directors
at academic medical centers, the <i>JCEHP</i>
Editor-in-Chief, and other published researchers [1,10] who carefully define
the educational program’s framework and collaboration model in the new quality
improvement paradigm of CME called for by the Institute of Medicine in 2001 [11].<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The CS2day initiative is so
big that this blog post cannot feature just one article reporting it. I will
focus on the introductory editorial [10] and 2 study articles that focus on (a)
developing competencies to assess needs and outcomes [3] and (b) the educational
and patient health outcomes data themselves [4]. The medical education expert
Donald Moore introduces the supplement and one article therein reports the
outcomes data. I hope you will do as Moore recommends, when you question what
you can take from articles describing “a huge project with significant funding,”
which is to ask, “What are the general principles that I can identify in these
articles and how can I use them in my CME practice[?]” [10]. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><a href="http://fullcirclece.blogspot.com/2015/09/patient-health-effects-of-performance.html">In
my previous post, I noted the difficulties of using PI-CME to change patient
health outcomes in a condition posing a major public health challenge</a>: the
COSEHC study addressed cardiometabolic risk factors and saw performance and
patient health improvements. The CS2day initiative faced the same challenge,
and happily also reported performance change and a change in patient health
outcomes: smoking cessation. Moore nicely summarizes the challenge of
connecting Level 5 performance changes among clinicians to Level 7 changes in
public health outcomes: “All of us want to improve the health of the public in
some way, but our approaches … may prevent us from having the impact that we
wish to have. The [CS2day] articles … suggest there might be another approach
that we should consider to address the important <i>public health issues that surround but do not seem to be impacted</i>
by our CME programs” [10; emphasis added].</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The articles in the </span><i style="font-family: Arial, Helvetica, sans-serif;">JCEHP </i><span style="font-family: Arial, Helvetica, sans-serif;">supplement are organized around 4
themes [10], to which I have added themes from the articles: </span></div>
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a) Collaboration is challenging but worth doing if guidelines are set and
a formative evaluation of the collaboration against known success factors is
carried out [1,2,5]<br />
b) Best-practice CME includes an outcomes orientation that connects learning
and performance objectives from the needs assessment to the outcomes assessment
in a valid framework to support content in all educational activities [3-6]<br />
c) A public health focus can lead to development of CME/CEhp activities
with a translational or implementation science function that transcends what
can happen when education addresses only a practice gap [7] <br />
d) Standards and competencies for CEhp and members of the CEhp profession
help initiatives meet the principles and characteristics of the IOM report’s
expectations [8,9,11] </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The two featured research
articles [3,4] function together as the Methods and Results sections of a
typical IMRAD-structured paper, but each is extensive enough to stand alone and
inform CEhp professionals. McKeithen </span><i style="font-family: Arial, Helvetica, sans-serif;">et al</i><span style="font-family: Arial, Helvetica, sans-serif;">
describe the following: the need for establishing clinical competency
statements related to supporting smoking cessation; the clinical guidelines
that informed performance expectations; “the 5 A’s” of support for smoking
cessation (Ask, Advise, Assess, Assist, and Arrange); the 14 competencies or
the 8 performance outcomes measures that fit into the 5 A’s algorithm being
assessed; and collaboration of clinical and educational experts on outcomes
tools to develop “a comprehensive set of measures at Levels 3 through 6” [3].</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The summative outcomes data
are extensively reported by Shershneva <i>et
al</i>, where “evaluation of a collaborative program” is presented as “translating”
the outcomes framework into practice [3,4]. Defining desired outcomes of the
program across Levels 1 to 6* was seen as useful in facilitating agreement among
stakeholders; guiding the evaluation process; gathering data from multiple
activities and collaborators in a central repository; and studying the effects
of mechanisms that link education to outcomes [4]. Thanks to effective
planning, the researchers were also able to add to the literature on
instructional design in CEhp by distinguishing performance outcomes from two
groups of activity types: a) live PI activities with either a collaborative
or practice-facilitator model and b) self-directed learning PI activities.
<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Also worth reading are
additional insights about using the Success Case Method (SCM) to determine
whether and why educational interventions succeed [6]. In CS2day reporting,
using the SCM allowed the research team to conclude remarkably confidently, stating,
“the PI activities were a primary and proximal cause of improvement in clinical
practice” [4]. Moore notes that “the results were impressive: physicians
integrated a new guideline into their practices and many patients stopped
smoking” [10]. The guideline integrated into practice through the CS2day
initiative was a “heavily researched evidence-based practice guideline
published by the U.S. Agency for Healthcare Research and Quality,” due to be
updated in 2008, the year after this collaborative initiative was begun [1]. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Finally, a comment: In CEhp,
change data are often seen as valid only when educational and program interventions
do not change before activity expiration, nor even when a formative assessment
shows changes to be necessary. This attitude can leave participating clinicians
with suboptimal educational opportunities and stakeholders in the educational
design frustrated. The use of the formative program evaluations that improved the
CS2day initiative, with acknowledgements of changes, is in my opinion better
than a pure pre/post comparison on an activity where valuable investments are
not updated when indicated. If the CME/CEhp profession helps clinicians link
medical care to public health through disease prevention, accountability to
quality, and more, then educational design should respond to data collected in
lengthy and large interventions. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The CS2day initiative is a model study in educational and performance improvement methods for a challenging public health problem. Please <a href="http://www.ncbi.nlm.nih.gov/pubmed/22190095" target="_blank">read the study articles</a> if you have print or online access to <i>JCEHP</i>, for I have only touched the surface of the initiative's methodology, results, and rationales in the limited confines of this space. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">* Note: In this study,
“Learning” was used as Level 3 and included knowledge and clinical skill (competence)
measures, while “Performance” including commitment to change (CTC) queries was
used as Level 4. Thus Level 5 was “Patient Health Status” and Level 6 was
“Population Health Status.”</span></div>
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<b style="font-family: Arial, Helvetica, sans-serif;">References cited: </b></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">
1. Olson CA, Balmer JT, Mejicano GC. Factors contributing to successful
interorganizational collaboration: the case of CS2day. <i>J Contin Educ Health Prof. </i>2011;31(Suppl 1):S3-S12. <br />
2. Ales MW, Rodrigues SB, Snyder R, Conklin M. Developing and implementing an
effective framework for collaboration: the experience of the CS2day
collaborative. <i>J Contin Educ Health Prof.</i>
2011;31(Suppl 1): S13-S20. <br />
<b>3. McKeithen T, Robertson S, Speight M.
Developing clinical competencies to assess learning needs and outcomes: the
experience of the CS2day initiative. <i>J
Contin Educ Health Prof.</i> 2011;31(Suppl 1):S21-S27. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22190097">http://www.ncbi.nlm.nih.gov/pubmed/22190097</a>.
[Featured Article]<br />
4. Shershneva MB, Larrison C, Robertson S, Speight M. Evaluation of a
collaborative program on smoking cessation: translating outcomes framework into
practice. <i>J Contin Educ Health Prof.</i>
2011;31(Suppl 1):S28-S36. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22190098">http://www.ncbi.nlm.nih.gov/pubmed/22190098</a>.
[Featured Article]<br />
</b>5. Mullikin EA, Ales MW, Cho J, Nelson TM, Rodrigues SB, Speight M. Sharing
collaborative designs of tobacco cessation performance improvement CME
projects. <i>J Contin Educ Health Prof. </i>2011;31(Suppl
1):S37-S49. <br />
6. Olson CA, Shershneva MB, Brownstein MH. Peering inside the clock: using
success case method to determine how and why practice-based educational
interventions succeed. <i>J Contin Educ
Health Prof. </i>2011;31(Suppl 1):S50-S59. <br />
7. Hudmon KS, Addleton RL, Vitale FM, Christiansen BA, Mejicano GC. Advancing
public health through continuing education of health care professionals. <i>J Contin Educ Health Prof. </i>2011;31(Suppl
1):S60-S66.<br />
8. Balmer JT, Bellande BJ, Addleton RL, Havens CS. The relevance of the
Alliance for CME competencies for planning, organizing, and sustaining an
interorganizational educational collaborative. <i>J Contin Educ Health Prof. </i>2011;31(Suppl 1):S67-S75. <br />
9. Cervero RM, Moore DE. The Cease Smoking Today (CS2day) initiative: a guide
to pursue the 2010 IOM report vision for CPD. <i>J Contin Educ Health Prof. </i>2011;31(Suppl 1):S76-S82. <br />
<b>10. Moore DE. Collaboration,
best-practice CME, public health focus, and the Alliance for CME competencies:
a formula for the new CME? <i>J Contin Educ
Health Prof.</i> 2011;31(Suppl 1):S1-S2. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22190095">http://www.ncbi.nlm.nih.gov/pubmed/22190095</a>.
[Featured Editorial] <br />
</b>11. Institute of Medicine (IOM) Committee on Planning a Continuing Health
Professional Education Institute. <i>Redesigning
Continuing Education in the Health Professions.</i> Washington, DC: The
National Academies Press; 2010. <a href="http://books.nap.edu/openbook.php?record_id=12704">http://books.nap.edu/openbook.php?record_id=12704</a>.
