These slides are for information only

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These slides are for information only and are
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American Osteopathic AssociationTask Force on CME

• Advancing and Assessing
• Physician Competence
• Carol L. Monson, D.O., M.S., FACOFP

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The Osteopathic Profession in 2005 An Overview

• In 2005, there are over 56,000 Doctors of
  Osteopathic Medicine (DOs) practicing in the US.
• There are 20 Colleges of Osteopathic Medicine
  with an enrollment of nearly 10,000 students.
  Three of the colleges have branch campuses.
• The number of osteopathic graduates is on the
  rise. In 2005, the graduating class was over
  2,800.

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There are 18 Certifying Boards

• -Anesthesiology (AOBA)
  -Ophthalmology Otolaryngology
• -Dermatology (AOBD) (AOBOO)
• -Emergency Medicine (AOBEM) -Orthopedic Surgery
  (AOBOS)
• -Family Practice (AOBFP) -Pediatrics (AOBPD)
• -Internal Medicine (AOBIM) -Pathology (AOBPA)
• -Nuclear Medicine (AOBNM) -Preventive Medicine
  (AOBPM)
• -Neuromusculoskeletal Med -Physical Medicine
  Rehab (AOBNMM) (AOBPMR)
• -Neurology Psychiatry -Proctology (AOBPr)
  
• (AOBNP) -Radiology (AOBR)
• -Obstetrics Gynecology -Surgery (AOBS)
• (AOBOG)

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Certifications Issued

• Approximately
• 25,000 Primary board certifications
• 2600 Subspecialty (CSQs) and Added Qualification
  (CAQs) have been issued since 1939.

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Areas of Certification

• Primary areas of certification include
• Anesthesiology Neuromusculoskeletal
  Medicine
• Dermatology Ophthalmology
• Emergency Medicine Otolaryngology
• Family Practice Pathology
• Internal Medicine Pediatrics
• Neurology Psychiatry Physical Medicine
  Rehabilitation
• Nuclear Medicine Preventive Medicine
• Obstetrics Gynecology Diagnostic Radiology
• Orthopedic Surgery Surgery (General, Vascular)
• (Subspecialty and Added Qualification
• Areas can be found on AOA web site)

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Recertification

• The AOA is committed to the continual assessment
  of physicians through the recertification process
  
• Currently all 18 osteopathic certifying boards
  have a time-dated certification policy

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Recertification and CME

• The AOA believes in the continual assessment and
  improvement of physician competence and therefore
  requires that AOA diplomates complete 120 credit
  hours of Continuing Medical Education for every
  three-year cycle
• A minimum of 50 credit hours in the specialty is
  required, though some specialties do have higher
  requirements

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An Overview of the AOA CME Program

• Created 1973
• Appointed a Council on CME to structure, process
  and governance
• Established at the direction of the AOA Board of
  Trustees
• Used by all osteopathic physicians who are AOA
  members. (Limited sources to non-members)

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How CME System Links to Accreditation of
Organizations

• Provides accreditation to the following AOA
  affiliated organizations such as
• AOA accredited Colleges of Osteopathic Medicine
  (20 COMs 3 branch campuses)
• AOA affiliated specialty colleges
• AOA nonpractice affiliates, alumni groups, AOF,
  DOCARE International, and foundations
• AOA affiliated divisional societies
• AOA accredited healthcare facilities (HFAP)

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Definitions and Examples of Categories

• Category 1-A Formal educational programs
  designed to enhance clinical competence and
  improve patient care.
• These programs must be sponsored by an
  AOA-accredited Category 1 CME Sponsor.
• Examples
• Formal educational programs sponsored by
  AOA-accredited sponsors
• Osteopathic medical teaching
• Approved standardized life support courses

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Definitions and Examples of Categories

• Category 1-B Less formal CME programs.
• Examples
• Publications, inspections, examination and
  committee work
• Osteopathic precepting
• Certification credit (recertification/CAQ)

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Definitions and Examples of Categories

• Category 2-A Formal educational programs that
  are ACCME accredited, AAFP-approved, or program
  sponsored by AOA-accredited Category 1 CME
  Sponsors
• Examples
• Formal educational programs
• Risk management and managed care programs
• Bioterrorism programs

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Definitions and Examples of Categories

• Category 2-B Less formal non-osteopathic
  programs
• Examples
• Journal-type CME on the Internet
• Home study
• Risk management programs (administrative in
  nature)

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Definitions and Examples of Categories-Exceptions

• Category 1-A/1-B credit could be approved by the
  AOA Council on Continuing Medical Education
  (CCME) for ACCME or AAFP accredited specialty or
  subspecialty programs if there are no equivalent
  courses available within the osteopathic
  profession.

