>>SINGER: Hi, I’m Steve Singer I’m the Director of Education and Outreach at the Accreditation Council for Continuing Medical Education.
>>KENNISON: Hi. I’m Rick Kennison President and General Manager of Peer-Point in Evanston, Illinois.
>>SINGER: Rick, nice to have you here.
>>KENNISON: Thank you, Steve. It’s a pleasure to be here today.
>>SINGER: So, tell me a little bit about the organization that you work with.
>>KENNISON: OK. Well currently I’m the president of Peer-Point up in Evanston, Illinois and what we primarily focus on is performance improvement as well as quality improvement initiatives. We took a change in a business model about three years ago, where we were primarily producing activities that were founded in traditional CME values. And we did a lot of Web conferencing, we did a lot of live meetings, we did a lot of activities, but we really were looking at, at providing more support for our mission statement. So, we converted our entire business model to a performance improvement organization.
>>SINGER: OK. So, when you talk about performance improvement I know that, that, that many CME providers sort of look in a very specific way, you know, there’s something that they think of when you say performance improvement they may think of the American Medical Association’s performance improvement CME, which is sort of a structured improvement model; but I also know that, that in terms of you’re organization the way that you reoriented your organization that you have gone from being sort of a CME production house to being a facilitator of change. So, help me cast the performance improvement sort of topic in terms of a range of things that you do.
>>KENNISON: We really had to put change front and foremost for the providers. And by using the AMA strategy as a foundation, as a backbone we knew that we were going to be able to be compliant in terms of what we were offering as a product, but we also realized it didn’t necessarily go far enough. Because if you look at some of the, the ABC structure there are certain gaps in there that really need to be filled. And we try to address those gaps by providing additional components to our activities to make sure that they are providing value to our participants at the end of the day. And so, it was a complete and utter change of what we’re traditionally used to. You know, so many different things that, that we currently do came not only out of the CME arena as well as the healthcare improvement arena, but we also looked at what many governmental organizations were doing. We worked with the QIOs. We worked with many medical societies, medical associations. So, we really tried to take a piece out of what everybody is doing and bring it together to form the overall activity.
>>SINGER: OK. So, let’s, let’s take sort of one deep slice and look at a particular healthcare or quality gap that you’re address and sort of follow it through with, with some of these interventions that you’re talking about.
>>KENNISON: OK. We’re currently finishing up an initiative right now that looks at patient adherence. You know, for years there’s been CME dedicated to how to improve patient adherence as this relates to particular drug therapies. But, one of the things that we found out through our needs assessment that it really wasn’t so much a problem with physician performance they’re, they know that their patients need to take medications in order for the medications to work. And so what we wanted to do is really to try to determine what the gaps and needs were associated with the reasons and the rational why patients were taking their medications. We realized a lot of the needs are actual barriers. You know, they’re, the patients may not have insurance, they have problems communicating with their provider or they may have problems understand what the medication is for as well as their disease state. So, one of the initiatives that we came out with was to try to address all of these, these obstacles and barriers from the patient side of the coin. And what we really were trying to focus on were things such as: what are the perceptions of the healthcare provider with patients in terms of what their knowledge base is, what their understanding is regarding their disease state as well as are there other barriers and obstacles within their own private lives that are preventing them from maintaining good adherence. So, what we were able to do is come up with very nice quality improvement plan that focused in on how to address these barriers in a moving practice. And so, some of the components and some of the resources that we provided were informations on how physicians and other providers can receive communications or translations in service for patients that don’t speak English as a primary language.
>>SINGER: So, let me back up for a second. I’ve been tracking with what you’ve been describing. You’re talking about what we would call a quality gap, which is that and what clinical discipline was this?
>>KENNISON: This was in primary care.
>>SINGER: OK. In primary care. So, that there is a healthcare outcome or a healthcare benefit, which is lower than what would be expected, because patients are not adhering to a recommended course of therapy.
>>KENNISON: That’s correct.
>>SINGER: OK. So, that’d sort of the quality gap and then from that you’re finding that, you’re really doing a root cause analysis to understand well what, how’s the physician or the professional or the practice team factor into that outcome? Or what could they do to change that outcome?
