The 2006 ACCME Updated Accreditation...

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Presented by: Presented by:

Murray Kopelow, MDMurray Kopelow, MD

The 2006 ACCME The 2006 ACCME Updated Accreditation Updated Accreditation

CriteriaCriteria



Why? Why? Why now?Why now?


““ Widely used CME delivery methods such Widely used CME delivery methods such as conferences have little direct impact on as conferences have little direct impact on improving professional practice.improving professional practice. ””

FromFrom D. A. Davis, et. al. D. A. Davis, et. al. JAMA 274 (9), Sept. 6, 1995JAMA 274 (9), Sept. 6, 1995

Started with people readingStarted with people reading ……



“…“… we must conclude that where we must conclude that where performance change is the immediate goal performance change is the immediate goal of a CME activity, the exclusively didactic of a CME activity, the exclusively didactic CME modality has little or no role to play.CME modality has little or no role to play. ””

FromFrom D. A. Davis, et. al. D. A. Davis, et. al. JAMA 282 (9), Sept. 6, 1999JAMA 282 (9), Sept. 6, 1999

Followed byFollowed by ……


JAMA 282 (9), Sept 6 1999JAMA 282 (9), Sept 6 1999

Turned into…

“We all know traditional CME is in effective...”



“…“… the majority of [CME] activities offered the majority of [CME] activities offered to physicians employ learning methods to physicians employ learning methods ……

that have been shownthat have been shown not to have a not to have a positive effect on the quality of positive effect on the quality of care physicians provide to their care physicians provide to their patientspatients ..””

A Vision for Medical Education in the United StatesA Vision for Medical Education in the United StatesAssociation of American Medical CollegesAssociation of American Medical Colleges

July 2004July 2004

Was applied in the system asWas applied in the system as ……


While the only While the only meta synthesismeta synthesis in the in the literature actually saidliterature actually said ……

““ Continuing education Continuing education is is effectiveeffective in assisting in assisting professionals to modify and professionals to modify and improve their practiceimprove their practice ””

Umble and Cervero, 1996Umble and Cervero, 1996

Robertson, Umble, Cervero, 2003Robertson, Umble, Cervero, 2003



At the same time, messages fromAt the same time, messages from ……

�� Maintenance of Certification Maintenance of Certification �� Maintenance of LicensureMaintenance of Licensure�� Quality and SafetyQuality and Safety�� Hospital credentialingHospital credentialing

……about what they needed from CMEabout what they needed from CME


“ CME has the potential to be a viable tool for use in ensuring ongoing physician competence if it is part of a system of continuous professional development that includes self-assessment, remediation, and reassessment.”

Johnson, Austin and Thompson inRole of State Medical Boards in Continuing Medical Education

JCEHP September 2005



Ideal

Performance

Performance

The difference between health care processes or outcomes observed in practice, and those potentially achievable on the basis of current professional knowledge.

AHRQ 2006

Quality gap

“ All adults in the United States are at risk for receiving poor health care, no matter where they live; why, where, and from whom they seek care; or what their race, gender, or financial status is.”

Rand 2006


Joint Commission 2007 Medical Staff Standards (Pre-publication)

“All licensed independent practitioners and other practitioners privileged through the medical staff process participate in continuing education.”

Rationale“Continuing education is an adjunct to maintaining clinical skills and current competence.” Hospital-Based Education:

– Hospital-sponsored educational activities are offered prioritized by the organized medical staff .

– These activities relate, at least in part, to the type and nature of care, treatment, and services offered by the hospital.

– The organized medical staff helps prioritize hospital-sponsored continuing education .

– Education is based on the findings of performance improvement activities .

Individual-Based Education:– Each individual's participation

in continuing education is documented .

– Participation in continuing education is considered in decisions about reappointment to membership on the medical staff or renewal or revision of individual clinical privileges.

