I. Welcome and Background
American medicine is under increasing societal pressure to improve the quality, value, and safety of the care that we deliver. The development of the concept of Maintenance of Certification (MOC) by the American Board of Medical Specialties (ABMS), and the recent adoption of Standards for Maintenance of Certification 2015 by the ABMS are manifestations of this societal interest that physicians engage in ongoing self-assessment and lifelong learning. The intent of the ABTS MOC Program is to provide ABTS diplomates with a robust mechanism for continuous professional development and practice quality improvement (PQI). The PQI initiative is a framework to facilitate improvement of thoracic surgical care and/or its delivery as an individual or as a group. Part IV of MOC encourages and provides a vehicle for cardiothoracic surgeons to demonstrate their engagement in improving the care of the cardiothoracic surgery patient.
The ABTS MOC Part IV program allows multiple pathways for diplomates to meet the requirements set forth by the ABMS. These include activities at the individual surgeon, individual practice, institutional, or regional collaborative level. It is anticipated that many institutionally mandated quality improvement initiatives will also qualify for MOC Part IV. The intent of the ABTS MOC Part IV program is to encourage our diplomates to take part in a meaningful and valuable exercise that will benefit both the diplomates and their patients by improving the quality, value, and safety of the care that is delivered.
II. Learning about PQI
Practice quality improvement (PQI) efforts are intended to engage diplomates in the application of quality improvement principles to improve important aspects of their practice. The Institute of Medicine discusses 6 aims for changing the healthcare system that include a safer, more timely, more efficient, more effective, more patient centered, and more equitable care provided in the framework for PQI projects. The intent of the ABTS is to recognize a variety of PQI projects directed toward achieving one or more of these goals as qualifying for the MOC Part IV requirement.
ABTS believes that the best way to begin individual participation in MOC Part IV is to learn about the rationale for its inclusion in MOC, the goals of PQI efforts, and how to choose and complete a PQI project. A good place for a new MOC participant to start is by reviewing the following pages on the ABMS website, including the reference list for ABMS Part IV.
Another useful link to healthcare quality improvement are: http://onlinelibrary.wiley.com/doi/10.1002/chp.21201/abstract
III. Choices of PQI Participation Pathways
To allow diplomates PQI opportunities that best suit their particular needs and practice situations, the ABTS will recognize 3 different pathways for participation in Part IV of MOC: individual PQI, group PQI, institutional/organizational PQI.
IV. PQI Participation Requirements
With the newest implementation in 2015 of Continuous Certification (MOC), diplomates must have completed at least one PQI project in the previous 2 years at both the 5 year and 10 year milestones during their MOC cycle.
Each PQI project includes certain required elements, which are outlined below. Documentation and record-keeping are also important components. Under usual circumstances, these documents will not be submitted to the ABTS. However, because a percentage of MOC participants will be audited each year, each diplomate must retain all source documentation for each PQI project in case he or she is selected for an audit. These records include, but are not limited to, the following:
- Title of project
- Initial measurements made
- Data analysis performed and conclusions reached
- Action plans for practice improvements implemented
- Result of repeat measurements and analysis
- Paragraph of narrative self-reflection on the impact of the project, written after completion
V. PQI and the PDSA Process
PDSA stands for “Plan – Do – Study – Act,” a 4-step process commonly used for continuous quality improvement. This simple, but powerful, tool may serve as the basis for an action-oriented repeating process by linking multiple PDSA cycles repeated in sequence. An initial cycle is performed to obtain baseline data, followed by subsequent cycles performed to assess the effects of the implemented quality improvement initiatives. PQI participants should be familiar with this process.
An area of your practice judged to be in need of improvement is identified, and a measure is devised to assess the degree of need. A plan is developed to implement the measure and obtain the required data. Finally, a target or goal for the measure to be reached is set.
Your plan is set in motion, and data are collected.
You determine how well your measure compared to the desired goal. Root causes for lacking goal achievement are explored.
You consider what can be done to address the root causes and develop an improvement plan to implement in the next PDSA cycle.
*The ABTS would like to thank the American Board of Radiology, whose MOC format was used in part to create our current website.