American Hospital Association Examines Value of CME: Champions Integrating Education With Quality Improvement; Performance-Based Programs

The American Hospital Association’s Physician Leadership Forum examined the value of CME to hospitals as a “strategic resource for physician-hospital alignment.” The report provides recommendations for how to improve the value of CME, including greater use of performance-based CME, more streamlined accreditation standards, broader sharing of best practices, increased communication between CME departments and senior leadership, and greater involvement of physician leaders as champions in CME.

View the full report: Continuing Medical Education as a Strategic Resource

According to AHA, in 2013, hospitals accounted for 35% of all CME activities and nearly 90% of locally accredited activities, reaching nearly 4.5 million contacts. More than 1,100 hospitals and health systems were accredited to provide CME in 2013, and they provided nearly 48,000 accredited activities.

In light of these numbers, the AHA asks: what do hospitals and health systems get for all of this CME investment?

“Historically, CME has focused on the sharing of medical knowledge rather than developing professional and institutional competencies that might be necessary to transform care, improve outcomes, and practice efficiently and effectively in the hospital setting,” the report states. “Today’s rapidly changing health care delivery system requires physicians and hospitals to partner to transform the delivery model, and CME, as an existing mechanism, can enhance and strengthen that partnership.”

To improve the value of CME as a strategic resource, AHA’s Physician Leadership Forum advises stakeholders to consider the following steps:

• Hospital associations should share best practices to increase adoption and explore partnerships with medical societies and others to increase awareness of CME.
• Hospitals and health systems should facilitate greater communication between the CME professionals, physician leadership, and organization leadership to improve CME offerings. Organizations should develop physician champions to drive engagement of the staff, and encourage the use of data from community health assessments to spur education on population health issues.
• The accreditation community should review accreditation standards for areas of improvement and simplification. For example, accrediting bodies should consider accreditation for smaller group projects that address current physician work. Hospital leaders also recommended using technology to streamline the accreditation paperwork burden.
• As health care delivery is changing, so to must the educational system. Greater use of performance-based CME, moving away from time-based activities, and increasing the diversity in accredited programs to adapt to the changing environment should all be considered.

Survey

During the Fall 2013 meeting of AHA’s policy development and governance groups, approximately 500 members were asked to share their views on the value of CME to hospitals, how it is currently being used, particularly to engage physicians in practice-based learning, and to identify challenges to its use. Respondents indicated CME was most effective in addressing medical knowledge and improving quality and patient care, but found it least effective in improving efficiency of physician practice, encouraging system-based care delivery and communication across the continuum, promoting team-based care delivery, and increasing physician engagement in the organization.

Quality Improvements

Members felt that hospitals should work to increase CME related to performance and quality improvement to enhance the full team’s understanding of the system aspects of improvement. According to the AHA report, a 2012 study found linkage of CME to quality and performance improvement among academic medical centers has increased from less than 10 percent to about 15 in the last six years, “but there is still much room for improvement.”

The report featured Scottsdale Healthcare as an example of a hospital which has created a quality curriculum for its residency programs that has driven interest across the medical staff. Scottsdale Healthcare uses CME to align physicians across the health care system and to drive performance improvement. The report also featured Lancaster General Hospital in Pennsylvania, which has had success integrating education with quality improvement and medical staff services at a community hospital. Efforts include a physician leadership development course that Lancaster’s CME department developed and implemented.

Performance Improvements

In 2012, hospital-based accredited CME activities were still over half didactic sessions while less than two percent of activities were formal performance improvement, the AHA report noted. The CME community is encouraged to consider increasing the use of performance improvement CME or other means to allow for activities where learning does not occur in measured credit hours. Improvement projects, just-in-time education, and other modes do not lend themselves to a time-based system to recognize educational outcomes, states the report. Opportunities to provide commensurate credit for these activities through different measurement mechanisms should be encouraged in hospitals and health systems.

AHA profiles the University of Utah School of Medicine, which is employing “Performance Improvement CME” or PICME for projects within the hospital, which allow credit to be granted not for hours spent, but for work to learn about specific performance measures, assess practice using the measures, implement interventions to improve performance related to these measures over a useful interval of time and then reassess their practice using the same performance measures.

CME For Transition to Practice

The report also encourages curriculums focused on transition to practice. Physicians completing residency move not only from student to practitioner, but often to different settings and practice from their training, states AHA. Health policy and economics, regulation, change management, and team based skills not necessarily emphasized in medical school and residency are required to thrive in practice. Members suggested that the medical education path consider a curriculum of structured learning for cementing these skills in early practice which could be integrated into the CME system.