1. ABP Practice Performance Improvement Summit American Board of Radiology Chicago, Il August 19, 2006 Paul V. Miles MD Vice President, Director of Quality Improvement And Practice Assessment American Board of Pediatrics MOC Part IV: The Role of the ABP in Improving Quality of Care for Children

2. ABP “I am sorry for you, young men (and women) of this generation. You will do great things. You will have great victories, and standing on our shoulders, you will see far, but you can never have our sensations. To have lived through a revolution, to have seen a new birth of science, a new dispensation of health, reorganized medical schools, remodeled hospitals, a new outlook for humanity, is not given to every generation.” …Sir William Osler

3. ABP Demands on Physicians for Quality of Care Professional obligation Maintenance of board certification Career development Maintenance of licensure Credentialing Malpractice Pay for performance

4. ABP The Program for Maintenance of Certification in Pediatrics™ PMCP-G ™  Generalist Pediatricians PMCP-S ™  Pediatric Subspecialists

5. ABP PMCP-GPMCP-S Part One: Professional Standing Part Two: Lifelong Learning Part Three: Cognitive Expertise Part Four: Performance in Practice Valid license, no restrictions ABP Knowledge self assessment AAP PREP (ABP approved) ABP Decision Skills Assessment Secure, proctored exam ABP Knowledge self assessment via literature review AAP Neo Reviews (ABP approved) A. Pediatric CAHPS Survey (and Peer Survey) B. eQIPP or eQIPP-like modules or local QI effort ABP: Maintenance of Certification

6. ABP Part 1 Valid, unrestricted license – Maintenance of licensure (MOL) Pediatric patient survey (CAHPS) 2007 Professionalism survey - future

7. ABP ExistingAvailable ABP Knowledge self-assessment2006 ABP Decision Skills2006 AAP PREP (broad based general knowledge)2006 Subspecialty modules (current best articles)2006-10 Subspecialty prep programs (eg. Neoreviews) 2006-10 In Development Patient Safety Self Assessment2008 QI Self Assessment & QI Basics Module2008 Part 2: Knowledge Self Assessment (Open book, low stakes, requires passing score)

8. ABP ABP is considering requiring the secure exam every 10 years instead of every 7 years Part 3

9. ABP Part 4 Part 4 Practice Assessment & Improvement Option A Option B Web based modules Participate in Established Such as eQIPP or ABMS Improvement Project Patient Safety Module (including attestation forms) Complete QI Knowledge Self Assessment or Stand Alone QI Module with Assessment (Required with Option B) Credit for Part IV MOC Diplomate enrolls in MOC On the ABP Web-site

10. ABP Part 4 Existing (Web based)Available eQIPP modules (Asthma & ADHD)2006 In Development – 4A Web based ABMS Patient Safety Module2007 eQIPP Nutrition & other modules2007-10 Performance Improvement Modules (PIMs) 2007 In Development – 4B Credit for ongoing projects2007

11. ABP Medical Knowledge Quality Improvement Knowledge Measurement Improvement Re Measurement

12. ABP eQIPP allows the learner to quickly assess their practice online.

13. ABP A real-time data analysis allows the learner to begin to identify opportunities for improvement.

14. ABP eQIPP offers an interactive learning environment. The program also includes practical, easy-to-use tools that can be implemented quickly into the office setting.

15. ABP After completing the clinical content, the learner uses the Model for Improvement to identify opportunities for improvement in their practice.

16. ABP Within each step, the learner will receive advice for identifying, prioritizing, refining, and launching new improvement cycles.

17. ABP e QIPP subscribers have access to the modules for three years. You will be able to track your progress, and monitor your successes over time.