Accessed September 17, 2015.</span></div>
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<b style="font-family: Arial, Helvetica, sans-serif;">MeSH “Major” Terms for the 3
Featured Articles <i>(common items
italicized)</i>: </b></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>
McKeithen <i>et al </i>[3]:</b> <i>Benchmarking</i>; <i>Clinical Competence</i>; Education, Medical,
Continuing/methods; Needs Assessment; Outcome and Process Assessment (Health
Care)/organization & administration; Practice Guidelines as
Topic/standards; Smoking Cessation/methods; Tobacco Use Disorder/prevention
& control<br />
<b>Shershneva <i>et al </i>[4]:</b> <i>Benchmarking</i>/methods;
<i>Clinical Competence</i>/standards; Health
Personnel/classification; Health Personnel/psychology; Health
Personnel/statistics & numerical data; Interprofessional Relations; Outcome
Assessment (Health Care)/organization & administration; Program Evaluation;
Smoking Cessation/methods; Tobacco Use Disorder/prevention & control <br />
<b>Moore [11]: </b><i>Benchmarking</i>; <i>Clinical
Competence</i>; Delivery of Health Care, Integrated; Education, Medical,
Continuing/methods; Interinstitutional Relations; Public Health</span>Anonymoushttp://www.blogger.com/profile/02329067552426761393noreply@blogger.com0tag:blogger.com,1999:blog-3398142311011328936.post-776037790963776762015-09-17T14:13:00.000-04:002015-09-17T14:13:30.529-04:00Patient-Health Effects of a Performance-Improvement CME Educational Intervention to Control Cardiometabolic Risk in the Southeastern U.S.<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Many of you who know me might
recall that I moved from the Northeast to the Southeast U.S. some years back. As
I learned about the people and culture of the Southeast, I commonly saw many
dietary and lifestyle factors that would confer increased risks for
cardiovascular diseases and diabetes—indeed, this part of the United States is
known as “The Stroke Belt.” </span><a href="http://onlinelibrary.wiley.com/doi/10.1002/chp.21217/abstract" style="font-family: Arial, Helvetica, sans-serif;" target="_blank">The Consortium for Southeastern Hypertension Control (COSEHC) initiative reported by Joyner <i>et al</i> sought to improve the control of these risk factors</a><span style="font-family: Arial, Helvetica, sans-serif;"> through a performance-improvement continuing medical
education (PI-CME) activity [1]. It somehow seems fated that I report this
study because the lead author is based in the same North Carolina city where I have
lived these many years, working at <a href="http://www.wakehealth.edu/" target="_blank">Wake Forest University</a>. The PI-CME
initiative itself was conducted with several primary care physician practices
with designation as a COSEHC Cardiovascular Center of Excellence in Charleston,
South Carolina; a comparable practice group served as a control. Results were
reported to Moore’s Level 6 (patient health outcomes) [2]. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The intervention included many
overlapping and reinforcing elements that we would expect to see in a major initiative
on a major health concern: using the plan-do-study-act (PDSA) model,
researchers worked to “improve practice gaps by integrating evidence-based
clinical interventions, physician-patient education, processes of care, performance
metrics, and patient outcomes.” The intervention design included an action plan
to include medical assistants and nurses in patient-level tasks and education,
patient chart reminders, patient risk stratification, and sharing of physicians’
feedback on successful practice changes with other participating practices. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Because patient health outcome
indicators were used to define educational effectiveness of the PI-CME
initiative, the selection of measures is important to our understanding of
study findings. The research team used cardiometabolic risk factor target
treatment goals for 7 lab values as recommended by 3 sets of evidence-based
guidelines (JNC-7, ATP-III, and ADA). The team set a more aggressive target for
low-density lipoprotein cholesterol (LDL-C) because many patients had multiple
risk factors for cardiometabolic diseases and coronary heart disease risk “can exist
even in the absence of other risk factors.” Researchers investigated changes in
patient subgroups: “diabetic, African American, the elderly (> 65 years),
and female patient subpopulations and in patients with uncontrolled risk
factors at baseline.” The authors note that the average patient in both
intervention and control groups was clinically obese; other baseline health
indicators were also similar. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Now to results, gathered at 6
months to assess changes in patients' cardiometabolic risk factor values and
control rates from baseline. The abstract summarizes findings as follows [1]:</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">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.<o:p></o:p></span></div>
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<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">I want to discuss some factors
that could explain the little change seen in this study. First, the
intervention was measured at just 6 months into the educational initiative;
this is known to be barely adequate for assessing clinicians’ performance
change, and even performance changes were not likely to produce significantly
different lab values in patients with years of health-related practices that
led to their higher risks. Interestingly, there was less room for improvement
because patients in both groups had higher baseline risk-control rates than is
seen at the U.S. national level, and the patients in the intervention group had
even higher baseline risk-control rates than patients in the physician control
group had. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">The study did appear to
improve noted performance gaps regarding gender disparities in care. The
authors note 4 studies pointing out suboptimal treatment-intensification to
control LDL-C in female vs. male patients and even physician bias or inaction
for female patients. Thus the improved patient outcome data for LDL-C and
non-HDL cholesterol among women treated by physicians in the intervention group
indicates a narrowing of established gaps in attitude (Level 4) and/or
performance (Level 5). <o:p></o:p></span></div>
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<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Here in “The Stroke Belt,” any
effort to control cardiometabolic risk factors must include population-level
initiatives and patient education, which I have seen state governments, public health
departments, recreation centers, and schools undertake at many levels. Two
items stand out as affecting the COSEHC report’s findings: that the study tried
to measure changed patient health indicators too soon after intervention, and
that the researchers tied themselves to the high standard of measuring Level 6 for
a health concern that needs interventions among patients and the public that
were not considered here. Indeed, because physicians’ feedback on successful
changes <i>during </i>the initiative were
shared across practices, we know that Level 4 - 5 competence and performance changes
were achieved. The authors should be commended on their work to tackle this
public health concern through a PI-CME initiative. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Finally, I want to mention that
Joyner <i>et al</i> cite two studies by others
I am humbled to name as colleagues. First, Sara Miller and others at Med-IQ (in
a team often featured in Don Harting’s earlier posts in this Back to School campaign)
published with PJ Boyle on improving diabetes care and patient outcomes in
skilled-care (long-term-care) communities [3]. Second, <a href="http://fullcirclece.blogspot.com/2015/09/todays-landmark-nhlbi-sprint-study.html">Joyner
<i>et al </i>cite the article featured in
this blog on September 11, 2015</a>—which itself came up in my reporting on that
day’s release of the landmark SPRINT study results of the NHLBI [4]—by Shershneva,
Olson, and others [5]. The Joyner article noted the Shershneva team’s finding
that “process mapping led to improvement in [a majority of CVD] measures” [1]. <o:p></o:p></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><b><br /></b></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>References cited: <br />
1. Joyner J, Moore MA, Simmons DR, et al. Impact of performance improvement
continuing medical education on cardiometabolic risk factor control: the COSEHC
initiative. <i>J Contin Educ Health Prof.</i>
2014;34(1):25-36. <a href="http://onlinelibrary.wiley.com/doi/10.1002/chp.21217/abstract">http://onlinelibrary.wiley.com/doi/10.1002/chp.21217/abstract</a>.
[Featured Article]<br />
</b>2. Moore DE, Green JS, Gallis HA. Achieving desired
results and improved outcomes: integrating planning and assessment throughout
learning activities. <i>J Contin Educ Health
Prof.</i> 2009;29(1):1-15. <br />
3. Boyle PJ, O’Neil KW, Berry CA, Stowell SA, Miller SC. Improving diabetes care
and patient outcomes in skilled-care communities: successes and lessons from a
quality improvement initiative. <i>J Am Med
Dir Assoc.</i> 2013;14(5):340-344. <br />
4. NHLBI. Landmark NIH study shows intensive blood pressure management may save
lives: lower blood pressure target greatly reduces cardiovascular complications
and deaths in older adults [press release]. NHLBI Website. <a href="http://www.nih.gov/news/health/sep2015/nhlbi-11.htm">http://www.nih.gov/news/health/sep2015/nhlbi-11.htm</a>.
Accessed September 11, 2015.<br />
5. <b>Shershneva</b> MB, Mullikin EA, Loose
A-S, Olson CA. <b>Learning to collaborate:
a case study of performance improvement CME.</b> <i>J Contin Educ Health Prof.</i> 2008;28(3):140-147. <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782606/">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782606/</a>.
<b>[See blog post on this previously
featured article at <a href="http://fullcirclece.blogspot.com/2015/09/todays-landmark-nhlbi-sprint-study.html">http://fullcirclece.blogspot.com/2015/09/todays-landmark-nhlbi-sprint-study.html</a>]
<br />
MeSH “Major” Terms of Featured Article [1]: </b>Education, Medical,
Continuing/organization & administration; Metabolic Syndrome X/prevention
& control; Models, Educational; Physicians, Family/education; Quality Improvement</span>Anonymoushttp://www.blogger.com/profile/02329067552426761393noreply@blogger.com0tag:blogger.com,1999:blog-3398142311011328936.post-43013399290225541352015-09-17T01:23:00.001-04:002015-09-17T14:33:53.564-04:00Study Design and Paired Comparisons: Individualized Education Fails to Change Practice—Or Was It Only Poor Matching?<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">We should commend Malone <i>et al </i>for submitting this
AHRQ-supported* study [1] for publication when a flaw in its design or
execution could be the authors’ main reason for concluding that “the current
study was not able to demonstrate a significant beneficial effect of the
educational outreach program on [the primary performance outcome measure].” This
blog’s “Back-to-School” service campaign did not exclude studies reporting
negative outcomes because these studies can potentially inform continuing education
in the health professions (CEhp) as much as positive studies can.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">CEhp/CME educational proposals,
audience-generation strategies, and outcomes reports now specify relevant “target
audiences,” recognizing that not all practitioners with a certain degree,
specialty, or other professional demographic description would benefit from the
same educational activity or design. With this more recent recognition of the
importance of targeting specific clinicians and learning about their needs has
come greater recognition that many CE participants should not be included in aggregated
data. This is even truer in studies with matched pairs, where the step of
greatest importance lies in setting match criteria. On September 15th, I
discussed an opioids-education study where matching criteria were so stringent
that the authors were not able to match certain participants (physicians in the
intervention group), and these participants’ data and group assignments were handled
nicely and reported clearly in the paper [2] (see post at </span><a href="http://fullcirclece.blogspot.com/2015/09/eight-year-canadian-study-on-opioid.html" style="font-family: Arial, Helvetica, sans-serif;">http://fullcirclece.blogspot.com/2015/09/eight-year-canadian-study-on-opioid.html</a><span style="font-family: Arial, Helvetica, sans-serif;">).</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Conversely, the first result
listed in this study’s abstract indicates a matching flaw for a study on
education on drug-drug interactions (DDIs): “The 2 groups were significantly
different with respect to age, profession, specialty, and geographic region.” This
finding undermines other benefits to the study, namely, that large samples (19,606
prescribers) were recruited to both groups (educational intervention vs.
control) and matched on prescribing volume. Individualized education (also
known as academic detailing) was delivered by trained pharmacists as clinical
consultants who met with prescribers to “provide one-on-one information …
promote evidence-based knowledge, create trusting relationships, and induce
practice change.” This study’s performance (behavioral) measure was a reduced
rate of prescribing potential DDIs. The prescribing of 25 clinically important,
potential DDIs increased more in the intervention group than it did in the control
group.</span></div>
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<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">In conclusion, when we look at
this presumably negative finding, we are left to wonder whether the educational
intervention was not effective—or whether a better matching process might have
revealed different results on reducing potential DDIs and improving health care
quality and utilization. One could argue that with nearly 20,000 prescribers in
both samples, more matching criteria could have been applied without
sacrificing so many data points that results would be inconclusive. The study’s
design as a retrospective study could also explain recruitment and matching
practices. In social sciences research (including educational outcomes
research), a core expectation is generalizability of a sample to a population of
interest; when reasonably achieved, generalizability lets us apply findings to practical
needs and future decisions. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Recall the study conclusion
quoted above: “The </span><i style="font-family: Arial, Helvetica, sans-serif;">current</i><span style="font-family: Arial, Helvetica, sans-serif;"> study was
not able to demonstrate a significant beneficial effect …” (emphasis added). A
secondary analysis with different pair-matching practices might yet inform national
initiatives in improving quality while reducing costs through academic
detailing, both of which help patients. Now let’s remember to thank Malone,
Liberman, and Sun for sharing their data and methods with the healthcare
quality and educational research communities in the </span><i style="font-family: Arial, Helvetica, sans-serif;">Journal of Managed Care & Specialty Pharmacy</i><span style="font-family: Arial, Helvetica, sans-serif;">.</span></div>
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<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">* AHRQ = United States Agency
for Healthcare Research and Quality<br /><o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>References cited: </b><br />
<b>1. Malone DC, Liberman JN, Sun D. Effect
of an educational outreach program on prescribing potential drug-drug
interactions. <i>J Manag Care Pharm.</i>
2013;19(7):549-557. <a href="http://www.ncbi.nlm.nih.gov/pubmed/23964616">http://www.ncbi.nlm.nih.gov/pubmed/23964616</a>.