JCAHOElements of Performance



So, it is So, it is ““ Mission CriticalMission Critical ”” thatthat ……

CME CME mustmust , , �� Contribute to patient safety and Contribute to patient safety and

practice improvementpractice improvement�� Be based on valid contentBe based on valid content�� Be independent of commercial Be independent of commercial

interestsinterests


Sept 2006 Sept 2006 –– Change in EmphasisChange in Emphasis

Focus on Focus on rewarding rewarding providers for providers for changing and changing and improving improving their practice their practice of CME.of CME.



ProgramProgramStructureStructure

ProgramProgramImpactImpactMissionMission NeedsNeeds ActivityActivity

ImpactImpactObjectivesObjectivesPlanningPlanningStandards Standards

for for Commercial Commercial

SupportSupport


Program ImpactProgram Impact•• CompetenceCompetence•• PerformancePerformance•• Patient OutcomesPatient Outcomes

MissionMission•• CompetenceCompetence•• PerformancePerformance•• Patient OutcomesPatient Outcomes

Interventions


NeedsNeeds ActivityActivityImpactImpactObjectivesObjectivesPlanningPlanning

Standards Standards for for

Commercial Commercial SupportSupport





NeedsNeeds ObjectivesObjectives

Interventions

Standards for Commercial

Support


Support

ActivityImpact

ActivityImpact

PlanningPlanning





NeedsNeeds ObjectivesObjectives

Interventions


Support


Support

Program Improvement

ActivityImpact

ActivityImpact

PlanningPlanning

Aligns Learner and ProviderAligns Learner and Provider



Starting Point : The “Professional Practice Gap” ---the “Questions in Practice”

Starting Point : The “Professional Practice Gap” ---the “Questions in Practice”

Know

Do

?

Abi

lity

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1.1 Have a written statement of its CME mission, wh ich 1.1 Have a written statement of its CME mission, wh ich includes the CME purpose, content areas, target aud ience, includes the CME purpose, content areas, target aud ience, type of activities provided, and expected results o f the type of activities provided, and expected results o f the program.program.

C…Has a mission statement that includes all of the basic components.

EC…Has a mission statement that includes all of the basic components with a strong emphasis on assessment of results.



Evolved toEvolved to,,1. .... all of the basic components (CME

purpose, content areas, target audience, type of activities, expected

results) with expected results articulated in terms of changes in competence, performance, or patient outcomes that will be the result of the program.

Has a mission statement that includes all of the basic components .

– Has a mission statement that includes all of the basic components with a strong emphasis on assessment of results.

1.1 Have a written statement of its CME mission, wh ich includes 1.1 Have a written statement of its CME mission, wh ich includes the CME purpose, content areas, target audience, ty pe of the CME purpose, content areas, target audience, ty pe of activities provided, and expected results of the pr ogram.activities provided, and expected results of the pr ogram.


Evolved toEvolved to,,1. .... all of the basic

components (CME purpose, content areas, target audience, type of activities, expected results) with expected results articulated in terms of changes in competence, performance, or patient outcomes that will be the result of the program.

Has a mission statement that includes all of the basic components.

– Has a mission statement that includes all of the basic components with a strong emphasis on assessment of results.

1.1 Have a written statement of its CME mission, wh ich 1.1 Have a written statement of its CME mission, wh ich includes the CME purpose, content areas, target includes the CME purpose, content areas, target audience, type of activities provided, and expected audience, type of activities provided, and expected results of the program.results of the program.


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2.1 C…Planning process(es) used consistently that link(s) identified educational needs and desired result.

EC…Innovative and creative planning process(es) ….documentation that identified educational needs contribute toappropriate methodology and desired results for the offered activities .

2.2 C…Needs assessment data are consistently used.EC…from multiple sources are consistently

used to plan and evaluate activities.”

2.3 C…Purpose or objectives of the activity are consistently communicated to the learner.

EC…Purpose or objectives of the activity describe learning outcomes in terms of physician performance or patient health and are consistently communicated to the learner.

2.1 Use a planning process(es) that links identified educationa2.1 Use a planning process(es) that links identified educational needs with al needs with adesired result in its provision of all CME activities.desired result in its provision of all CME activities.

