CME/QI Integration

CME Conference

Most hospital physician executives are involved with continuing medical education (CME). You are also involved in quality improvement activities. You should consider being a champion of CME/QI integration.

For physicians not actively involved in planning CME, it often seems straightforward: select a topic, identify a speaker, present a lecture and use a satisfaction survey to determine if the lecture was successful.

As anyone involved in producing CME for AMA Category 1 Credit understands, creating such activities should use adult learning principles. And it must comply with the requirements of the Accreditation Council on CME (ACCME).

Several requirements must be met:

  • Address a verifiable gap in knowledge, performance or outcomes
  • Present education in an appropriate format that addresses the gap as well as certain physician attributes
  • Measure whether the gap was closed
  • Demonstrate that the process was done in a manner free of commercial influence

The ideal educational activity would improve physician competence or performance, or patient outcomes. And, it would use the same method to determine both the initial gap and the resulting improvement.

Let me illustrate by providing two examples of CME in hospitals today.

  1. Legacy Process. The Internal Medicine Department makes a formal request to the CME Committee. Its members are interested in a half day seminar addressing the evaluation and treatment of congestive heart failure. Based on expert opinion, teh committee selects three subtopics. Then it assigns local faculty and plans the activity. Following its completion, each participant completes a written evaluation regarding the achievement of the objectives of the activity.
  2. Integrated Process. The QI Committee determines by reviewing its quality data, that its mortality and readmission rates for heart failure patients is higher than national averages. And rates have not improved in 2 years. It convenes a subcommittee to investigate further. The subcommittee identifies five or six processes that can be improved. With the help of the CME Committee, it develops and presents a series of lectures and written educational materials (called enduring materials in CME accreditation parlance). The two committees evaluate the effectiveness of the educational effort by monitoring the same mortality and readmission rates that led to the development of the activity.
CME/QI Integration in Teams


CME/QI Integration

Hospitals have been measuring and reporting quality data for decades. Outside entities, including CMS, have mandated the measurement and reporting of several quality measures. The list of measures is growing. Unlike medical education companies or publishing companies, which lack access to patient level outcome data, hospitals have been tracking these and other metrics for years.

It is time that all hospitals integrate its QI and CME efforts. This can be done by folding CME planning under quality, or by simply developing a more integrated process.

The Benefits

There are several benefits of CME/QI integration that will accrue to hospitals that take this approach.

  1. Patient outcomes will materially benefit from the focus on education and quality. There is something idealistic and personally fulfilling about measuring and improving actual patient outcomes. It may also be be necessary to measure process measures, such as the use of evidence based protocols. At times, physician competence may need to be assessed. But demonstrating improved patient outcomes satisfies a basic desire of physicians, administrators, boards and the public.
  2. The integrated approach simplifies CME accreditation for those that provide AMA Category 1 CME credit. Many hospitals devote a significant effort demonstrating compliance with  ACCME requirements of addressing bona fide gaps in competence, performance or outcomes. The integrated process uses existing data collection and reporting. It eliminates the use of perception of educational gaps. And it reduces the need to collect, sort and analyze written evaluations addressing “intention to change”, and pre- and post-tests.
  3. The hospital will achieve lower overall costs. The two departments will not be collecting and analyzing redundant information. And QI improvement efforts and CME planning efforts will be coordinated. Quality improvement staff will learn basic CME principles, and vice versa.
  4. External reporting by CMS, HealthGrades and others will improve. As a result, the morale and pride of hospital employees, physicians, board and community will climb. Finally, marketing efforts and finances will benefit.

The Challenge

Making this transition will require educating your medical staff, many of whom still think of CME under the old model. It may require structural change to the medical staff structure and hospital departmental structure. It will require re-educating members of the QI and CME Departments, or even shifting staff from one to the other.

In other words, it will take leadership.

Has your hospital already achieved this transition? If so, please comment on how things have changed. Has the transition been successful?