1. Clinical Assessment Program for Residencies Jim Czarnecki, D.O.

2. Introduction

3. The Clinical Assessment Program (CAP) for Residencies provides a mechanism for osteopathic residency programs to measure and improve the quality of patient care they provide patients. Current clinical practices are measured and compared with evidence-based practice guidelines representing state-of- the art professional standards of care. The Clinical Assessment Program (CAP) for Residencies provides a mechanism for osteopathic residency programs to measure and improve the quality of patient care they provide patients. Current clinical practices are measured and compared with evidence-based practice guidelines representing state-of- the art professional standards of care.

4. Introduction The CAP project analyzes data abstracted directly from patient’s medical records to determine the current performance of residents and the impact of effectiveness of residency program treatment protocols in meeting selected standards of practice for certain selected clinical categories of patients.

5. Objectives

6. To provide a structure for quantitative evaluation of current osteopathic care provided individually and in the aggregate by AOA accredited residency programs –To identify strengths and weakness in each program’s curriculum –To provide osteopathic and national benchmarks to evaluate performance. To provide a structure for quantitative evaluation of current osteopathic care provided individually and in the aggregate by AOA accredited residency programs –To identify strengths and weakness in each program’s curriculum –To provide osteopathic and national benchmarks to evaluate performance.

7. Objectives To identify where quality-of-care improvements can be made in AOA accredited residency program –To offer these residency programs assistance in establishing and implementing protocols and procedures to improve clinical practices To identify where quality-of-care improvements can be made in AOA accredited residency program –To offer these residency programs assistance in establishing and implementing protocols and procedures to improve clinical practices

8. Objectives To provide residents with “hands on” experience in the execution of observational studies. To demonstrate the osteopathic profession’s commitment to continuous quality improvement. To provide for a perpetual program To provide near-real-time quality assurance tools for residency programs To provide residents with “hands on” experience in the execution of observational studies. To demonstrate the osteopathic profession’s commitment to continuous quality improvement. To provide for a perpetual program To provide near-real-time quality assurance tools for residency programs

9. Practice Guidelines

10. Evidence-based practice guidelines are derived or authenticated by three sources: 1.Large, controlled, randomized clinical trials; 2.Observational scientific studies; and 3.Consensus recommendations from a panel of recognized experts in the clinical or research field. Evidence-based practice guidelines are derived or authenticated by three sources: 1.Large, controlled, randomized clinical trials; 2.Observational scientific studies; and 3.Consensus recommendations from a panel of recognized experts in the clinical or research field.

11. Overview

12. Measures current clinical practices in participating osteopathic family practice and internal medicine residency programs. Current clinical practices are measured and compared with evidence-based practice guidelines that represent state-of- the-art professional standards of care. Measures current clinical practices in participating osteopathic family practice and internal medicine residency programs. Current clinical practices are measured and compared with evidence-based practice guidelines that represent state-of- the-art professional standards of care.

13. Overview Analyzes data abstracted directly from patient’s records to determine the current clinical practices of residents and the impact and effectiveness of residency program treatment protocols in meeting the present standards of practice for selected measurement sets and clinical indicators.

14. Overview The information collected can then be used to modify residents’ clinical behavior and teaching programs, thereby improving patient outcomes. Each program’s independent performance report can be compared to previous program reports allowing trending of performance over time. The information collected can then be used to modify residents’ clinical behavior and teaching programs, thereby improving patient outcomes. Each program’s independent performance report can be compared to previous program reports allowing trending of performance over time.

15. Overview CAP is a web-based program highly dependent on technology for information and exchange of data and reports.

16. Qualifying Patients

17. Before abstraction begins, patients that qualify to participate in the study are identified. This process includes narrowing the fields of medical records down using the parameters of the study period, the diagnostic criteria, patient inclusion and exclusion criteria, and sampling technology. Before abstraction begins, patients that qualify to participate in the study are identified. This process includes narrowing the fields of medical records down using the parameters of the study period, the diagnostic criteria, patient inclusion and exclusion criteria, and sampling technology.