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The Purpose of the Credit System

• The emphasis of AOA CME leans more toward formal
  education at this time.
• The assessment component is growing and we
  expect the Core Competency movement will
  influence AOA CME and assessment.

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The Core Competencies

• These Seven Core competencies have been mandated
  by the AOA Council on Postdoctoral Training
• Medical Knowledge
• Osteopathic Philosophy and Osteopathic
  Manipulative Medicine
• Patient Care
• Professionalism
• Interpersonal and Communication Skills
• Practice-based Learning
• Improvement and Systems Based Practice

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Osteopathic Continuous Certification

• Will vary within the various specialties and
  will be dependent on the decisions of the
  respective specialty colleges and specialty
  boards.
• Choices may include
• Module System (such as MOC)
• Clinical Assessment Program
• Certified CME

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The AOA Clinical Assessment Program (CAP)

• The Clinical Assessment Program (AOA-CAP) is a
  quality improvement tool for physicians in
  training and practicing physicians to evaluate
  the safety of their patient care in the
  ambulatory setting
• This type of program introduces physicians to
  active participation in quality improvement
  activities while still in their graduate medical
  education training

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The AOA Clinical Assessment Program (CAP)

• The AOA-CAP developed several guiding principals
  for the program, including
•   The use of information technology to drive the
  program
• This resulted in the development of an
  AOA-supported, Web-based architecture providing
  key components to participating programs and
  physicians

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The AOA Clinical Assessment Program (CAP)

• The National Standards used for this AOA
  effort include
• the NCQA Health Employer Data and Information Set
  (HEDIS) measures
• Center for Medicare and Medicaid Services (CMS)
• Doctors Office Quality Initiative (DOQ)
• Joint Commission on Accreditation of Healthcare
  Organizations (JCAHO) core measures.

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The AOA Clinical Assessment Program (CAP)

• The AOA-CAP is offered as a voluntary program to
  primary care physicians
• CAP topics are organized around clinical
  conditions, such as diabetes mellitus or
  hypertension, as sets of measures pertinent to
  the conditions
• The AOA Bureau of Osteopathic Specialists (BOS)
  is currently reviewing the ability of this
  program to be adapted to all AOA specialties

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AOA CAP Quality Improvement System Powered by
CECitys MedConcert QI Platform
Enter Chart Data for Initial Patient Chart Review
Performance Assessment
Submit for Credit
Assess Performance
Re-assess Performance
Enter One or More Benchmarks to Compare User
Results vs. Benchmark Data vs. Peer Data
Build and Implement Action Plan
Second Chart Review
Lag Period (3 Months)
Action Plan

• Suggested Interventions
• User-Directed Interventions

Including eCME via www.do-online.org
Action plan displays the detailed intervention
information along with any resources to support
it.
DO -Online CPD Center
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AOA CAP QI System Personalized Home Page
Personalized Home Page Upon Login, Each Member
is Presented with Their Personal Home Page One
or more modules can be accessed
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AOA CAP QI System Program Introduction
Practice Assessment
Step 1 Review Module Overview Learning
Objectives
Step 2 Practice Assessment
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AOA CAP QI System Baseline Patient Chart
Abstraction
Step 3 Baseline Patient Chart Abstraction
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AOA CAP QI System Baseline Practice Performance
Assessment
Step 4 Assess Performance Present User
Data Vs. One or More Benchmarks for
Comparison Vs. Peer Data
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AOA CAP QI System Build an Actionable
Improvement Plan
Step 5 Build Implement Improvement
Plan Select Suggested Interventions Based on
Performance Assessment and/or Practice Assessment
Results
Action plan displays the summary detailed
intervention information plus instant access to
associated resources (e.g. add CME to Curriculum)
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AOA CAP QI System Cycle 1 Chart Abstraction (3
month lag)
Step 6 Follow-up Patient Chart Abstraction and
Review
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AOA CAP QI System Cycle 1 Practice Performance
Assessment
Step 7 Re-Assess Performance Present User
Data Baseline vs. Follow-up Vs. One or More
Benchmarks for Comparison Vs. Peer data
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AOA CAP QI System CAP Module Completion and
Credit
Step 8 Module Completion Review Action Plan
Before Submission And Apply for AOA CME Credit
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The AOA Clinical Assessment Program (CAP)