18. ABP Additional eQIPP Modules Nutrition Bright futures (well child care) Six to ten additional common topics by 2009

19. ABP ABMS Patient Safety Module Accurate and Complete Medication List Safer Prescription and Medication Order Writing Accurate and Complete Allergy Information Hand Hygiene Correct Patient/Site/Procedure Critical Test Results Notification

20. ABP Performance Improvement Modules (PIMs) Diplomate Registers & Chooses Module Diplomate Measures Practice Quality Diplomate Chooses Change Package Diplomate Re Measures Quality Clinical Data Survey Data Rapid Cycle Improvement Change Package 1 Change Package 2 Change Package 3

21. ABP Annotated Comparative Run Chart Annotation Goal Time 

22. ABP Part 4 Part 4 Practice Assessment & Improvement Option A Option B Web based modules Participate in Established Such as eQIPP or ABMS Improvement Project Patient Safety Module (including attestation forms) Complete QI Knowledge Self Assessment or Stand Alone QI Module with Assessment (Required with Option B) Credit for Part IV MOC Diplomate enrolls in MOC On the ABP Web-site

23. ABP Pass a QI Knowledge Self Assessment Exercise: an open book multiple choice question exam Part 2 (in development) Complete a valid QI project Competence in Quality Improvement

24. ABP ABP Standards for Part 4 B Standards for Established Programs to receive ABP approval for Part 4 Standards for meaningful participation by a diplomate in an Established Program

25. ABP “Perfect Care”: composite measure of severity classified, identified management plan, and controller medications for patients with persistent asthma Copyright © 2005 Cincinnati Children’s Hospital Medical Center; all rights reserved Cumulative % of Asthma Population with "Perfect Care": Network and Select Practices

26. ABP Cumulative % of Asthma Population with "Perfect Care": Commercial vs. Medicaid/Uninsured Copyright © 2005 Cincinnati Children’s Hospital Medical Center; all rights reserved

27. ABP Subspecialty Care: What to do about small numbers? Collaborative practice with standardization of care Enroll patients in multicenter studies with shared data to determine best practices

28. ABP Acute Lymphoid Leukemia Simone J., Lyons, J: J Clin Oncology 1998 Sep;16(9):2904-5 5 year survival rate

29. ABP Percent of Patients Meeting the NKF- DOQI Target Urea Reduction Ratio of 65% figure 4.25, prevalent hemodialysis patients, 1999, by HSA Percent of patients USRDS Atlas

30. ABP Quality of Care (ESRD)

31. ABP Adequacy of Hemodialysis Sehgal A, JAMA 2003;289:1996-1000

32. ABP Initial Efforts in Subspecialty Care PIBDnet – Inflammatory Bowel Disease Cystic fibrosis - Pulmonology High risk newborns – Neonatology Catheter Related Blood Stream Infections in PICU – Critical care Neonatal Congenital Heart Disease – Cardiology

33. ABP Prevention of Catheter-related Blood Stream Infections Marlene R. Miller, M.D., M.Sc. Christopher T. McKee, DO Ivor Berkowitz, M.D. Claire Beers, R.N., M.S.N. Johns Hopkins Children’s Center and Hospital Epidemiology and Infection Control

34. ABP Subsequent BSI Outcomes PREPOST

35. ABP New Products and Programs that ABP has invested in Part 2 General pediatric knowledge self assessment Decision skills exercise Subspecialty specific (13 subspecialties) knowledge modules Quality Improvement knowledge self assessment exam

36. ABP Part 4 Web based modules  AAP eQIPP nutrition module  Performance Improvement Modules  Patient safety module Practice based QI efforts  Pediatric GI – inflammatory bowel disease database and collaborative  Critical care – catheter related blood stream infections  Cardiology – Congenital heart disease project  General pediatrics – RWJF funded Improving Performance in Practice (IPIP) with internal medicine and family medicine New Products and Programs that ABP has invested in

37. ABP A collaboration of four major national pediatric organizations formed to measurably improve the quality of health care for America’s children. Alliance for Pediatric Quality

38. ABP Timeline Certificates expiring between 2003 and 2009 – Parts 1 and 3: Valid license and secure exam Certificates expiring in 2010 and 2014 – all four Parts: One activity each in Parts 2 and 4