Sue Pelletier

Going to the National Institute for Quality Improvement and Education Fall Conference, held in Chicago in September, felt a little like diving off a cliff into reams of notes, PowerPoints, lectures, conversations, case studies, and resources to go to for more information (as if I weren't drowning in the stuff already) about the screaming need for improving the quality of healthcare in the U.S., and continuing medical education's potential role in making those improvements.

When I finally came up for air and started to write this issue's cover story, three things were glaringly obvious: 1) Healthcare is changing as the demand for quality increases; 2) To stay relevant, CME needs to change along with it; and 3) The necessary changes will not be easy. While how to make it happen is up for debate, it's clear that everyone is demanding that we find ways to reduce errors and improve patient outcomes, while reducing costs. Who better to help drive improved quality than CME providers?

But to do what's needed now, CME must move from producing one-time didactic activities that are evaluated more on the quality of the coffee served than the knowledge gained — much less on actual improvements in behavior — to an experientially oriented, continuous series of activities that will result in improved outcomes in patient health (aka, continuous performance improvement). Did I mention that you'll also have to be able to prove those better outcomes the learners achieve resulted from the education?

This of course brings many challenges. One that many NIQIE participants said they were bumping up against was a reluctance on the part of healthcare providers to participate once their involvement entailed more than just planting their seats in seats. CPI generally demands more of their time and energy than going to a conference lecture or an online activity — though either or both of those could also be involved. Participants also likely will have to pull charts, enter data, incorporate follow-up activities, and ultimately measurably change their behavior in a way that benefits patients.

That's asking a lot, and there was fairly unanimous agreement at NIQIE that CME credit alone isn't going to be enough to drive participation. In some cases, you can't even pay docs to do it. As Atul Grover, MD, PhD, FACP, FCCP, chief advocacy officer, Association of American Medical Colleges, Washington, D.C., reported in his session on the promise of healthcare reform, even when physicians were given a financial incentive to participate in the Physician Quality Reporting Initiative, which was established by the Tax Relief and Health Care Act of 2006, the 2007 results showed only 16 percent of those eligible reported. And that was just asking them to report on metrics (such as the number of foot exams performed on patients with diabetes), not performance (i.e., whether or not they are in compliance with the standards for performing foot exams on patients with diabetes).

They may soon get another big nudge, however. Last year, the Federation of State Medical Boards' Maintenance of Licensure program, which requires licensed physicians to participate in programs that enable them to maintain or improve their competence in their daily practice, adopted five principles to help guide the state boards in their licensing programs, including “maintenance of licensure should support physicians' commitment to lifelong learning and facilitate improvement in physician practice.” While licensing requirements are determined by state law in each state, not by the federal board, this is yet another step pushing healthcare providers in the direction of continuous performance improvement.

Then there's the plight of the medical education and communication companies, which worry that the continuous performance improvement model is a poor fit for them. Since I'm out of space to talk about that here, join me over at the Capsules blog (blog.meetingsnet.com/capsules) for some discussion on where you think MECCs fit into CPI — or don't.