[Featured Article]</b><br />
2. Kahan M, Gomes T, Juurlink DN, et al. Effect of a course-based intervention
and effect of medical regulation on physicians’ opioid prescribing. <i>Can Fam Physician.</i> 2013;59(5):e231-e239.
<a href="http://www.cfp.ca/content/59/5/e231.full.pdf+html">http://www.cfp.ca/content/59/5/e231.full.pdf+html</a>. <br />
<b>Free Full Text: </b><a href="http://www.amcp.org/JMCP/2013/September_2013/17103/1033.html">http://www.amcp.org/JMCP/2013/September_2013/17103/1033.html</a><br /><b>MeSH “Major” Terms:</b> Drug Interactions; Drug Prescriptions; Education,
Medical, Continuing; Health Education; Physician's Practice Patterns; Prescription
Drugs/administration & dosage</span>Anonymoushttp://www.blogger.com/profile/02329067552426761393noreply@blogger.com0tag:blogger.com,1999:blog-3398142311011328936.post-39090544723229313142015-09-16T11:52:00.000-04:002015-09-17T02:07:34.756-04:00Personalized MD Curriculum in Personalized NSCLC Treatment Produces High, “Clinically Significant” Educational Effect Size<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">In non-small cell lung cancer
(NSCLC), evidence points to the benefits of tumor biopsy for biomarker
analysis, which in turn may allow individually targeted therapy [e.g., 1-3]. In
the last five years of this age of pharmacogenomics and prognostic markers, the
clinical excitement for individualized medicine has produced a robust count of 256
<i>review</i> articles indexed in PubMed
found with a search on “non small cell lung cancer treatment biomarker review,”
even with additional filtering to “Abstract [available], English, [and] Humans.”
But diagnostics in surgery and pathology, as well as personalized treatment for
cancer are expensive, so the societal context of the Affordable Care Act
enacted five years ago (March 23rd, 2010, with its emphases on quality measures,
patient-centered care, and accountability in care decisions) cannot be ignored.
<o:p></o:p></span></div>
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<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Individualized intervention is
not just important to cancer biology and treatment: it is important to clinical
education, as well. Not only do clinicians caring for patients with cancer have
their own knowledge and competence gaps—mainly because of the discovery of new
evidence in this rapidly changing therapeutic area—they have the healthcare
system context to work within, from local to national levels. The newly
published, featured </span><a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=26115247" style="font-family: Arial, Helvetica, sans-serif;" target="_blank">articleby Hermann et al focuses on NSCLCeducation in the quality-driven system environment of the ACA, titled, “EducationalOutcomes in the Era of the Affordable Care Act: Impact of PersonalizedEducation About Non-Small Cell Lung Cancer.”</a><span style="font-family: Arial, Helvetica, sans-serif;"> The authors argue for timely opportunities
for immediate, practical, and translatable education for individual clinicians,
as follows: “Quality medical education must be available when the health care
provider is ready to learn, provide feedback, and maximize translation of
knowledge from desk to clinic” [4].</span></div>
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<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">The educational methods and
instructional design are of greatest interest. Oncologists completed a pre-intervention
self-assessment of knowledge, skills, and attitudes. This was used to develop an
individualized learning plan and a personalized curriculum, which included up
to 5 distinct activities selected to address identified knowledge and practice
gaps. The activities were distributed online, and learners received feedback at
the completion of each activity. Learners were tested on 5 knowledge and decision-making
areas relevant to NSCLC treatment. </span><span style="font-family: Arial, Helvetica, sans-serif;"> </span></div>
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<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">The results of education were
dramatic: “Completion of the learning plan was associated with a high effect
size (</span><i style="font-family: Arial, Helvetica, sans-serif;">d</i><span style="font-family: Arial, Helvetica, sans-serif;"> = .70),” a Cohen’s </span><i style="font-family: Arial, Helvetica, sans-serif;">d </i><span style="font-family: Arial, Helvetica, sans-serif;">that indicates that the educational
intervention was much more meaningful than the statistically significant
differences between learners’ pre- and post-intervention testing would suggest.
(Remember that </span><i style="font-family: Arial, Helvetica, sans-serif;">p </i><span style="font-family: Arial, Helvetica, sans-serif;">values tell the
statistician only how likely it is that the hypothesis could be accepted or
rejected in error.) If one reviews the </span><a href="http://www.uccs.edu/lbecker/effect-size.html" style="font-family: Arial, Helvetica, sans-serif;" target="_blank">Effect Size (ES) lecturenotes provided by Dr. Lee Becker</a><span style="font-family: Arial, Helvetica, sans-serif;"> on his University of Colorado webpages, this
translates to what Cohen himself (reluctantly) defined as a medium-to-large
effect but which has become standard usage where historical data from research
teams are not published with current results. This effect size surpasses even what
Wolf (1986) identified as the lowest benchmark for change results that are “clinically
significant,” not just educationally meaningful, at </span><i style="font-family: Arial, Helvetica, sans-serif;">d</i><span style="font-family: Arial, Helvetica, sans-serif;"> = .50.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Looking at this educational
study’s effect size more simply at Becker’s site, Cohen’s </span><i style="font-family: Arial, Helvetica, sans-serif;">d</i><span style="font-family: Arial, Helvetica, sans-serif;"> = .70 means that 43.0% of participating learners (oncologists) had
posttest scores that did not overlap with pretest scores, indicating learning
that facilitates change. This is a big percentage when one considers that even
an effect size of .20 (small) is difficult to achieve in one initiative. In
other words, personalized education on NSCLC affected quality care. Kudos to
the researchers.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">P.S. For additional reading on Cohen's <i>d</i> and effect sizes in CEhp, check out the AssessCME blog written by my outcomes colleague,
Jason Oliveri: </span><span style="font-family: Arial, Helvetica, sans-serif;"><a href="https://assesscme.wordpress.com/category/effect-size/" target="_blank">assesscme.wordpress.com/category/effect-size</a></span><span style="font-family: Arial, Helvetica, sans-serif;">.</span></div>
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<b style="font-family: Arial, Helvetica, sans-serif;"><br /></b></div>
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<b style="font-family: Arial, Helvetica, sans-serif;">References cited: </b></div>
<span style="font-family: Arial, Helvetica, sans-serif;">1. Remark R, Becker C, Gomez JE, et al. The
non-small cell lung cancer immune contexture. A major determinant of tumor
characteristics and patient outcome. <i>Am J
Respir Crit Care Med.</i> 2015;191(4):377-90. <br />
2. Cagle PT, Allen TC, Olsen RJ. Lung cancer biomarkers: present status and future
developments. <i>Arch Pathol Lab Med.</i>
2013 Sep;137(9):1191-8. <br />
3. Raparia K, Villa C, DeCamp MM, Patel JD, Mehta MP. Molecular profiling in non-small
cell lung cancer: a step toward personalized medicine. <i>Arch Pathol Lab Med.</i> 2013;137(4):481-91. <br /><b>
4. Herrmann T, Peters P, Williamson C, Rhodes E. Educational outcomes in the
era of the Affordable Care Act: impact of personalized education about non-small
cell lung cancer. <i>J Contin Educ Health
Prof.</i> 2015;35(Suppl 1):S5-S12. [Featured Article]</b><br />
5. Becker L. Effect size (ES). University of Colorado—Colorado Springs Website.
<a href="http://www.uccs.edu/lbecker/effect-size.html">http://www.uccs.edu/lbecker/effect-size.html</a>.
Accessed September 16, 2015.<br />
<b>MeSH *Major* terms: </b>This study [4] is
so new, NLM librarians have not yet assigned Medical Subject Headings. Check for
updates at <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=26115247">http://www.ncbi.nlm.nih.gov/pubmed/?term=26115247</a>. </span>Anonymoushttp://www.blogger.com/profile/02329067552426761393noreply@blogger.com0tag:blogger.com,1999:blog-3398142311011328936.post-10034864611449422292015-09-15T12:28:00.002-04:002015-09-17T14:31:58.132-04:00Eight-year Canadian study on opioid prescribing among regulator- and self-referred physicians to intensive course<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">This educational study in a clinical journal by <a href="http://www.cfp.ca/content/59/5/e231.full.pdf+html" target="_blank">Kahan <i>et al</i> at the University of Toronto</a>
examined “the effects of an intensive 2-day course on physicians' prescribing
of opioids” [1]. The most impressive feature of this study is its eight-year-plus
data-gathering period of opioid-prescribing levels among participating physicians,
most of whom were family physicians. Other interesting features are worth
mentioning, in both instructional design and study design. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">The study design grouped participants
into self-referred physicians vs. physicians who were referred by medical
regulators, and added a control (nonparticipant) group. Undertaking a challenging
matching procedure, researchers matched nonparticipants according to specific
variables, including quarterly rates of opioid-prescribing, expressed as milligrams
of morphine equivalent. Subgroups of participant groups with very high
opioid-prescribing patterns were also identified; unfortunately, nonparticipants
to match these participants were difficult to find. Yet this targeted approach
to matching is appropriate and represents a significant investment of the
researchers’ time, allowing the comparative group findings shown below. Nonparticipants
were added to the study concurrently with their matched participants, per an
“index date” defined as “the date of course completion for participating
physicians. Control physicians were assigned the same index date as their
matched pair.” In one deviation from the primary outcome measure, matching was
done by number of opioid prescriptions rather than milligrams of morphine
equivalent. Another study design feature is the specific comparison of
opioid-prescribing rates for 2 years before vs. 2 years after the educational intervention,
again by group and subgroup vs. nonparticipants; participants who could not be
matched were analyzed separately from participants with matched pairs. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">The instructional design of
the 2-day course incorporated several educational settings and modalities.
Planners used didactic presentations but added problem-based case discussions and
mock-interview learning interactions with standardized patients who offered
feedback. Pros and cons of changing prescribing patterns were discussed in a
session at the end of the course, featuring a faculty interview with a patient.
The course also provided a detailed syllabus with notes and references before
the course, as well as office materials. It should be noted that
benzodiazepine-prescribing was also addressed in course content. Finally, each
2-day course enrolled up to 12 participants, a limit that would confer an
individualized learning environment and some professional privacy in what might
be a sensitive concern among participating physicians. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">The authors noted in the
introduction, “Medical education has been suggested as one strategy to improve
opioid prescribing among physicians” [2,3] and “Educational interventions
focused on opioid prescribing lead to positive improvement in physicians’ knowledge
and self-reported practices” [4]. Let's look at results by
reported subgroup. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Among physicians referred by medical
regulators, “the rate of opioid prescribing decreased dramatically in the year
before course participation compared with matched control physicians,” and “the
course had no added effect on the rate of physicians' opioid prescribing in the
subsequent 2 years.” It seems that these physicians might have changed their
behavior by arbitrarily reducing prescribing rates because of the regulatory investigation,
even without an educational intervention to inform their clinical decision-making.