>>SINGER: And I just wanted to clarify you said in a practice setting so this is primary care small offices did you
>>KENNISON: this was both hospital-based as well as private practice.
>>KENNISON: physicians that were participating in it. But, you’re absolutely right in terms of the, the root cause analysis. One of the things that we do when we design our activities is almost come up, we almost design all of our activities like it’s a clinical trial. Where we form a hypothesis: if we change variable X, we expect to see this result. And so, by finding out truly what the quality gaps were we’re able to laser in on those and address then accordingly.
>>SINGER: OK. So, so coming back to what you were describing you have sort of a, the hypothesis, and then, you’re approaching the care team, you said a working practice, I’m, I’m anticipating sort of how you got in the middle of this sort of complex process.
>>KENNISON: I think, we’re very fortunate in that we have a lot of thought leaders that can assist us in trying to get the inner workings of the practice. What are the perceptions? We also, went a step further and did a couple of other things. First we took a survey, you know, once we figured out the, had a suspicion as to what quality gaps were we did a physician survey of 2,000 participants and to find out and to confirm that. You know, so that we could once again
>>SINGER: this is confirming the obstacles or the attitudinal
>>SINGER: issues that are sort of in between current practice and best practice?
>>KENNISON: Absolutely. But, by using the needs assessment as a tool we were really able to determine and, and which are the top 10 that we want to confirm etcetera and so, we were able to do that by survey and through partnerships as well as through multiple discussions then activities. We even went a step further with participants as they registered for the activity that of having them go through a psychometric assessment. So, what we really tried to do is to determine what the perceptions and what the practices were for each of our participants were. So, we could determine where their quality gap actually lies, if they do have a quality gap. And if you take the literature that’s out there, most healthcare professionals overestimate the competence of their practice. And so, by asking them very straight forward and honest questions we can also determine where their own individual quality gaps lie, so we can target them more appropriately.
>>SINGER: OK. So, you prepared them to learn and then what did you do what was the, what was the intervention?
>>KENNISON: The intervention was primarily focusing in on, having, doing, you know, we going if we followed the AMA stages we first had the do a baseline assessment of a number of patients. We had a minimum of 10 patients per participant. And this one is a little bit different from what we’re used to in that we actually allow chart poles for the participant to obtain the identified patient information so they could submit it to us so we could do a true baseline, nonbiased assessment as to
>>SINGER: what’s the current practice? What are they currently doing? What it looks like
>>KENNISON: what it looks like, exactly, what’s the status quo? Where are the gaps? What do they need to focus on? How are their patients doing? Are we noticing trends in their patients? Which is very evident once you get tremendous amounts of patient data in. The next step that we did was we provided educational interventions that were both essentially global as to here’s what most people are feeling are the real causes to patient adherence or lack of patient adherence in the medical community. All the way down to you know, what I can do as an individual for my patients based on my practice environment. And we had, we had participants basically determine which of those or the highest need with in their practice to incorporate those for a period of time. To work with patients, to teach patients, you know, not only about the disease state, but about the medications that they’re receiving and then follow up with a, you know, couple months down the road with another data collection where we ended up looking at what was the patient adherence over this period of time? Did they have any secondary events? You know, that could have been prevented perhaps, by the use of medications and increased adherence. What we found were data that supported the fact that with laser sided approaches that were geared toward individualized patients or patient groups that we were able to increase patient adherence. And we were able to do this through two primary methods. Number one were, was that we were able to assist the participant in having the proper discussions, having the proper tools and resources in front of them so they could confront concerns that they may have over adherence and be able to address them directly. The second area that we found that we had a significant impact on patient care was, was that we were able to show a statistically significant improvement in the knowledge base of the patient regarding their disease state as well as their medications that they were taking.
>>SINGER: And you had seen that as one of those root causes of their not adhering?
>>SINGER: That their ignorance about the disease or their ignorance about the benefits of the treatment was a reason why they might not have adhered to the regimen?