18. Qualifying Patients Data is then abstracted from qualifying medical records and electronically transmitted to the AOA for analysis. Within 90 to 120 days, the residency program receives a performance analysis report. Data is then abstracted from qualifying medical records and electronically transmitted to the AOA for analysis. Within 90 to 120 days, the residency program receives a performance analysis report.

19. Qualifying Patients Over the course of the academic year, the residency program may compare their performance to national and osteopathic benchmarks. Each residency program can have an opportunity to discuss and share ‘best practice’ protocols with each other. Over the course of the academic year, the residency program may compare their performance to national and osteopathic benchmarks. Each residency program can have an opportunity to discuss and share ‘best practice’ protocols with each other.

20. Qualifying Patients Re-measure studies, as elected by the residency program, can be ongoing to enable trending of performance overt ime and assessment of the impact of interventions.

21. Participation

22. CAP is available to all AOA-accredited internal medicine residency and family practice programs, and participation is mandatory for both programs. The ACOI requires that its programs select at least two of the measure sets per year – Diabetes and Coronary Artery Disease. CAP is available to all AOA-accredited internal medicine residency and family practice programs, and participation is mandatory for both programs. The ACOI requires that its programs select at least two of the measure sets per year – Diabetes and Coronary Artery Disease.

23. Measure Sets

24. CAP will provide measure sets and selected clinical indicators for each of eight selected key clinical encounters. CAP is designed for primary care physicians, and focus will be on clinical practice indicators most often associated with outpatient care. CAP will provide measure sets and selected clinical indicators for each of eight selected key clinical encounters. CAP is designed for primary care physicians, and focus will be on clinical practice indicators most often associated with outpatient care.

25. Measure Sets A measure set is a generic or specific clinical diagnosis or grouping (e.g., coronary artery disease, immunizations, low back pain).

26. Measure Sets For each measure set, a collection of significant clinical indicators is selected for measurement (e.g., for the diabetes measure set, clinical indicators might be: “Did the patient receive a HgbA1c test in the past year, was a dilated retinal exam done in the past year, is the average HgbA1c below 9.5,” etc.)

27. Logging into CAP

28. In order to logon to the CAP program via the World Wide Web, use the following URL: http://www.do-online.osteotech.org/index.cfm In order to logon to the CAP program via the World Wide Web, use the following URL: http://www.do-online.osteotech.org/index.cfm

39. CAP Packets

40. Each packet includes: –Selecting Charts for CAP –Abstractor’s Guide –Pharmaceutical Appendix –Participant Survey Each packet includes: –Selecting Charts for CAP –Abstractor’s Guide –Pharmaceutical Appendix –Participant Survey

41. Selecting Charts for CAP

42. This is an overview document which provides a set of instructions to select charts for abstraction. There are two steps to the process. This is an overview document which provides a set of instructions to select charts for abstraction. There are two steps to the process.

43. Abstractor’s Guide

44. This is a nine-page guide for chart abstraction. It is organized in three sections: –Section One consists of information on how to access DO-Online and CAP for Residencis web pages. –Section Two consists of procedures leading to efficient selection of medical records for abstraction This is a nine-page guide for chart abstraction. It is organized in three sections: –Section One consists of information on how to access DO-Online and CAP for Residencis web pages. –Section Two consists of procedures leading to efficient selection of medical records for abstraction

45. Abstractor’s Guide –Section Three deals with actual abstraction of indicator information, entry of data into the abstraction tool screen and transmission of data to the AOA.

46. Pharmaceutical Appendix

47. Serves as an aid to those individuals interpreting and abstracting certain clinical data elements for CAP Measurement Sets.

48. Participant Survey

49. This is a Microsoft Word document which can be filled out on screen, saved, and then e-mailed back to the AOA, at this address: CAP@osteopathic.org This is a Microsoft Word document which can be filled out on screen, saved, and then e-mailed back to the AOA, at this address: CAP@osteopathic.org

50. Participant Survey This document will be made readily available on the Internal Medicine Residency Web Site when the CAP Program at MCH is underway.

51. End of Lecture This lecture will be made available at the MCH IM Web Site: http://IM.Official.WS This lecture will be made available at the MCH IM Web Site: http://IM.Official.WS