In fact, the authors acknowledge this, noting, “We measured only the quantity
of opioids prescribed, not the quality of opioid prescribing.” The regulatory
concerns may have created a false baseline for the educational study that
measured only quantity of opioid prescribed rather than patient-selection or
other measure of competence. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Among the self-referred
physicians who were matched to nonparticipants, “there was no statistically
significant effect on the rate of opioid prescribing observed” from baseline to
2-year follow-up, although there had been a temporary decrease, particularly in
prescribing for patients aged 15 – 64 (here’s a nice graph with patient ages: <a href="http://www.cfp.ca/content/59/5/e231/F4.expansion.html" target="_blank">http://www.cfp.ca/content/59/5/e231/F4.expansion.html</a>).
On the other hand, “the rate of opioid prescribing decreased by 43.9% in the
year following course completion” among self-referred physicians with high
prescribing rates who could not be matched, suggesting that these physicians “might
have responded to what was taught in the course.” <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>References cited:</b> <br /><b>
1. Kahan M, Gomes T, Juurlink DN, et al. Effect of a course-based intervention
and effect of medical regulation on physicians’ opioid prescribing. <i>Can Fam Physician.</i> 2013;59(5):e231-e239.
<a href="http://www.cfp.ca/content/59/5/e231.full.pdf+html" target="_blank">http://www.cfp.ca/content/59/5/e231.full.pdf+html</a>. <br />[Featured Article]</b><br />
2. College of Physicians and Surgeons of Ontario. <i>Avoiding Abuse, Achieving a Balance: Tackling the Opioid Public Health
Crisis.</i> Toronto, ON: College of Physicians and Surgeons of Ontario; 2010. <br />
3. National Opioid Use Guideline Group. <i>Canadian
Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain</i>.
Hamilton, ON: National Opioid Use Guideline Group; 2010.<br />
4. Midmer D, Kahan M, Marlow B. Effects of a distance learning program on
physicians’ opioid- and benzodiazepine-prescribing skills. <i>J Contin Educ Health Prof</i>. 2006;26(4):294-301.<br />
<b>Free full text PDF: </b><a href="http://www.cfp.ca/content/59/5/e231.full.pdf" target="_blank">http://www.cfp.ca/content/59/5/e231.full.pdf</a>.<b> <br />
MeSH *Major* terms: </b>Analgesics, Opioid/therapeutic use*; Drug
Prescriptions/standards*; Education, Medical, Continuing*; Physician's Practice
Patterns/standards* </span>Anonymoushttp://www.blogger.com/profile/02329067552426761393noreply@blogger.com0tag:blogger.com,1999:blog-3398142311011328936.post-43886199531916972242015-09-12T19:51:00.001-04:002015-09-16T14:08:48.704-04:00Medical education with EMR-based reminders reduces antibiotic prescribing and dispensing for respiratory tract infections in Norway<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">It is known that British
guidelines for otitis media support delayed antibiotic prescribing [1], and
other countries have guidelines to reduce certain antibiotic prescribing for
otitis media, for example, France [2]. Conversely, Finnish guidelines do not
[3]. A 2013 Norwegian <a href="http://bjgp.org/content/63/616/e777.full.pdf" target="_blank">study published in the British Journal of General Practice compares the varying effectiveness of 2 interventions</a> in
delaying primary care antibiotic prescribing for respiratory tract infections,
including otitis [4].</span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Notwithstanding a complicated design
for recruiting and assigning general practitioners across multiple sites, this
article offers several interesting features. First, it compares an education-only
intervention with the same education enhanced by pop-up reminders of a
physician’s own prescribing patterns in the electronic medical record (EMR), a
nice reinforcement of the educational intervention for participating physicians.
While not a focus of this post, I would like to mention a new Penn study of adherence
to guidelines on otitis media using EMRs for decision support at Children’s
Hospital of Philadelphia [5]. This shows interest in implementation science combined
with continuing medical education (CME) for changing physicians’ practice
patterns.</span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">The </span><a href="http://bjgp.org/content/63/616/e777.full.pdf" style="font-family: Arial, Helvetica, sans-serif;" target="_blank">Norwegian study featured here</a><span style="font-family: Arial, Helvetica, sans-serif;"> [4] data collected and linked data on prescribed and dispensed
antibiotics from (a) 1 year before and (b) 1 year during the intervention,
which allowed prescribing practice patterns to be displayed to physicians in
the EMR at the point of prescribing antibiotics for a respiratory tract
infection. It also collected pharmacy fill rates by patients, which I find
interesting because it may offer insights into patients’ (or parents’)
agreement with the need for the prescription, after any access barriers to
medication adherence. </span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Both study arms showed slightly
reduced antibiotic prescribing from baseline (pre-intervention) rates: 1%
reduction vs. 4% reduction in “approximated risk” (risk ratio, RR) in the
education-only vs. education-plus-EMR study arms, respectively. Both results
report very tight ranges around a 95% confidence interval (CI), increasing
confidence in the findings. (It is further nice to see the CI reported instead
of the </span><i style="font-family: Arial, Helvetica, sans-serif;">p </i><span style="font-family: Arial, Helvetica, sans-serif;">value, for those who often
hesitate to report CI because of many readers’ greater familiarity with the </span><i style="font-family: Arial, Helvetica, sans-serif;">p</i><span style="font-family: Arial, Helvetica, sans-serif;"> value.) While reporting of “risk ratio”
may be used as simply a convenient and appropriate way of reporting
epidemiological data, it seems to me that its use for reporting educational
outcomes with practice data is unusual and perhaps a comment on antibiotic
prescribing for these infections as a risk.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">The authors find that upper</span><span style="font-family: Arial, Helvetica, sans-serif;">
</span><span style="font-family: Arial, Helvetica, sans-serif;">respiratory tract infection, sinusitis, and
otitis “gave highest odds for delayed prescribing and lowest odds for
dispensing,” which led them to conclude that the greatest potential for “savings”
is greatest for these infections, a comment that brings this CME study with implementation
science into the context of health utilization research. The article offers </span><a href="http://bjgp.org/content/63/616/e777.full.pdf" style="font-family: Arial, Helvetica, sans-serif;" target="_blank">freely accessible full text</a><span style="font-family: Arial, Helvetica, sans-serif;">,
so enjoy reading the study.</span></div>
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<b style="font-family: Arial, Helvetica, sans-serif;"><br /></b></div>
<div class="MsoNormal">
<b style="font-family: Arial, Helvetica, sans-serif;">References cited:</b><span style="font-family: Arial, Helvetica, sans-serif;"></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">
1. Centre for Clinical Practice at NICE (UK). <i>Respiratory Tract Infections - Antibiotic
Prescribing: Prescribing of Antibiotics for Self-Limiting Respiratory Tract
Infections in Adults and Children in Primary Care.</i> London: National Institute
for Health and Clinical Excellence (UK); 2008 Jul. <a href="http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0010014/" target="_blank">http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0010014/</a>.
<br />
2. Levy C, Pereira M, Guedj R, et al. Impact of 2011 French guidelines on
antibiotic prescription for acute otitis media in infants. <i>Médecine Mal Infect.</i> 2014;44(3):102-106. <a href="http://www.ncbi.nlm.nih.gov/pubmed/24630597" target="_blank">http://www.ncbi.nlm.nih.gov/pubmed/24630597</a>.
<br />
3. [Update on current care guidelines: acute otitis media]. <i>Duodecim.</i> 2010;126(5):573-4. Finnish. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20597310">http://www.ncbi.nlm.nih.gov/pubmed/20597310</a>.
<br /><b>
4. Hoye S, Gjelstad S, Lindbaek M. Effects on antibiotic dispensing rates of
interventions to promote delayed prescribing for respiratory tract infections
in primary care. <i>Br J Gen Pract.</i>
2013;63(616):e777-e786. <a href="http://bjgp.org/content/63/616/e777.full.pdf" target="_blank">http://bjgp.org/content/63/616/e777.full.pdf</a>. [Featured Article]</b><br />
5. Fiks AG, Zhang P, Localio AR, et al. Adoption of electronic medical
record-based decision support for otitis media in children. <i>Health Serv Res.</i> 2015;50(2):489-513. <a href="http://www.ncbi.nlm.nih.gov/pubmed/25287670" target="_blank">http://www.ncbi.nlm.nih.gov/pubmed/25287670</a>.
