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TRANSITIONING FROM NEEDS ASSESSMENT TO PRACTICE GAPS

November 16 2010November 16, 20102:00 – 3:00 PM ET

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PRESENTERS

Chris PrestaSenior Manager, Enduring MaterialsAmerican Academy of Dermatology

Rebecca DeVivo, MPH, MSWSenior Director Professional EducationSenior Director, Professional EducationAmerican Society for Gastrointestinal Endoscopy

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OBJECTIVES

Define the difference between needs assessment and practice gap.Identify evidence-based sources toIdentify evidence-based sources to gather practice gap data.Develop tools to collect practice gap data from learners and experts.p

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DISCLAIMER

• This is only our experience – We have not had any direct feedback from the ACCME.

All i diff t d di• All experiences are different depending on your organization.

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WHERE I STARTED: NEEDS ASSESSMENT

Q ti Wh i thi ti it d d?Question: Why is this activity needed?

Typical answers:- Data says this is a topic of importance and

education is needed:education is needed:- Published, peer-reviewed research- Practice Guidelines

- Members say they want education in this y yarea - Evaluation data- Member surveys

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WHERE I STARTED: NEEDS ASSESSMENT

EXAMPLE 1: Capsule EndoscopyEXAMPLE 1: Capsule Endoscopy

Evidence Base: ASGE Guideline

States education requirements before competency b dcan be assessed:

“Completion of a hands-on course with a minimum of 8 hours CME Credit, endorsed by a national or international GI or surgical society and review of first 10 capsule studies by a credentialed capsulefirst 10 capsule studies by a credentialed capsule endoscopist.”

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BUT, ALONG CAME NEW ACCME CRITERIA and LABELS…A ti it L b l f C it i 2 (f th N bActivity Labels for Criterion 2 (for the November

2011 cohort):

#1: Verification that the activity is developed from a professional practice gap connected p p g pto your own learners.

(What do physicians need to be able to do?)(What is the practice-based problem?)

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BUT, ALONG CAME NEW ACCME CRITERIA and LABELS…A ti it L b l f C it i 2 (f th N bActivity Labels for Criterion 2 (for the November

2011 cohort):

#2: Verification that educational needs(knowledge, competence or performance) ( g p p )underlying the professional practice gaps were identified.

(Why does the problem exist?)(How can we close the practice gap?)(How can we close the practice gap?)

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UPSHOT: “NEEDS ASSESSMENT” NOT ENOUGH!We had identified an educational need but basedWe had identified an educational need, but based

on what professional practice gap?

However, our Practice Guideline also states the Endoscopists wishing to perform capsule endoscopy:

- Must be able to integrate capsule endoscopy into the overall clinical evaluation of appropriately selected patients.

- Must be familiar with the hardware and the softwarenecessary to perform and interpret the capsule endoscopy imagesMust be able to accurately identify and interpret capsule- Must be able to accurately identify and interpret capsule endoscopy findings

These are practice gaps!

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UPSHOT: “NEEDS ASSESSMENT” NOT ENOUGH!To be more specific:To be more specific:

Practice Gap (what do they need to be able to?): - Must be able to integrate capsule endoscopy into the

overall clinical evaluation of appropriately selected patients.

Educational Need (Why does the gap exist? How can we help them close the gap?):

- Knowledge: Evidence-based information on when it is appropriate to use capsule endoscopy in the treatment of a patient.

- Competence: Skills training with the equipmentCompetence: Skills training with the equipment- Performance: Additional experience/confidence in

reading cases

= Hands-on CME Course

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So, what are some examples of resources we can use?

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Practice Guidelines

Went through and picked out specific recommendations related to practice.

Collated all “practice gap” information into one document that can be used for multiple activity filesdocument that can be used for multiple activity files.

ACCME has indicated they are looking for an overall analysis of practice gaps.

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EVALUATION DATA

Ask attendees to describe a clinical question in practice encountered in the last year.Dermatologists told us that they need strategies to:

Safely administer biologic treatments in pediatric patientspatientsSkills to use a dermoscopeAppropriate treatment for alopecia in women

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EXPERTSThe Epidemiology ERG serves as resource of “experts”The Epidemiology ERG serves as resource of experts” to identify practice gaps. The practice gap evaluation was based on the ERG review of literature, informal surveys and interviews with course directors and speakers.

S ifi i ti d k l d d fSpecific gaps in practice and knowledge were proposed for the following:

Reporting adverse events for drugs and/or other treatmentsPatient compliance with recommended treatments and behaviorsUse of total body skin exam to screen for skin cancersIdentification of ocular symptoms in rosacea that might lead toIdentification of ocular symptoms in rosacea that might lead to corneal diseaseIdentification of psoriatic arthritis in psoriasis patients that might lead to morbidity and disability

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JOURNALS

The sited article reports 8 pts (2 from a previous study) responding well to UVA-1 therapy. Irradiation with UVA-1 increases the collagenase production by cultured fibroblasts, which could be the pathophysiologic mechanism that explains the p p y g pgood effect of UVA-1. This form of phototherapy may be a treatment option for patients with this disabling and often therapy-resistant disease.

Kroft EB, Jong EM. Scleredema diabeticorum case series: successful treatment with UVA-1 Archseries: successful treatment with UVA-1. Arch Dermatol. Vol 144:(No7):947-948.