2.2 Use needs assessment data to plan CME activities.2.2 Use needs assessment data to plan CME activities.2.3 The provider must 2.3 The provider must communicatecommunicate the purpose or objectives of the activity so thethe purpose or objectives of the activity so the

learner is informed before participating in the activity.learner is informed before participating in the activity.

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2.1 Use a planning process(es) that links identified educationa2.1 Use a planning process(es) that links identified educational needs with a desiredl needs with a desiredresult in its provision of all CME activities.result in its provision of all CME activities.

2.2 Use needs assessment data to plan CME activities.2.2 Use needs assessment data to plan CME activities.2.3 The provider must communicate the purpose or objectives of 2.3 The provider must communicate the purpose or objectives of the activity so thethe activity so the

learner is informed before participating in the activitylearner is informed before participating in the activity..

Evolved to,

2. The provider incorporates into CME activities theeducational needs (knowledge, competence, or performance) that underlie the professional practice gaps of their own learners .

3. The provider generates activities/educationalinterventions that are designed to changecompetence, performance, or patient outcomes as described in its mission statement.

4. The provider generates activities/educational interventions around content that matches the learners’current or potential scope of professional activities.

5. The provider chooses educational formats for activities/interventions that are appropriate for the setting, objectives and desired results of the activity.

6. The provider develops activities/educational interventions in the context of desirable physician attributes (e.g., IOM competencies, ACGME Competencies).

Planning process(es) used consistently that link(s) identified educational needs and desired result.

– Innovative and creative planning process(es) …. documentation that identified educational needs contribute to appropriate methodology anddesired results for the offered activities.

Needs assessment data are consistently used.

– …. from multiple sources are consistentlyused to plan and evaluate activities.”

Purpose or objectives of the activity are consistently communicated to the learner.

– Purpose or objectives of the activity describe learning outcomes in terms of physicianperformance or patient health and areconsistently communicated to the learner.


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2.1 Use a planning process(es) that links identified educationa2.1 Use a planning process(es) that links identified educational needs with al needs with adesired result in its provision of all CME activities.desired result in its provision of all CME activities.

2.2 Use needs assessment data to plan CME activities.2.2 Use needs assessment data to plan CME activities.2.3 The provider must communicate the purpose or objectives of 2.3 The provider must communicate the purpose or objectives of the activity so thethe activity so the

learner is informed before participating in the activity.learner is informed before participating in the activity.

Planning process(es) used consistently that link(s) identified educational needs and desired result.

– Innovative and creative planning process(es) …. documentation that identified educational needs contribute to appropriate methodology and desired results for the offered activities.

Needs assessment data are consistently used.– …. from multiple sources are consistently used

to plan and evaluate activities.”

Purpose or objectives of the activity are consistently communicated to the learner.

– Purpose or objectives of the activity describe learning outcomes in terms of physician performance or patient health and are consistently communicated to the learner.

Evolved to,

2. The provider incorporates into CME activities the educational needs (knowledge, competence, or performance) that underlie the professional practic e gaps of their own learners.

3. The provider generates activities/educational interventions that are designed to change competence, performance, or patient outcomes as described in its mission statement.

4. The provider generates activities/educational interventions around content that matches the learners’ current or potential scope of professional activities.

5. The provider chooses educational formats for activities/interventions that are appropriate for t he setting, objectives and desired results of the acti vity.

6. The provider develops activities/educational interventions in the context of desirable physician attributes (e.g., IOM competencies, ACGME Competencies).

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NoYesPlanning @ Level 2

Designed to ∆ C, P, PO ?

K,C,P need incorporated ?

Gap of own learners ?

Gap identified ?

NoYesImplementation @ Level 2

Formats appropriate to desired result ?

Formats appropriate to objectives ?

Formats appropriate to setting ?

Content matches scope ?


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3.3 The provider must present CME activities in3.3 The provider must present CME activities incompliance with ACCMEcompliance with ACCME ’’s policies for disclosures policies for disclosureand commercial support.and commercial support.