>>KENNISON: Absolutely. I think when you take the healthcare system as a whole when physicians barely have enough time to come and do a history and physical find out what’s going on education kind of falls by the waste side, patient education falls by the waste side. And so, being able to take a couple minutes out or give them a patient based tool where they can learn about it on their own really seemed to increase adherence in this group of about 700 patients. One of the biggest benefits that we noticed, however, and keep in mind that we’re still collecting data on this initiative, was that there was, there was a 100% reduction in, in secondary events in this small sample size. Now this was only over a two month period so, yes, the timing is short and yes, the sample size is short, but what we’re able to statistically show was that in comparison from the baseline period where events seemed to be high we were able to reduce them, or we hope that the education we provided was able to assist the patients in their adherence which in turn prevented them from having secondary events.
>>SINGER: Right. And it’s interesting from what you’re describing you, you know, it’s beneficial and certainly deserving for you to claim that success as your own, but in the at the same time there’s a whole complex process, complex team
>>SINGER: care process, there’s all the complexities of the patient and whether it’s coverage or access or their knowledge and adherence you’re probably moving several things at the same time? So, the benefit may not be just due to a single intervention and may be a little bit of luck, but it’s certainly a trend in the right direction, and you know, so congratulations on that.
>>KENNISON: Thank you, Steve. I think, but to your point I think you’re absolutely right I think we have moved past the mentality that one participant equals one learner. And I believe that CME in order to be successful in the future has to really look at a coordinated care team. It really needs to look at all the players. It needs to look, you know, from everybody from the physician all the way down to the person answering the phones. Because if we don’t address those or at least have components of being able to determine their efficacy and placement within a particular system it really causes more variance and more inefficiency as it goes on. And so, I think that’s one thing that’s kind of a takeaway is just don’t focus on one participant equals one learner.
>>SINGER: So, you’ve really taken this improvement model or sort of positioning your organization, as a medical education company for profit company, as a change agent using CME as a tool to achieve some very dramatic change not only in, in practice team behavior, but also in some patient outcomes, some patient impact. One question I have for the people who may be listening is that if there not for profit, medical education company, or may not have the flexibility or the resources to do what you’re doing what are some suggestions you would have for them as to how they could start being, sort of practice focused on change?
>>KENNISON: I think that’s a very good question, Steve. I look back at some of the early initiatives that we focused in on and at that time I think one of the biggest draw backs that we were shooting for the moon on everything. We wanted to solve all the world’s problems in one initiative. And one of the things that I tell people all the time is, start small, smart, start with what you can handle, and maybe that’s one measure. You know, there’s nothing wrong with doing just one measure. If your needs assessment shows that there’s a quality gap in obtaining a particular blood test for instance, at your institution. Then you can come up with a very easy program or initiative where you can really focus in and laser sight your attention towards that. Don’t think that in some of the basic PI and QI activities that you’re planning on doing that you need to have everything. You know, we’ve done it over a period of years, s, we have statisticians, we have outcomes people, we have folks who can really almost gauge where the performance measures are going to take us. But, not everyone needs that and especially if we’re looking at smaller providers the important takeaway is: do what’s best for your situation. If it’s your needs assessment and or if it’s your objectives in your association or your society then focus in on that. And you can do it very cheaply and you can do it very simplistically. But, you just can’t lose focus of it. And the only ways that you’re going to be able to grow in this arena is to go out and take the leap. And so, there’s a lot of opportunities out there in terms of funding that are currently available. Some of the, some of the stimulus packages from the government are looking at performance improvement. They’re not really calling it performance improvement; what they’re looking at is healthcare improvement opportunities. And so, so look at the governmental Web sites. See what going on there, find out what kind of resources are available. And collaboration, a partnership, you know, in these situations is incredibly vital. I know for myself, you know, I’ve had multiple conversations with people across the country that are saying, you know, I really need to do this or I’d really like our institution to focus on this. And so, I think many of us, who have experience in this arena more than willing to talk to you and assist you in anyway that we can in terms of getting this program off the ground with limited resources.
>>SINGER: Thanks for joining us, Rick.
>>KENNISON: I appreciate it, thank you for your time, Steve.
This is a transcript of CME Designed to Impact Patient Outcomes).
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