<o:p></o:p></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>MeSH *Major* terms:</b> Anti-Bacterial Agents/therapeutic use*; Education, Medical,
Continuing*; General Practice/statistics & numerical data*; Physician's
Practice Patterns/statistics & numerical data*; Respiratory Tract
Infections/drug therapy* </span>Anonymoushttp://www.blogger.com/profile/02329067552426761393noreply@blogger.com0tag:blogger.com,1999:blog-3398142311011328936.post-35675720567737005962015-09-11T18:22:00.001-04:002015-09-17T14:28:59.050-04:00Today's Landmark NHLBI SPRINT study results relate to this 2008 PI-CME article by Shershneva, Olson, et al<span style="font-family: Arial, Helvetica, sans-serif;">Today the National Heart, Lung, and Blood Institute (NHLBI) of the United States National Institutes of Health announced the <a href="http://www.nhlbi.nih.gov/news/press-releases/2015/landmark-nih-study-shows-intensive-blood-pressure-management-may-save-lives">early completion of the landmark SPRINT study into recommended systolic blood pressure</a>, which was led by researchers in my own town, at <a href="http://www.wakehealth.edu/">Wake Forest University School of Medicine</a>. Therefore I am featuring a <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782606/">hypertension performance-improvement CME study by Marianna Shershneva, Curt Olson, and others</a>, whose care is a quality measure in this country and elsewhere. <br /><br />This PI-CME study was published in 2008, before most educational providers who now have outcomes-reporting capacities were able to study educational outcomes within a clinical context. Marianna Shershneva, M.D., Ph.D., is Building Block Leader for Quality Metrics of the <a href="file:///C:/Users/USER/Downloads/ACEhp_QIE_Roadmap_FINAL.pdf">Alliance's Quality Improvement Education (ACEhp QIE) Initiative</a>, and Curtis Olson, Ph.D., has been guiding our field through his influence and tenure as Editor-in-Chief of the Journal of Continuing Education in the Health Professions. With their coauthors, Elizabeth Mullikin and Anne-Sophie Loos, we have a nice study for historical review that might have escaped attention on this day because the article title does not specify hypertension. <br /><br />Consider this excerpt from the abstract, which lays out the opportunities for quality improvement professionals and clinical educators to work together for better patient care: "Although QI practices and CME approaches have been recognized for years, what emerges from their integration is largely unfamiliar, because it requires the collaboration of CME providers and stakeholders within the health care systems who traditionally have not worked together and may not have the same understanding of QI issues to close performance gaps." This was an observational case study with nine clinicians completing the study, and while we could wish for a larger sample, we should agree with the authors that "PI CME required unprecedented collaboration between CME planners and QI stakeholders to enable change in clinical practice." Let's applaud the effort and enjoy the three core findings that you'll see if you access this article. <br /><br />This is a <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782606/">FREE article in PubMed Central</a>, and I encourage you to review it for findings on physicians' practice patterns that have bearing on today's news from NHLBI. Thanks to the National Library of Medicine reviewers of articles for their assignments to this article's medical subject headings (MeSH terms), without which this article may not have risen to most noteworthy mention after today's NHLBI news. And by the way, proving the relevance of this sort of work to our nation, this study was <i>also </i>funded by <i>two </i>NIH grants.<br /><br /><b>References Cited:</b> Shershneva MB, Mullikin EA, Loose A-S, Olson CA. Learning to collaborate: a case study of performance improvement CME. J Contin Educ Health Prof. 2008;28(3):140-147. doi:10.1002/chp.181.<br />NHLBI. Landmark NIH study shows intensive blood pressure management may save lives: lower blood pressure target greatly reduces cardiovascular complications and deaths in older adults [press release]. NHLBI Website. http://www.nih.gov/news/health/sep2015/nhlbi-11.htm. Accessed September 11, 2015.<br />Reboussin D, NHLBI, NIDDK, NINDS, and NIA. Systolic Blood Pressure Intervention Trial (SPRINT). NCT01206062. ClinicalTrials.gov Website. https://clinicaltrials.gov/ct2/show/NCT01206062. Accessed Accessed September 11, 2015.<br /><b>MeSH *Major* Terms:</b> Education, Medical, Continuing/standards; Hypertension/prevention & control; Physician's Practice Patterns; Quality Assurance, Health Care. </span>Anonymoushttp://www.blogger.com/profile/02329067552426761393noreply@blogger.com0tag:blogger.com,1999:blog-3398142311011328936.post-67712233762817175072015-09-10T19:40:00.000-04:002015-09-10T19:40:40.211-04:00Seven Days Remaining in CME TweetFest, Highlighting Clinical Education Outcomes Articles! <div class="MsoNormal">
<span lang="EN"><span style="font-family: Arial, Helvetica, sans-serif;">Check out this
month’s service project featuring #Meded QI, PI, and #CME outcomes articles at
blog <a href="http://fullcirclece.blogspot.com/" target="_blank">http://fullcirclece.blogspot.com/</a>.
Only 7 days remain for $100 prize contest for retweeting at <a href="https://twitter.com/SHB_CMEedit" target="_blank">https://twitter.com/SHB_CMEedit</a>. Blog
comments earn prize entries too! This campaign is led by Donald Harting and
yours truly, at #CMEtf, from August 17 - September 17, 2015. Don’t miss Don’s
video introduction to the series at <a href="https://www.youtube.com/embed/VlVY4KlkdmA" target="_blank">https://www.youtube.com/embed/VlVY4KlkdmA</a>
(but I have to insist that he deserves at least as much credit for starting the
campaign as he gives me)! <o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></span></div>
<div class="MsoNormal">
<span lang="EN"><span style="font-family: Arial, Helvetica, sans-serif;">I wanted to
mention some colleagues who have authored the featured articles or
been mentioned in Don Harting's or my blogs thus far: Ed Dellert, William
Mencia, Derek Dietze, Erik Brady, Alexandra Howson, Jason Olivieri, Wendy
Turell, Sara Miller, Allison Gardner, and Kathleen Moreo. Support publication of
Medical Education outcomes reports! <o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></span></div>
<div class="MsoNormal">
<span lang="EN"><span style="font-family: Arial, Helvetica, sans-serif;">Featured articles
so far: <o:p></o:p></span></span></div>
<div class="MsoNormal">
</div>
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Bekanich SJ,
Wanner N, Junkins S, et al. A multifaceted initiative to improve clinician awareness
of pain management disparities. Am J Med Qual. 2014;29(5):388-96.</span></li>
<li><span lang="EN" style="font-family: Arial, Helvetica, sans-serif;">Peterson ED,
Heidarian S, Effinger S, et al. Outcomes of an interprofessional team learning
and improvement project aimed at reducing postsurgical delirium in elderly
patients admitted with hip fracture. CE Measure. 2014;8(1):3-7. </span><a href="http://dx.doi.org/10.1532/cemeasure.v8i1.134" style="font-family: Arial, Helvetica, sans-serif;" target="_blank">http://dx.doi.org/10.1532/cemeasure.v8i1.134</a><span style="font-family: Arial, Helvetica, sans-serif;">.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Adams SG,
Pitts J, Wynne J, Yawn BP, Diamond EJ, Lee S, Dellert E, Hanania NA. Effect of
a primary care continuing education program on clinical practice of chronic
obstructive pulmonary disease: translating theory into practice. Mayo Clin
Proc. 2012 Sep;87(9):862-70.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Stevens L-M,
Cooper JB, Raemer DB, et al. Educational program in crisis management for
cardiac surgery teams including high realism simulation. J Thorac Cardiovasc
Surg. 2012;144(1):17-24.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Dobesh PP,
Stacy ZA. Effect of a clinical pharmacy education program on improvement in the
quantity and quality of venous thromboembolism prophylaxis for medically ill
patients. J Manag Care Pharm. 2005;11(9):755-62.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Raffini
L, Trimarchi T, Beliveau J, Davis D. Thromboprophylaxis in a pediatric
hospital: a patient-safety and quality-improvement initiative. </span><i style="font-family: Arial, Helvetica, sans-serif;">Pediatrics.</i><span style="font-family: Arial, Helvetica, sans-serif;">
2011 May;127(5):e1326-32.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Lapolla J, Morrice A, Quinn S, et al. Diabetes management
in the hospital setting: a performance improvement continuing medical education
program. </span><i style="font-family: Arial, Helvetica, sans-serif;">CE Meas</i><span style="font-family: Arial, Helvetica, sans-serif;">. 2013;7(1):54-60. doi:10.1532/CEM08.12103. </span><a href="http://www.cardenjenningspublishing.com/journal/index.php/cem/article/view/116" style="font-family: Arial, Helvetica, sans-serif;" target="_blank">http://www.cardenjenningspublishing.com/journal/index.php/cem/article/view/116</a><span style="font-family: Arial, Helvetica, sans-serif;">.</span></li>
</ul>
<br />
<div class="MsoNormal">
<span lang="EN"><span style="font-family: Arial, Helvetica, sans-serif;">Our coverage of
these articles goes deeper in this blog and in </span></span><span style="font-family: Arial, Helvetica, sans-serif;">Don Harting’s at </span><a href="http://dvmw.blogspot.com/2015/08/rt-to-win-100-your-fun-guide-to-cme.html" style="font-family: Arial, Helvetica, sans-serif;" target="_blank">http://dvmw.blogspot.com/2015/08/rt-to-win-100-your-fun-guide-to-cme.html</a>. </div>
<ul style="margin-top: 0in;" type="disc">
</ul>
<div class="MsoNormal">
<span lang="EN"><span style="font-family: Arial, Helvetica, sans-serif;">Why is there a
contest? Because the more clinical education professionals see this series, the
more we can prove that CME matters! So RT for a chance to win up to $100! CME
outcomes contest rules at <a href="http://cmetweetfest.blogspot.com/" target="_blank">http://cmetweetfest.blogspot.com/</a>.