C…Provider consistently– in control of content ;

– discloses required information and relationships;

– demonstrates appropriate management of funds from commercial supporters.

– ensures that promotion and education areseparate ;


3.3 The provider must present CME activities in 3.3 The provider must present CME activities in compliance with ACCMEcompliance with ACCME ’’s policies for disclosure and s policies for disclosure and commercial support.commercial support.

C…Provider consistently

– in control of content ; – discloses required

information and relationships;

– demonstrates appropriatemanagement of fundsfrom commercial supporters.

– ensures that promotion and education are separate ;

Evolved to,

7. The provider develops activities/educational interventionsindependent of commercial interests(SCS 1, 2 and 6).

8. The provider appropriately manages commercial support (SCS3).

9. The provider maintains a separationof promotion from education (SCS 4).

10. The provider actively promotes improvements in health care and NOT proprietary interests of a commercial interest (SCS 5).



3.3 The provider must present CME activities in 3.3 The provider must present CME activities in compliance with ACCMEcompliance with ACCME ’’s policies for disclosures policies for disclosureand commercial support.and commercial support.

C…Provider consistently

– in control of content ; – discloses required information

and relationships; – demonstrates appropriate

management of funds from commercial supporters.

– ensures that promotion and education are separate ;

Evolved to,

7. The provider develops activities/educational interventions independent of commercial interests (SCS 1, 2 and 6).

8. The provider appropriately manages commercial support (SCS3)

9. The provider maintains a separationof promotion from education (SCS 4).

10. The provider actively promotes improvements in health care and NOT proprietary interests of a commercial interest (SCS 5).

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2.4 The provider must evaluate the effectiveness of its CME2.4 The provider must evaluate the effectiveness of its CMEactivities in meeting identified educational needs. activities in meeting identified educational needs.

C…Educational activities are evaluated consistently foreffectiveness in meeting identified educational needs , as measured by satisfaction, knowledge , or skills .

EC…Educational activities are evaluated consistently for effectiveness in meeting identified educational needs, as measured bypractice applicationand/or health status improvement.



C…Educational activities areevaluated consistently for effectiveness in meeting identified educational needs , as measured by satisfaction, knowledge , or skills .

EC…Educational activities are evaluated consistently for effectiveness in meeting identified educational needs, as measured by practice application and/or health status improvement.

Evolved to,

11. The provider analyzes changes in learners(competence, performance, or patient outcomes)achieved as a result of the overall program’s activities/educational interventions.

2.4 The provider must evaluate the effectiveness o f its CME2.4 The provider must evaluate the effectiveness o f its CMEactivities in meeting identified educational needs.activities in meeting identified educational needs.


C…Educational activities are evaluatedconsistently for effectiveness in meeting identified educational needs , as measured by satisfaction, knowledge , or skills .

EC…Educational activities are evaluated consistently for effectiveness in meeting identified educational needs, as measured by practice application and/or health status improvement.

Evolved to,

11. The provider analyzes changes in learners (competence, performance, or patient outcomes) achieved as a result of the overall program’s activities/educational interventions.

2.4 The provider must evaluate the effectiveness o f its CME2.4 The provider must evaluate the effectiveness o f its CMEactivities in meeting identified educational needs.activities in meeting identified educational needs.


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2.5 The provider must evaluate the effectiveness o f its overall2.5 The provider must evaluate the effectiveness o f its overallCME program and make improvements to the program.CME program and make improvements to the program.

Mechanism in place to measure the effectiveness of the program…..

PC …but no documentation exists that the mechanism has been used or any changes have resulted from the process

C …with evidence thatimprovements have been made.

EC …Innovative and creative mechanism(s) ….. improvements being made on a regular basis .


Mechanism in place to measure theeffectiveness of the program…

PC … but no documentation exists that the mechanism has been used or any changes have resulted from the process

C… with evidence thatimprovements have been made.

EC….Innovative and creative mechanism(s) ….. improvements being madeon a regular basis .

