THE AMERICAN MEDICAL Association has recently authorized providers to offer a new type of activity for AMA PRA Category 1 credit: Performance Improvement. It's very exciting from an educational perspective and really focuses on bringing the intended educational results down to the level of an individual learner. This new learning platform can be used by all types of providers.

No More Time-based Metric

An academic medical center can announce a new PI type of CME credit opportunity for medical center — affiliated physicians. Physicians will be able to choose areas for improvement in their practice for which they can apply for credit. So this is unstructured in the sense that individual physicians choose their own areas; however they must meet certain criteria to qualify for credit. They can submit in three areas, each one of which qualifies for a flat five credits (no time-based metric anymore).

• Stage A: Assess current practice. Physicians assess their current practice using identified performance measures, either through chart reviews or another mechanism.

• Stage B: Apply performance improvement to patient care. Physicians implement an intervention based on the performance measures selected in stage A, using suitable tracking tools (e.g., flow sheets). Learners should receive guidance at this stage on using appropriate parameters for applying an intervention and assessing performance change, specific to the performance measure and the physician's patient base (e.g., how many patients with a given condition, seen for how long, will produce a valid assessment).

• Stage C: Evaluate performance. Participants reevaluate and reflect on performance in practice (stage B) by comparing to the assessment that were done in stage A. They summarize any practice, process, and/or outcome changes that resulted from the PI activity.

Extra Incentives

In another use of PI, any type of provider could attach a PI process to another certified activity where it makes sense to provide extra incentives to support learners in implementing the new learning in their practices. This would qualify for extra credit and probably be offered as a follow-up by e-mail. The learner would click on a hyperlink and go to instructions for completing this PI project according to stages A through C. The project could be completed and submitted electronically. The difference here is that in stage A, providers would give the learner specific metrics relevant to the connected activity by which to conduct his or her personal PI activity. The provider should be aware that this use of PI requires diligence in assuring that such activities are developed within the Accreditation Council for CME Essential Areas and policies and with due regard to the full AMA/PRA guidance on the PI initiative.

We think this new initiative is both an excellent opportunity for reinforcing education and a mechanism to change clinical practice that will ultimately affect patient outcomes. This gives us an impressive new mechanism to demonstrate real outcomes to the ACCME and the public. Both providers and supporters of CME activities should encourage and embrace this new opportunity in CME.

For more on Performance Improvement, you can download additional information from our Web site, www.passinassociates.com, on the splash page under “Performance Improvement Initiative.”

Steven M. Passin is president of the CME consulting firm, Steve Passin & Associates LLC in Newtown Square, Pa. He has also served as deputy health secretary for California. Contact him at passin@passinsssociates.com. Susan O'Brien is senior associate, Steve Passin & Associates LLC. Contact her at obrien@passinassociates.com.