Please make sure you follow Don or me on Twitter so that we can notify you of
any Tweet Fest winnings! <o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: x-small;"><span lang="EN"><span style="font-family: Arial, Helvetica, sans-serif;">Thanks for your
many retweets thus far, and please tell your colleagues about the service
campaign to feature CME outcomes successes. I look forward to hearing from you
at <a href="mailto:shbinford@fullcircleclinicaleducation.com">shbinford@fullcircleclinicaleducation.com</a>.</span></span></span><span style="font-family: Arial, Helvetica, sans-serif;"> At the end of the service campaign, we will be preparing a report of featured articles, which you can sign up to receive from me at the <a href="http://www.acehp.org/p/cm/ld/fid=20" target="_blank">Alliance Quality Symposium in Chicago</a> or via electronic mail. </span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Now <a href="https://twitter.com/SHB_CMEedit" target="_blank">start Tweeting</a> and let’s have some fun promoting the challenging
work that goes into measuring health education outcomes! </span></div>
<br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Best, <br />
Sandra </span></div>
Anonymoushttp://www.blogger.com/profile/02329067552426761393noreply@blogger.com0tag:blogger.com,1999:blog-3398142311011328936.post-69267395092543800672015-09-10T12:13:00.000-04:002015-09-17T14:40:41.883-04:003-Hospital Quality- and Performance-Improvement CME Project With Systems Change Support for Diabetes Care, With CE Measure Editor, Derek Dietze<div class="MsoNormal">
<span style="font-size: 8.0pt;"><span style="font-family: Arial, Helvetica, sans-serif;">This <a href="http://www.cardenjenningspublishing.com/journal/index.php/cem/article/view/116/102" target="_blank">performance-improvement/continuingmedical education (PI-CME) study by Lapolla and colleagues</a> at three mid-sized, regional hospitals in the United States focused on clinicians’ behaviors that can be documented as “validated metrics of diabetes care” in patient charts. <o:p></o:p></span></span></div>
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<span style="font-size: 8.0pt;"><span style="font-family: Arial, Helvetica, sans-serif;"><br />
</span></span></div>
<div class="MsoNormal">
<span style="font-size: 8.0pt;"><span style="font-family: Arial, Helvetica, sans-serif;">When you look at this example of a multi-center performance-improvement initiative with educational and institutional change supports, you’ll see that most of the intervention involved obvious reminders of the change initiative and its measures, graphs and data regarding performance trends, and a PI specialist as leader or champion of the campaign in each hospital. Even though the researchers chose hospitals that were willing to invest in change, the following implementation tools and collaborative approaches were incorporated as being necessary to change: "</span></span><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">In the design and implementation of this program, we applied recognized PI principles and developed a </span><b style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">dedicated <i>working group</i></b><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;"> to </span><b style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">evaluate, monitor, and disseminate data, provide timely feedback, monitor outliers, attend to project management details, and maintain support of institutional leadership</b><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">. We </span><b style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;"><i>encouraged</i> physicians' engagement</b><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;"> by </span><b style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">minimizing their time requirements, soliciting their input throughout the initiative, sharing meaningful data</b><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">, and taking an 'improvement-oriented' approach rather than 'mandating change.'” [Emphases added.]</span></div>
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<span style="font-size: 8.0pt;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></span>
<span style="font-size: 8.0pt;"><span style="font-family: Arial, Helvetica, sans-serif;">I wanted to point out the reminder of the American Medical Association’s recommendation of using a three-stage PI-CME structure, “comprising assessment of current performance (Stage A), design and implementation of strategies to improve performance (Stage B), and evaluation of PI efforts (Stage C).” Any outcomes project or program evaluation that sets its goals after educational content and resources are nearly final faces great challenges for later measurement. Permit me to include related content from the <a href="http://www.acehp.org/p/do/sd/topic=216&sid=811" target="_blank">May 2015 <i>Almanac</i></a> article that Erik Brady and I wrote for the series, “Beginner’s Guide to Measuring Educational Outcomes in CEhp”: </span></span><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">"A common error in assessment item-writing is the
construction of assessment items that focus on a minor or trivial data point
found in the content. This practice is particularly common in two cases: first,
when assessment items are written from finished content that offers too little
material for assessment; and second, when the minimum score a learner needs to request
educational credit dictates the number of items on a tool, causing planners to
test trivial points in their desperation to hit an arbitrary quota."</span></div>
<div class="MsoNormal" style="margin-bottom: 6.0pt; margin-left: .5in; margin-right: .5in; margin-top: 6.0pt; text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 8.0pt;"><span style="font-family: Arial, Helvetica, sans-serif;"><br />
</span></span></div>
<div class="MsoNormal" style="margin-bottom: 6.0pt; margin-left: .5in; margin-right: .5in; margin-top: 6.0pt; text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: 8.0pt;"><span style="font-family: Arial, Helvetica, sans-serif;">Because assessment items are optimally designed to assess how well a learning objective has been met, aligning a learning objective with an assessment item should ensure that your items are focused on the key points of the activity content and that activity content consistently supports learners’ achievement of the educational and performance objectives. </span></span><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">Thus when Lapolla </span><i style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">et al</i><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;"> planned the educational content and reinforcing health-systems supports according to well-established metrics, they made certain that they had all desired outcomes mapped to hospital-specific care gaps before they started. This allowed the research team to provide “timely feedback” and manage the project better at each institution by identifying outliers in the PI datasets. A </span><a href="http://fullcirclece.blogspot.com/2015/09/implementation-science-extends.html" style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;" target="_blank">previously featured article in this month’s “Back to School” Tweet Fest</a><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;"> mentioned incorporation of VTE prophylaxis therapies into order sets, and how this was effective. Notably, we see the same in this study: “the PI specialists at all 3 participating hospitals saw marked improvement once order sets included the metrics.”</span></div>
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</span></span></div>
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<span style="font-size: 8.0pt;"><span style="font-family: Arial, Helvetica, sans-serif;">Look at this article for its insights into quality improvement, implementation science, and educational methods. It is also nicely written and described, with model writing and brevity for a research report—especially remarkable given the number of study authors. Finally, note that Derek Dietze, Editor-in-Chief of <i>CE Measure</i>, participated in this large PI-CME study on improving care practices for diabetes, one of the most challenging epidemiological issues in the United States. <o:p></o:p></span></span></div>
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<span style="font-size: 8.0pt;"><span style="font-family: Arial, Helvetica, sans-serif;"><br />
</span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><b><span style="font-size: 8pt;">References cited: <br />
</span></b><span style="font-size: 8pt;">Lapolla J, Morrice A, Quinn S, et al. Diabetes management in the hospital setting: a performance improvement continuing medical education program. <i>CE Meas</i>. 2013;7(1):54-60. doi:10.1532/CEM08.12103. doi:10.1532/CEM08.12103. <a href="http://www.cardenjenningspublishing.com/journal/index.php/cem/article/view/116" target="_blank">http://www.cardenjenningspublishing.com/journal/index.php/cem/article/view/116</a>. Accessed September 10, 2015. [FREE full text]<br />
Brady ED, Binford SH. How to write sound educational outcomes questions: a focus on knowledge and competence assessments [series: “Beginner’s Guide to Measuring Educational Outcomes in CEhp”]. <i>The Almanac</i>. 2015;37(5):4-9. <a href="http://www.acehp.org/p/do/sd/topic=216&sid=811" target="_blank">http://www.acehp.org/p/do/sd/topic=216&sid=811</a>. Accessed September 10, 2015. [Full text] <br />
Raffini L, Trimarchi T, Beliveau J, Davis D. Thromboprophylaxis in a pediatric hospital: a patient-safety and quality-improvement initiative. <i>Pediatrics.</i> 2011 May;127(5):e1326-32. doi: 10.1542/peds.2010-3282. <a href="http://pediatrics.aappublications.org/content/127/5/e1326.full.pdf+html" target="_blank">http://pediatrics.aappublications.org/content/127/5/e1326.full.pdf+html</a>. Accessed September 8, 2015. [FREE full text (Pediatrics final version)] </span></span>Anonymoushttp://www.blogger.com/profile/02329067552426761393noreply@blogger.com0tag:blogger.com,1999:blog-3398142311011328936.post-56766116531161581592015-09-08T18:31:00.000-04:002015-09-17T14:42:16.653-04:00Implementation Science Extends Multidisciplinary Education on VTE Prophylaxis at World-Class Children’s Hospital<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">Let’s continue yesterday's thread with
venous thromboembolism (VTE) education in a new patient population: children.</span><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 8pt;"> In <a href="http://www.ncbi.nlm.nih.gov/pubmed/21464186" target="_blank">this quality improvement article</a>, </span><span style="font-size: 8pt;">Raffini </span><i style="font-size: 8pt;">et al</i><span style="font-size: 8pt;"> </span></span><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">point out that while risks of VTE are far lower in children than in adults,
children still need clinicians to maintain an appropriate level of suspicion
and take action on VTE risk with prophylaxis.</span></div>
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<span style="font-size: 8.0pt;"><span style="font-family: Arial, Helvetica, sans-serif;">What a nice way to phrase a
practice gap and the need to narrow that gap: “VTE prophylaxis for patients at
risk is often overlooked in pediatric health care institutions, which provides
an opportunity to improve patient care.” Even at the world-class Children’s
Hospital of Philadelphia (CHOP) at the University of Pennsylvania, children and
adolescents were not receiving an appropriate level of risk assessment and
prophylaxis, leading researchers to undertake this four-year quality
improvement study. <o:p></o:p></span></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b><span style="font-size: 8.0pt;">CME/CEhp initiatives often do not extend into local
facilities, but this study used reinforcing methods of implementation science to
communicate and support the desired behaviors and tasks.</span></b><span style="font-size: 8.0pt;"> These extended “multidisciplinary educational forums” into
patient-care settings. Here’s a summary of the intervention’s rollout of CHOP’s
locally established guidelines to “encourage timely initiation of
thromboprophylaxis." These interventions included 1) VTE risk
assessment in the nursing admission intake forms; 2) a VTE-prophylaxis order
set implemented into the computerized ordering system; 3) ICU nurses
assessing VTE risk and preventive practice daily during team rounds;
4) trials of various pneumatic compression devices with appropriate sizing
for children; 5) acquisition of more compression devices with storage near
high-risk areas; and 6) development of a protocol for perioperative nurses
to initiate pneumatic compression before surgery for certain patients, later
expanded to all inpatient settings. <o:p></o:p></span></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b><span style="font-size: 8.0pt;">So was extension of multidisciplinary education into
care settings, using methods of implementation science, effective? YES.</span></b><span style="font-size: 8.0pt;"> The study’s primary outcome measure was “compliance
with thromboprophylaxis guidelines in patients at risk for VTE.” Clinically
meaningful improvements were seen: “Over the 4-year study period, the observed
rate of VTE prophylaxis in patients at risk increased from a baseline of 22% to
an average rate of 82%, and there were intermittent improvements up to 100%.” <b>Implementation science methods, when added
to multidisciplinary clinical education, quadrupled or even quintupled
guidelines-based care in an underserved population.</b> <o:p></o:p></span></span></div>
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<span style="font-size: 8.0pt;"><span style="font-family: Arial, Helvetica, sans-serif;">There’s also a nice feature to
point out to those watching <b>IRB</b>
“requirements” that peer-reviewed journals increasingly expect of performance-change
initiatives: “This project was a quality-improvement activity and exempt from
review from the institutional review board at the Children's Hospital of
Philadelphia.” The QI initiative was not seen as human subjects research (HSR).