Evolved to,

12. The provider gathers data or information and conducts a program-based analysis on the degree to which the CME mission of the provider has been met through the conduct of CME activities/educational interventions.

13. The provider identifies, plans and implementsthe needed or desired changes in the overall program (e.g., planners, teachers, infrastructure, methods, resources, facilities, interventions) that are required to improve on ability to meet the CME mission.

14. The provider demonstrates that identified programchanges or improvements, that are required to improve on the provider’s ability to meet the CME mission, are underway or completed .

15. The provider demonstrates that the impacts of program improvements, that are required to improve on the provider’s ability to meet the CME mission, are measured .

2.5 The provider must evaluate the effectiveness o f its overall2.5 The provider must evaluate the effectiveness o f its overallCME program and make improvements to the programCME program and make improvements to the program


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2.5 The provider must evaluate the effectiveness o f its overall2.5 The provider must evaluate the effectiveness o f its overall CMECMEprogram and make improvements to the program.program and make improvements to the program.

Mechanism in place to measurethe effectiveness of the program…..

PC …but no documentation exists that the mechanism has been usedor any changes have resulted from the process

C…… with evidence that improvements have been made.

EC…..Innovative and creative mechanism(s) ….. improvements being made on a regular basis .

Evolved to,

12. The provider gathers data or information and conducts a program-based analysis on the degree to which the CME mission of the provider has been met through the conduct of CME activities/educational interventions.

13. The provider identifies, plans and implements th e needed or desired changes in the overall program (e.g., planners, teachers, infrastructure, methods, resources, facilities, interventions) that are required to improve on ability to meet the CME mission.

14. The provider demonstrates that identified progra m changes or improvements, that are required to improve on the provider’s ability to meet the CME mission, are underway or completed.

15. The provider demonstrates that the impacts of program improvements, that are required to improve on the provider’s ability to meet the CME mission, are measured.

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Level 3: Accreditation with CommendationLevel 3: Accreditation with Commendation2.1 EC ... Innovative and creative planning process(es) used consistently, with documentation that identified educational needs contribute to appropriate methodology and desired results for the offered activities.

2.4 EC ... Educational activities are evaluated consistently for effectiveness in meeting identified educational needs, as measured by practice application and/or health status improvement.

3.1 EC ... Organizational framework for the CME unit exists, all components of the Element (resources and support) are present including a process to review and continually improve the organizational framework.

2.5 EC ... Innovative and creative mechanism(s) in place to measure the effectiveness of the program with evidence of improvements being made on a regular basis.



Evolved to,

16. The provider operates in a manner thatintegrates CME into the process for improving professional practice.

17. The provider utilizes non-education strategiesto enhance change as an adjunct to its activities/educational interventions (e.g., reminders, patient feedback).

18. The provider identifies factors outside the provider’s control that impact on patient outcomes.

19. The provider implements educational strategies toremove, overcome or address barriers to physician change.

20. The provider builds bridges with other stakeholders through collaboration and cooperation.

21. The provider participates within an institutional or system framework for quality improvement .

22. The provider is positioned to influence the scope and content of activities/educational interventions.

2.1 EC ... Innovative and creative planning process(es) used consistently, with documentation that identified educational needs contribute to appropriate methodology and desired results for the offered activities.

2.4 EC ... Educational activities are evaluated consistently for effectiveness in meeting identified educational needs, as measured by practice application and/or health status improvement.

3.1 EC ... Organizational framework for the CME unit exists, all components of the Element (resources and support) are present including a process to review and continually improve the organizational framework.

2.5 EC ... Innovative and creative mechanism(s) in place to measure the effectiveness of the program with evidence of improvements being made on a regular basis.

Level 3: Accreditation with CommendationLevel 3: Accreditation with Commendation

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Timeline for ImplementationTimeline for Implementation

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Timeline for ImplementationTimeline for Implementation

Time

% Enterprise / Programs / Activities in Compliance

0

100

xx

x

xx x x x

x

’06 – ‘08 ’08 – ‘10 ’10 – ‘12



Questions & AnswersQuestions & Answers

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