• The CAP Process
• Incorporates continuous quality improvement into
  graduate medical education and the practice of
  osteopathic medicine, and
• Allows the physician to do self-assessment of his
  or her medical practice skills

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CAP and Board Certification

• AOA-CAP includes
• Heavy emphasis on quality measurements and
  quality improvement
• CAP measurements of quality could be a component
  of board certification and recertification

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Clinical Assessment ProgramObjectives

• To offer residency programs assistance in
  establishing and implementing protocols and
  procedures to improve clinical practices
• 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 a perpetual program of assessment
• To provide near-real-time quality assurance tools
  for residency programs

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Clinical Assessment ProgramObjectives

• 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 weaknesses in each
  programs curriculum
• To provide osteopathic and national benchmarks to
  evaluate performance
• To identify where quality-of-care improvements
  can be made in AOA accredited residency program

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Clinical Assessment ProgramCurrent Available
Modules

• Coronary Artery Disease
• Diabetes Mellitus
• Womens Health
• Low Back Pain

• Childhood Immunizations
• Hypertension
• COPD
• Asthma

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Clinical Assessment ProgramExample

• Coronary Artery Disease Measure Set (CAD)
• Description of Indicator
• Aspirin use in ideal patients
• Smoking cessation advice
• LDL level - Treatment to goal
• Beta Blockers use in ideal patients

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Clinical Assessment ProgramExample

• Coronary Artery Disease Measure Set (CAD)
• Ace Inhibitors/ARB use in ideal patients
• Warfarin - Efforts to reduce stroke in atrial
  fibrillation patients
• Screening for Depression
• Osteopathic Assessment of Patient

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Clinical Assessment ProgramExample

• Diabetes Mellitus (DM)
• Use of glycosylated hemoglobin (HgbA1c)
• Frequency of Foot exams
• Screening and treatment of microalbuminuria
• Assessment and control of hyperlipidemia
• Assessment and control of hypertension

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Clinical Assessment ProgramExample

• Diabetes Mellitus (DM)
• ACE Inhibitor use for hypertension
• and/or proteinuria
• Vaccinations
• Osteopathic Assessment and Treatment

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Clinical Assessment ProgramExample

• Women's Health (WH)
• Cervical Cancer Screening
• Breast Cancer Screening
• Chlamydia Screening
• Osteoporosis Screening Treatment
• Osteopathic Assessment of Patient

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Continuous Professional Development(CPD)

• Provides
• On-Line CME Opportunities
• Curriculum Tracking System
• View of Activity Status
• Addition of Other Activities
• Foundation for Lifetime Learning Portfolio

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AOAs DOCMEOnline CPD Center - Home Page
Keyword Category Search provides Immediate
location of highly indexed programming
Easy to use tab navigation to Members CME
account information
Seamless Login between AOAs DO-Online.org
website and the CME Center
Seamless Integration w/ AOA CAP QI System
Spotlight Page Provides Quick Direct Access to
New and Upcoming Activities
Integrated Access to AOA Affiliate CME Programming
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AOAs DOCMEOnline CPD Center My CME Profile
My CME Profile Provides Snapshot Overview of the
Members Personal CME Portfolio
Course Overview Provides a Roll-up of the
Members active curriculum progress
Licensure Tracking Tool Allows users to track
their licensure period across one or more states
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AOAs DOCMEOnline CPD Center My CME Courses
My CME Courses Provides Curriculum Tracking
System that Bookmarks Activities Selected
Members can Add activities to their CME Course
Curriculum From 65 Points Throughout the CME
Center

• My CME Courses allows members to
• View activity status
• Number of attempts remaining
• Rate Programs
• Bookmark Activities

Serves as the Foundation for CPD and Lifetime
Portfolio systems

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AOAs DOCMEOnline CPD Center My CME Activity
Report
My CME Activity Report Provides Seamless Access
to the AOA Member CME Record System Plus instant
access to Certificates earned online
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Questions

• Do you think that new Pay for Performance (P4P)
  system overrides the need for Maintenance of
  Certification (MOC) or CAP type programs?
• ____ Yes
• ____ No
• ____ Other
• 2. How are your CME program sponsors awarding
  credit for MOC?
• ____ By module completion set equally for each
  module
• ____ By specialty recommendation based on module
  differences
• ____ Other _____ Will not award CME
• 3. The CAP program is completely a physician
  self-assessment program, would you consider AOA
  CAP completion for CME category 1 or 2.
• ____ Category 1
• ____ Category 2
• ____ No CME award