<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><b><span style="font-size: 8pt;"><br /></span></b></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b><span style="font-size: 8pt;">Reference cited: </span></b><span style="font-size: 8pt;">Raffini L, Trimarchi T, Beliveau J, Davis D. Thromboprophylaxis in a
pediatric hospital: a patient-safety and quality-improvement initiative. <i>Pediatrics.</i> 2011;127(5):e1326-32.</span><span style="font-size: 12pt;"> </span><span style="font-size: 8pt;">PMID: 21464186.<br />
<i>See also the ACCP and ICSI guidelines linked
from the September 7, 2015 post (<a href="http://fullcirclece.blogspot.com/2015/09/pharmacy-education-for-hospital.html">http://fullcirclece.blogspot.com/2015/09/pharmacy-education-for-hospital.html</a>)</i><b><br />
PubMed: </b><a href="http://www.ncbi.nlm.nih.gov/pubmed/21464186">http://www.ncbi.nlm.nih.gov/pubmed/21464186</a>
<br />
<b>Free full text (<i>Pediatrics </i>final version): </b><a href="http://pediatrics.aappublications.org/content/127/5/e1326.full.pdf+html">http://pediatrics.aappublications.org/content/127/5/e1326.full.pdf+html</a>
<br />
<b>MeSH *Major* terms:</b> Anticoagulants/administration
& dosage*; Guideline Adherence*; Patient Selection*; Primary
Prevention/organization & administration*; Venous
Thromboembolism/prevention & control*<br />
(And for those of you who love MeSH and UMLS, many quality-improvement and program
change-related MeSH terms were assigned by NLM but not starred as “major”
terms.) </span></span>Anonymoushttp://www.blogger.com/profile/02329067552426761393noreply@blogger.com0tag:blogger.com,1999:blog-3398142311011328936.post-20717442871256756642015-09-07T21:20:00.000-04:002015-09-17T14:30:47.679-04:00Pharmacy Education for Hospital Clinicians on VTE Prophylaxis Changed Performance, Bringing Guideline-Adherent Care To Most Patients<div class="MsoNormal">
<span style="font-size: 8.0pt;"><span style="font-family: Arial, Helvetica, sans-serif;">Earlier today, I wrote of
interprofessional clinical education regarding team communication during
cardiac surgery. Now I continue the theme of nonphysician education by
highlighting <b>contributions of pharmacy
education to patient care</b>, and one that particularly relates to (post)surgical
care. While this month’s Back-to-School campaign (illustrating published educational
outcomes) mainly features recent articles, this 2005 <a href="http://amcp.org/data/jmcp/contemporary_755-762.pdf" target="_blank">study by Dobesh and Stacy in the Journalof Managed Care Pharmacy (free full text available)</a> is a worthy
read for its contributions to quality care research from the pharmacy perspective
and scope of practice.<o:p></o:p></span></span></div>
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<span style="font-size: 8.0pt;"><span style="font-family: Arial, Helvetica, sans-serif;">Venous thromboembolism (VTE and/or
DVT, PE) is a great concern among surgeons and other physicians. In fact, <b><a href="http://www.guideline.gov/content.aspx?id=39350" target="_blank">the VTE evidence-basedguideline by the Institute for Clinical Systems Improvement (ICSI; Jobin et al 2012)</a> names 10 stakeholder
groups</b>—including physicians and pharmacists—as “intended users.” The
current article used the <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Chest.+2004%3B126%3A338S-400S." target="_blank"><b>2004 American College of Chest Physicians (ACCP) recommendations</b></a>. Effectively preventing VTE can dictate the chances of successful
outcomes and reduce patient readmission rates for many conditions. Because of
the <b>challenges of selecting the optimal anticoagulant
agent and dosage</b> for individual patients, pharmacists can clearly
collaborate with physicians in making decisions about VTE prophylaxis. The 2012
guideline considered pharmacological thromboprophylaxis with unfractionated
heparin (UFH), low-molecular-weight heparin (LMWH), fondaparinux, warfarin,
aspirin, apixaban, dabigatran, and rivaroxaban—enough therapeutic options to suggest
the need for consultation between physicians and pharmacists. <o:p></o:p></span></span></div>
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<span style="font-size: 8.0pt;"><span style="font-family: Arial, Helvetica, sans-serif;">The pharmacy intervention for nurses,
pharmacists, and physicians in the community hospital was traditional in instructional
format, involving reinforcing in-service and quality-assurance presentations,
as well as newsletters. The <b>educational outcomes
assessment method </b>was more notable, using retrospective chart reviews with statistically
similar patients before and after the educational intervention (15 months of
patient charts before, and 6 months after). <b>Patient chart reviews showed statistically significant and clinically
meaningful change in VTE prophylaxis performance in practice. </b>Specifically,
both “suitable” and “optimal” prophylaxis increased (P = .006 and P < .0001
respectively), with <b>a fourfold increase
in the optimally treated percentage of patients</b> associated with pharmacy
education of physicians, nurses, and pharmacists. <o:p></o:p></span></span></div>
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<span style="font-size: 8.0pt;"><span style="font-family: Arial, Helvetica, sans-serif;">These data show that
traditional educational initiatives developed by one health care profession for
others can be effective in changing performance, especially when guidelines for
practice and risk categories are presented in reinforcing text-based and live formats.
This intervention brought guideline-adherent care to 93% of patients with risk,
up from 49% before the intervention. <o:p></o:p></span></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b><span style="font-size: 8pt;">References cited:</span></b><span style="font-size: 8pt;"> <br />
Dobesh PP, Stacy ZA. Effect of a clinical pharmacy education program on
improvement in the quantity and quality of venous thromboembolism prophylaxis
for medically ill patients. <i>J Manag Care
Pharm.</i> 2005;11(9):755-62.</span><span style="font-size: 12pt;"> </span><span style="font-size: 8pt;">PMID: 16300419. <br />
Geerts WH, Pineo GF, Heit JA, et al. </span><span style="font-size: 8pt;">Prevention of venous thromboembolism: </span><span style="font-size: 8pt;">the Seventh ACCP Conference on Antithrombotic and Thrombolytic
Therapy. </span><i style="font-size: 8pt;">Chest.</i><span style="font-size: 8pt;"> 2004;126:338S-400S.
PMID: 15383478.</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 8pt;">
Jobin S, Kalliainen L, Adebayo L, et al. Venous thromboembolism prophylaxis.
Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2012. Available at: </span><span style="font-size: 12.8px;"><a href="http://www.guideline.gov/content.aspx?id=39350" target="_blank">http://www.guideline.gov/content.aspx?id=39350</a>. Accessed September 7, 2015. </span><br />
<b style="font-size: 8pt;"><br /></b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 8pt;"><b>PubMed: </b> <a href="http://www.ncbi.nlm.nih.gov/pubmed/16300419">http://www.ncbi.nlm.nih.gov/pubmed/16300419</a>
<br />
<b>Journal Free Full Text:</b> <a href="http://amcp.org/data/jmcp/contemporary_755-762.pdf">http://amcp.org/data/jmcp/contemporary_755-762.pdf</a>
<br />
<b>MeSH *Major* terms: </b>Health
Personnel/education; Heparin, Low-Molecular-Weight/therapeutic use; Inservice
Training; Thromboembolism/prevention & control; Venous
Thrombosis/prevention & control</span></span>Anonymoushttp://www.blogger.com/profile/02329067552426761393noreply@blogger.com0tag:blogger.com,1999:blog-3398142311011328936.post-36273224307481048602015-09-07T12:18:00.000-04:002015-09-07T12:18:01.439-04:00Mixed-Methods Study Improves Team Communication After Non-Didactic Interprofessional Education on Cardiac Surgical Crisis<div class="MsoNormal">
<span style="font-size: 8.0pt;"><span style="font-family: Arial, Helvetica, sans-serif;">It would be hard to imagine a
more crucial setting for effective interdisciplinary <b>clinical interactions</b> than the cardiac surgery operating theater. <b><a href="http://www.ncbi.nlm.nih.gov/pubmed/22502966">Stevens and colleagues published
this 2012 pilot study on interprofessional education</a></b> to “sharpen
performance of experienced cardiac surgical teams in acute crisis management.”</span></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">The </span><b style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">educational methods</b><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;"> support existing effectiveness research for
non-didactic education, incorporating both </span><b style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">interactive
workshops</b><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;"> for an entire care unit and computer-based, </span><b style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">crisis-case simulations</b><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;"> (whose “high-realism” scenarios improved
over time). Researchers found that 82% of the 79 participants recommended
repetition of case simulations every 6 – 12 months. Workshop participants identified
priorities in “encouraging speaking up about critical information and
interprofessional information sharing,” particularly early communication of the
surgical plan.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">The </span><b style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">mixed-methods outcomes assessment methodology</b><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;"> is also noteworthy
because of its appropriateness to this </span><b style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">study
of human communications and behaviors</b><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;"> during a patient crisis: the </span><b style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">structured interviews</b><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;"> with study
participants added context and insights to the quantitative data that could be
gathered from periodic surveys. The surveys that were administered before, just
after, and 6 months after the educational activities noted that the “concept of
working as a team improved between surveys,” as well as “trends for improvement
in gaining common understanding of the plan before a procedure and appropriate
resolution of disagreements.” The </span><b style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">qualitative
arm</b><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;"> of the study found that interviewees valued the initiative’s “positive
effect on their personal behaviors and patient care, including speaking up more
readily and communicating more clearly.”</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">In the continuing medical
education field, we often see the Canadians leading educational research,
standards, and innovative methods. In fact, looking only at the </span><a href="http://www.nlm.nih.gov/pubs/factsheets/mesh.html" style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">U. S. National Library
of Medicine’s assignment of Medical Subject Headings (MeSH terms)</a><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;"> to this
indexed article shows the </span><b style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">relevance of
this study for medical education methods for promoting competence in decision-making,
performance-in-practice change, and quality improvement</b><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;"> (see “major” MeSH terms
listed below, and others on the </span><a href="http://www.ncbi.nlm.nih.gov/pubmed/22502966" style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">PubMed page</a><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">). One hopes
to see a follow-up on this pilot study at the Centre Hospitalier Universitaire
de Montréal (Quebec, Canada). </span><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;"> </span></div>
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<b style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 8pt;">PubMed: </span></b><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;"> <a href="http://www.ncbi.nlm.nih.gov/pubmed/22502966">http://www.ncbi.nlm.nih.gov/pubmed/22502966</a></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 8pt;">
<b>MeSH *Major* terms:</b> Cardiac Surgical
Procedures/education; Clinical Competence; Critical Care/standards; Education,
Medical, Continuing/methods; Patient Care Team/organization &
administration</span></span>Anonymoushttp://www.blogger.com/profile/02329067552426761393noreply@blogger.com0tag:blogger.com,1999:blog-3398142311011328936.post-62398852877083729812015-09-05T18:38:00.000-04:002015-09-17T02:10:41.854-04:00ACEhp’s President Ed Dellert Co-Authored COPD CME Mayo Clinic Article With Robust Follow-Up Data<div class="MsoNormal">
<span style="font-size: 8.0pt;"><span style="font-family: Arial, Helvetica, sans-serif;"><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538496/" target="_blank">Mayo Clinic Proceedings published this free 2012 article by SG Adams</a> (University of Texas Health Science Center) and colleagues
on an educational change intervention on chronic obstructive pulmonary disease
(COPD) among primary care clinic. What’s more, our own Alliance for CE in the
Health Professions president, Ed Dellert, is a co-author!</span></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">There was a clear educational gap among target clinicians: The authors report that, “before the
program, 173 of 320 participants (54.1%) had never used the Global Initiative
for Chronic Obstructive Lung Disease recommendations for COPD.” Those of us who
collect educational outcomes data can applaud the tremendous follow-up survey’s
response rate of 48.7% of the 313 participants. We all struggle with the
problematic use of self reported performance data in CEhp outcomes articles;
the authors even acknowledge this, stating, “physician self assessment is
unreliable” (Methods). Yet, this article is impressive because of its inclusion
of the word “completely: “Of the follow-up survey respondents, 92 of 132
(69.7%) reported completely implementing at least one clinical practice change.”
