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November 11, 2014

“Continuing Medical Education” meets “Quality Improvement Education”

QIE

The Alliance for Continuing Education in the Health Professions is supporting an initiative to promote quality improvement programs through continuing education activities.

ACEhp members are invited to submit comments on the “Quality Improvement Education” Roadmap for the committees’ consideration until November 24, 2014. ACEhp will host a webinar this Friday, November 14, to discuss the Roadmap, provide feedback, and hear comments from colleagues.

We have featured an article written by Destry Sulkes, MD, MBA, Board President of the Alliance for Continuing Education in the Health Professions (ACEhp)

 

“Continuing Medical Education” meets “Quality Improvement Education”

Destry Sulkes, MD, MBA, Board President of the Alliance for Continuing Education in the Health Professions (ACEhp)

It’s no secret that a lack of coordination and continuity is a serious flaw in the nation’s health system. Even with electronic health records, an estimated 80 percent of serious medical errors involve some form of miscommunication.

As a healthcare education leader for over 15 years and current Board President of the ACEhp, it’s increasingly clear that continuing medical education (CME) must expand to all healthcare stakeholders, and focus more on the daily interactions among practitioners and their patients.

Until recently, CME and broader healthcare professional development has been very successful in helping us maintain competence, licensure requirements and to learn about new and developing areas of their field. Each profession and each medical specialty has outlined critically important updates in skills. But we’re realizing we have had our heads down too far. We’re missing the big picture.

“The Pennsylvania Project” is a perfect example of dramatic improvement in care made possible through an expanded focus on not just medical education, but a broader “inter-professional” education effort that focuses on National Quality Forum measures, in this case targeted to those at the center of the big picture – community pharmacists.

One in five prescriptions written are never filled, failing to improve patients’ health and reduce hospitalization. To address this problem, the project used the expertise and accessibility of pharmacists and care teams to keep patients on track in taking medications prescribed by their doctors.

The University of Pittsburgh School of Pharmacy trained care teams to screen patients to identify those at risk for missing or skipping medications for chronic conditions like diabetes, high-cholesterol, hypertension and heart disease.

This innovative “screening and brief intervention” approach, featured in the August 2014 Health Affairs, brought pharmacists and patients together to work through barriers like cost, side effects or silent symptoms that keep patients from taking medications as prescribed.

As part of “The Pennsylvania Project,” pharmacists access a cloud-based report card that keeps track of patient adherence by condition and compares rates to neighboring pharmacy patients. The monthly report cards spark conversations with patients who need more help with their medications. The patients are provided with more information about their medication and also have more interactions with their primary care physicians.

After a year, adherence rates significantly improved for all conditions tracked. An additional 1,500 patients in the project’s pharmacies started taking medications as prescribed to improve their health. This represents a 5% increase in adherence rates overall.

Non-adherence raises the risk for mortality from 12 to 25 percent for cholesterol-lowering statins and 50 to 80 percent for drugs that treat cardiac disease.  Medication non-adherence costs between $100 billion and $289 billion and 125,000 lives annually. A 1 percent improvement among Medicare patients is estimated to save the federal government $1.5 billion, according to the Congressional Budget Office.

We can no longer afford continuing medical education that operates independently of other healthcare professionals, patients, and quality improvement efforts. Bringing “quality improvement” and “continuing medical education” together is our “Eureka” moment in health care.

Pharmacists are an untapped source of patient engagement and quality improvement in health care. They train to get a doctorate in pharmacy and are uniquely positioned to see all the medications each patient is taking and all the practitioners who are prescribing them. It only makes sense for continuing education efforts to enlist pharmacists in quality improvement.

With the US healthcare environment in the midst of a refocus on results and outcome metrics versus quantity of services delivered, we have a great opportunity to bridge divides and forge a collective responsibility for better results. This new era of continuing education for health professionals creates new collaborations among healthcare stakeholders who haven’t traditionally worked together.

To jumpstart a more systemic focus on education’s role in quality improvement, ACEhp issued a Call for Comments on a Draft Quality Improvement Education (QIE) Roadmap. The QIE Roadmap will provide a vision for improving the quality of health care through continuous education of practicing health professionals. We see this as a prime opportunity for health education professionals and the practitioners they train to focus broad healthcare continuing education where it matters most – the daily interactions among and between health care providers and patients.

With so many new advances and discoveries being made in health care every day, continuing education for health professionals is one of the most challenging and critically important jobs. Now is a prime time to move from compliance-driven continuing medical education to performance-driven quality improvement education.  

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