Duffy F Daniel, Lynn Lorna A, Didura Halyna, Hess Brian, Caverzagie Kelly, Grosso Louis, Lipner Rebecca A, Holmboe Eric S
American Board of Internal Medicine, Philadelphia, PA 19010, USA.
J Contin Educ Health Prof. 2008 Winter;28(1):38-46. doi: 10.1002/chp.154.
Quality measurement and improvement in practice are requirements for Maintenance of Certification by the American Board of Medical Specialties boards and a component of many pay for performance programs.
To describe the development of the American Board of Internal Medicine (ABIM) Practice Improvement Module (PIM) and the average performance of ABIM diplomates who have completed the Preventive Cardiology PIM.
Observational study of self-administered practice quality improvement.
Office practices through the United States.
A total of 179 cardiologists and general internists completing requirements for ABIM Maintenance of Certification from 2004 through 2005.
Physicians self-audited at least 25 charts to obtain performance measures, patient demographics, and coronary heart disease risk factors. At least 25 patients completed surveys regarding their experience of care in the physician's practice. Physicians completed a self-assessment survey detailing the presence of various practice systems.
The mean rate for systolic blood pressure control was 48%, for diastolic blood pressure 84%, and for low-density lipoprotein (LDL) cholesterol at goal 65%. Of patients 61% rated the quality of care as excellent and 58% rated the practices excellent at encouraging questions and answering them clearly. More than 85% of patients reported "no problem" obtaining a prescription refill, scheduling an appointment, reaching someone in the practice with a question, or obtaining lab results. Targets for improvement were increasing the rates for LDL cholesterol or systolic blood pressure at goal, improving patients' physical activity, patient education, and accuracy of risk assessment. Improvement strategies included implementing chart forms, patient education, or care management processes.
Patients and charts were selected by physicians reporting their performance for the purpose of MOC.
The Preventive Cardiology PIM successfully provides a self-assessment of practice performance and provides guidance in helping physicians initiate a cycle of quality improvement in their practices.
实践中的质量测量与改进是美国医学专业委员会认证维持的要求，也是许多按绩效付费项目的组成部分。
描述美国内科医学委员会（ABIM）实践改进模块（PIM）的开发情况以及完成预防心脏病学PIM的ABIM专科医师的平均表现。
自我管理的实践质量改进观察性研究。
美国各地的门诊实践。
2004年至2005年期间共有179名心脏病专家和普通内科医生完成了ABIM认证维持要求。
医生自行审核至少25份病历以获取绩效指标、患者人口统计学信息和冠心病危险因素。至少25名患者完成了关于他们在医生实践中护理体验的调查。医生完成了一份自我评估调查，详细说明了各种实践系统的存在情况。
收缩压控制的平均达标率为48%，舒张压为84%，低密度脂蛋白（LDL）胆固醇达标的为65%。61%的患者将护理质量评为优秀，58%的患者认为在鼓励提问并清晰回答问题方面实践表现优秀。超过85%的患者表示在获取处方续填、预约、向实践机构中的人员咨询问题或获取检查结果方面“没有问题”。改进目标是提高LDL胆固醇或收缩压的达标率，改善患者的身体活动、患者教育以及风险评估的准确性。改进策略包括实施病历表格、患者教育或护理管理流程。
患者和病历由报告其绩效以进行认证维持的医生选择。
预防心脏病学PIM成功地提供了对实践表现的自我评估，并为帮助医生在其实践中启动质量改进循环提供了指导。