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VERIFICATION THAT THE NEEDS UNDERLYING THE GAP WERE IDENTIFIED?

Planning Documentation:Planning Documentation:

- Planning tools – Grids, templates, applications – may need updating.

Previously: Why is this activity needed?

Now:GAP: What do physicians need to be able to do?

NEED: Why aren’t they able to do it? How can we help them do it? (i.e., knowledge, skills, etc.)

- Planning committee minutes/emails

- Board reports

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OKAY, SO BACK TO WHERE I STARTED: NEEDS ASSESSMENT

Question: Why is this activity needed?

Typical answers:- Data says this is a topic of importance and y p p

education is needed:- Published, peer-reviewed research- Practice Guidelines

Members say they want education in this area- Members say they want education in this area - Evaluation data- Member surveys

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AND NOW?GAP ANALYSIS

New Question: What do our physicians need to be able to do?

(that they’re not doing now…)

Typical answers (for ASGE):- Integrate new technologies or procedures into practice- Evaluate the latest research in the context of their own practice- Efficiently and accurately process reimbursement- Train their nursing staff/endoscopy team

THEN, what do we need to do to help themdo it?

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KEY POINTS

Gap Analysis identifies and documents the objectives – what do physicians need to be able to do? Needs Assessment defines the content – how can we help them do it?we help them do it? Sources can include:

Clinical GuidelinesEvaluationsExpertsJournalsResults of Performance Improvement Activities

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SOME THINGS YOU CAN DO RELATIVELYEASILY…

1 Look at your planning process:1. Look at your planning process:

Odds are, the answers are already there. You just need to tap into them.

A H d d id t d d ti l ti iti ?A. How do you decide to do educational activities?

B. Who decides to do educational activities?

C. What are they basing their decision on?y g

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SOME THINGS YOU CAN DO RELATIVELYEASILY…

2 Look at your data does the data address practice2. Look at your data – does the data address practice gaps specifically?

A. Practice guidelines often specify practice gaps.

B E l ti /S D t Sh ld th ti bB. Evaluation/Survey Data: Should the questions be updated to assess practice gaps more specifically?

“What topics would interest you for future courses” vs.

“What practice areas could you use additional training in to practice more effectively?”

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SOME THINGS YOU CAN DO RELATIVELYEASILY…

C. If you’re using published research, how does it relate to physician practice?

D. Other sources?

• Public Adverse Events• New technologies approved by FDA

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SOME THINGS YOU CAN DO RELATIVELYEASILY…3. Look at your planning and evaluation tools:3. Look at your planning and evaluation tools:

Do they document the process of planning the activity based on a practice gap?

Do your learning objectives focus on whatDo your learning objectives focus on what participants will be able to do?

Does your evaluation assess the practice gaps you identified?

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SOME EASY EVALUATION QUESTIONS THAT MAY HELP…

My ability to [insert Learning Objective #1] is:My ability to [insert Learning Objective #1] is:

Example: My ability to define the difference between needs assessment and practice gaps is:- Significantly increased

Somewhat increased- Somewhat increased- About the same

My ability to identify evidence-based sources to gather practice gap data is:- Significantly increased- Somewhat increased- About the same

What will you change in your practice as a result of attending this session?

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AUDIENCE RESPONSE

My ability to define the difference between needsMy ability to define the difference between needs assessment and practice gaps is:

- Significantly increased- Somewhat increasedAbout the same- About the same

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AUDIENCE RESPONSE

My ability to identify evidence based sources toMy ability to identify evidence-based sources to gather practice gap data is:

- Significantly increased- Somewhat increased- About the sameAbout the same

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SOME THINGS YOU CAN DO RELATIVELYEASILY…4 Everything should line up:4. Everything should line up:

Practice Gaps: What physicians need to be able to do…

Learning Objectives: What physicians will be able toLearning Objectives: What physicians will be able to do as a result of the activity…

Evaluation: What physicians indicate they are able to do as a result of the activity

Follow-up Evaluation: What physicians did as a result of the activity.

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TAKE HOME MESSAGES

Th t i t t thi i t hift hThe most important thing is to shift how you are thinking about “needs assessment” to focus on “practice gaps.”

In most cases, the data and information you need is yalready there or from the same resource – it’s all in how you identify and document it.

You can use the same tools you have been, but you may want to update the language to easemay want to update the language to ease documentation needs. Better to start now!

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ADDITIONAL RESOURCES

National Quality Forum: http://www.qualityforum.org/

National Guideline Clearinghouse: http://www guideline gov/http://www.guideline.gov/

ACCME tutorials: www.accme.org

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FINAL THOUGHTS…

Thank you

Questions?

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QUESTIONS

We welcome your questions and comments.

Please use the chat box on the left side of your screen to submit a question.

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THANK YOU!

Please take a moment to complete the brief pevaluation.

We appreciate your feedback!

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THANK YOU!

Join us for the Alliance’s next Takeout Tuesday webinar!

Engaging Physicians in Quality Improvement by Teaching a Fair Culture: Partnering of CME,

Medical Staff, and QI Leaders

Tuesday, December 14, 20102:00 – 3:00 PM ET2:00 3:00 PM ET

www.acme-assn.org