Clinical Assessment Programfor Residencies

Jim Czarnecki, D.O.

Introduction

IntroductionIntroduction

• 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.

IntroductionIntroduction

• 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.

• 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.

Objectives

ObjectivesObjectives

• 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.

ObjectivesObjectives

• 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

ObjectivesObjectives

• 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

Practice Guidelines

Practice GuidelinesPractice Guidelines

Evidence-based practice guidelines are derived or authenticated by three sources:

1. Large, controlled, randomized clinical trials;

2. Observational scientific studies; and3. 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; and3. Consensus recommendations from a

panel of recognized experts in the clinical or research field.

Overview

OverviewOverview

• 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.

OverviewOverview

• 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.

• 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.

OverviewOverview

• 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.

OverviewOverview

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

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

Qualifying Patients

Qualifying PatientsQualifying Patients

• 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.

Qualifying PatientsQualifying 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.

Qualifying PatientsQualifying 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.

Qualifying PatientsQualifying 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.

• 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.

Participation

ParticipationParticipation

• 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.

Measure Sets

Measure SetsMeasure Sets

• 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.

Measure SetsMeasure Sets

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

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

Measure SetsMeasure 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.)

• 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.)

Logging into CAP

Logging into CAPLogging into CAP

• 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

CAP Packets

CAP PacketsCAP Packets

• 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

Selecting Charts for CAP

Selecting Charts for CAPSelecting Charts for CAP

• 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.

Abstractor’s Guide

Abstractor’s GuideAbstractor’s Guide

• 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

Abstractor’s GuideAbstractor’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.

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

Pharmaceutical Appendix

Pharmaceutical AppendixPharmaceutical Appendix

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

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

Participant Survey

Participant SurveyParticipant Survey

• 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

Participant SurveyParticipant Survey

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

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

End of Lecture

This lecture will be made available at the MCH IM Web Site:

http://IM.Official.WS