This helps us appreciate the knowledge and comprehension data reported as
increasing significantly, as well as the value of improved self-confidence
developed through CME/CEhp. Confidence is a measure of competence (Moore’s
Level 4), and competence is, to me, “the glue that sticks” knowledge to performance-in-practice. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">The initiative featured
systematic instructional design methods using the Analysis, Design,
Development, Implementation, and Evaluation (ADDIE) approach. This construct was followed
by a team of educators and medical experts from multiple disciplines,
particularly from the American College of Chest Physicians and American Academy
of Nurse Practitioners. Especially interesting for us instructional designers,
the team used “self-directed learning” and “case and problem-based learning”
before ever beginning “lecture-based learning” (<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538496/table/tbl1/" target="_blank">Table 1</a>), indicating that they incorporated
the benefits of exploration in scientific learning that ideally occurs </span><i style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">before</i><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;"> the didactic introduction of terms
(per the Learning Cycle teaching model). </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">To challenge medical educators, I ask that we all continue to look for and
share CEhp studies that feature professional instructional design that other
clinical sites and educational teams can reproduce. This will help us highlight
Why We Matter. So I close with the image that my educational outcomes colleague,
Wendy Turell, tweeted (@WTevalu8), showing Ed Dellert discussing </span><i style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">Why We Matter</i><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;"> at the Alliance Industry Summit
in May 2015. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b><span style="font-size: 8pt;">PubMed:</span></b><span style="font-size: 8pt;"> <a href="http://www.ncbi.nlm.nih.gov/pubmed/22958990">http://www.ncbi.nlm.nih.gov/pubmed/22958990</a>
<br />
<b>PubMed Central:</b> <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538496/">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538496/</a>
<br />
<b>MeSH *Major* terms:</b> Clinical
Competence; Education, Medical, Continuing; Physicians, Primary Care/education;
Pulmonary Disease, Chronic Obstructive/diagnosis; Pulmonary Disease, Chronic
Obstructive/therapy</span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTw_fKW_3jq3hnhLOI02SNvGzErhVPV8pSfA_75qm3Cxj1Jnz3ew43rVRZkO3jkxvsCFMBxuHNnEEwQLxd_SDBwRRQE7VuxZ6s6xD9zSw8iDWxbr51avoO-WOKoO1XkzogUquLXXmbsOE/s1600/Dellert-WhyWeMatter-AIS15-Tweet-BacktoSchool.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTw_fKW_3jq3hnhLOI02SNvGzErhVPV8pSfA_75qm3Cxj1Jnz3ew43rVRZkO3jkxvsCFMBxuHNnEEwQLxd_SDBwRRQE7VuxZ6s6xD9zSw8iDWxbr51avoO-WOKoO1XkzogUquLXXmbsOE/s320/Dellert-WhyWeMatter-AIS15-Tweet-BacktoSchool.jpg" width="320" /></a></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 8pt;"><br /></span></span>Anonymoushttp://www.blogger.com/profile/02329067552426761393noreply@blogger.com0tag:blogger.com,1999:blog-3398142311011328936.post-75257287945677443222015-09-02T17:39:00.001-04:002015-09-02T17:41:37.839-04:00Open-Access Article on Interprofessional Care and Team Learning for Delirium in Hospital<div class="MsoNormal">
<span style="font-size: 8.0pt;"><span style="font-family: Arial, Helvetica, sans-serif;">A few years ago, I asked a
nurse practicing in the hospital in my neighborhood whether she would be
interested in continuing education on any particular topic. Given such an
opening, her response probably had the benefit of the being the topmost concern
in her daily practice, although one might disagree that this is the case. What
CE did she request? <b><i>Diagnosing and managing DELIRIUM.</i></b></span></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">This <b><a href="http://www.cardenjenningspublishing.com/journal/index.php/cem/article/view/134" target="_blank">article by Peterson <i>et al</i> features interprofessional education and team-based learning on delirium</a></b> in patients
recovering from hip fracture surgery at Eisenhower Medical Center. With an
aging population and hip fracture as a potentially fatal injury within the
first 30 days, this study informs us on a topic that is </span><span style="font-family: Arial, Helvetica, sans-serif; font-size: 12.8000001907349px;">relevant</span><span style="font-family: Arial, Helvetica, sans-serif; font-size: 12.8000001907349px;"> </span><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">to hospital care
providers with education that also could widely improve patient health outcomes in this </span><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">practice setting. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;">Even better … </span><i style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;"><b>CE
Measure </b></i><span style="font-family: Arial, Helvetica, sans-serif; font-size: 8pt;"><b>is a peer-reviewed, open-access journal</b>, so you can <a href="http://www.cardenjenningspublishing.com/journal/index.php/cem/article/view/134" target="_blank">link to the full article</a> here
and now. </span></div>
Anonymoushttp://www.blogger.com/profile/02329067552426761393noreply@blogger.com0tag:blogger.com,1999:blog-3398142311011328936.post-6425712578453032862015-09-01T17:32:00.001-04:002015-09-01T17:32:37.812-04:00Improved Confidence in Pain Management for Minority Populations Can Improve Care DisparitiesThis article reporting <a href="http://ajm.sagepub.com/content/29/5/388.abstract">outcomes of pain CME</a> nicely highlights the fact that clinical educational effectiveness depends on everyday practice factors—in this case, the demographics of the patient population. In looking at influences on undertreatment of pain in minority populations, researchers Bekanich <i>et al</i> identified “language barriers, miscommunication, fear of medication diversion, and financial barriers as major obstacles to optimal pain management.” <div>
In this field, where patient education and shared decision-making are critical to effective care, interpersonal communication gaps can quickly reduce the quality of care. The authors note that increased confidence in caring for disadvantaged patients, which is a measure of competence and professionalism, improved after continuing education on pain management disparities. The researchers also did not shy away from reporting suboptimal knowledge-level outcomes. Increased confidence in care practices is more likely to change a clinician’s practice than increased knowledge is, and I cannot think of a more appropriate topic for addressing care disparities: pain management is one of the most widely discussed concerns in American life.<br /> <br /></div>
Anonymoushttp://www.blogger.com/profile/02329067552426761393noreply@blogger.com0tag:blogger.com,1999:blog-3398142311011328936.post-79234759217058789462015-09-01T13:19:00.000-04:002015-09-17T02:04:18.167-04:00Back to School: See How Clinical Continuing Education Has Improved Health Care Quality – Proven in Peer-Reviewed Journals!<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">We often hear that there is little evidence of CME’s success
in teaching clinicians relevant strategies for better patient care, for
changing practice through education, and for connecting with the quality
improvement (QI) movement. Witness the current initiatives of the Alliance for Continuing
Education in the Health Profession (ACEhp), <a href="http://www.acehp.org/p/cm/ld/fid=277">“Why We Matter”</a> and the 10-year
<a href="http://www.acehp.org/p/cm/ld/fid=43">Roadmap and 10 complementary Building
Blocks of the Quality Improvement Education (QIE) Initiative.</a> While Davis
and others have noted historical effectiveness of CEhp, such as in <a href="http://www.ncbi.nlm.nih.gov/pubmed/1501333">this 1992 article</a>, later
articles by Bloom, Davis, and Ratanawongsa have questioned CME effectiveness (e.g.,
in <a href="http://www.ncbi.nlm.nih.gov/pubmed/7650822">1995</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/16110718">2005</a>) and identified <a href="http://www.ncbi.nlm.nih.gov/pubmed/18316877">reporting inconsistencies</a>
that reduce the validity of CME outcomes reports.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">It is true that our reporting of CEhp methods and outcomes
has need of greater readership and better reporting. Yet CME, performance
improvement (PI), interprofessional education (IPE), and education-driven QI
projects already have many achievements reported, in both initiative-level
outcomes reports and the published, peer-reviewed literature. Going beyond <i><a href="http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1554-558X">JCEHP</a></i>,
where articles feature methods and case studies for improving clinical
education, and <i><a href="http://www.cardenjenningspublishing.com/journal/index.php/cem/index">CE
Measure</a></i>, which reports on-the-ground initiatives and specific outcomes
data, we see that clinical journals and meetings are publishing increasing
numbers of CEhp studies. What’s more, reporting of these achievements is
certain to grow after the <a href="http://www.acehp.org/e/in/eid=2&s=28&req=info">ACEhp QIE
Initiative launches its custom version of the SQUIRE tool this month</a>, at
September 2015’s <a href="http://www.acehp.org/p/cm/ld/fid=20">Alliance Quality
Symposium</a>. The SQUIRE tool, created by the group developing <a href="http://squire-statement.org/">Standards for Quality Improvement Reporting
Excellence</a>, will help all of us doing CEhp research design our studies and
publish our findings in a standardized manner … for later meta-analyses of into
CME/CEhp effectiveness as a mechanism for quality improvement.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Today our goal is to show the past effectiveness of CEhp initiatives
in published educational outcomes studies, as we prepare—as a profession—to begin
reporting CME and IPE initiatives with greater rigor, and to illustrate the
effectiveness of certified clinical education by accredited providers on a
greater scale. Therefore, Don Harting, my friend and colleague who specializes
in medical education needs assessments, and I have embarked on a “Back-to-School” campaign to highlight published articles where CME, IPE, PI, and QI
initiatives worked to change clinicians’ behavior or improve performance in
routine, clinical practice. Don featured 15 of our 30 articles on Twitter (<a href="http://twitter.com/CME_Scout">@CME_Scout</a>) and <a href="http://dvmw.blogspot.com/2015/08/rt-to-win-100-your-fun-guide-to-cme.html">his
blog</a> from August 17 – August 31, 2015, and I will be posting to publicize another
15 articles at <a href="http://twitter.com/SHB_CMEedit">@SHB_CMEedit</a> and
this blog from September 1 – September 15, 2015. You can sign up to receive a summary
report of the published studies we feature by following <a href="http://fullcirclece.blogspot.com/">fullcirclece.blogspot.com</a>, or find
me in person at the Alliance Quality Symposium at the end of September. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">We want you to take away these messages from this campaign,
so let me encourage you to put yourself in the first person and say these motivational
statements: </span></div>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">I can talk about CEhp initiatives
that were effective in improving the quality of health care</span></li>
<li class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">There is evidence in the peer-reviewed
literature to prove CEhp effectiveness</span></li>
<li class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">I am ready to read CEhp
outcomes studies, to help me learn to prepare my own (if you are not sure
you’re ready, check out the 12-article research and statistics series in
the ACEhp <i><a href="http://www.acehp.org/p/cm/ld/fid=52">Almanac</a></i>, which started
in February 2015)</span></li>
<li class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">My group’s CEhp outcomes data
do <i>not</i> have to show change to be
worth publishing, i.e., it’s okay to publish negative findings because I
am a dispassionate researcher of clinical education</span></li>
<li class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">I <i>can </i>find clinical and educational journals to whom to submit my
CME outcomes data</span></li>
<li class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">My CEhp work in content
and faculty development, instructional design, and outcomes analysis <i>matters</i></span></li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif;">Now don’t you feel better? Not sure? Ready to go? Follow our
tweets, read the articles or their abstracts, and then say these points to
yourself again. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Finally, to promote articles showing the achievements of the
continuing education profession in improvement health care quality, we have a
contest where you can <a href="http://cmetweetfest.blogspot.com/">Retweet to
Win (see rules)</a> by sharing our featured articles with your network of CEhp professionals. <a href="http://www.hartingcom.com/">Harting Communications LLC</a> is
offering a $100 Amazon gift card as first prize, and <a href="http://www.linkedin.com/company/full-circle-clinical-education-inc">Full
Circle Clinical Education, Inc</a>, is offering a $50 Amazon gift card as second
prize!</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Remember to <i>follow</i>
us on Twitter <a href="http://twitter.com/SHB_CMEedit">@SHB_CMEedit</a> and <a href="http://twitter.com/CME_Scout">@CME_Scout</a> so that you can notified via
direct message if you win! And tell Don and me whether this service campaign supporting awareness of CEhp effectiveness was helpful to you. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Good luck, happy reading, and enjoy! </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Best wishes, and thanks for viewing my updates, </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Sandra</span></div>
Anonymoushttp://www.blogger.com/profile/02329067552426761393noreply@blogger.com1