Improving Clinical and Performance Outcomes for

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Improving Clinical and Performance Outcomes for Physician Practices and Their Patients in Ulcerative Colitis A Study of an Innovative Quality CME Model to Impact Patient Outcomes

Kathleen Moreo, RN-BC, BSN, BHSA, CCM, Cm, CDMS Laurence Greene, PhD PRIME Education Education, Inc Inc. Tamarac, FL © 2013 PRIME Education, Inc. (PRIME®). All Rights Reserved.

Coauthors Tamar Sapir, PhD Scientific Affairs Director of S PRIME Education, Inc. Tamarac, FL Katie Stringer, PhD Director of Outcomes Research T t l Therapeutic Th ti Management, M t Inc. I Total Kennesaw, GA Greg Salinas, PhD Director of Research and Assessment Services CE Outcomes, LLC Birmingham, AL © 2013 PRIME Education, Inc. (PRIME®). All Rights Reserved.

Study Objectives  To evaluate the impact of continuing education on:  Adherence to Physician Quality Reporting System (PQRS) measures for inflammatory bowel disease (IBD)  Quality improvement (QI) study  Knowledge, competence, and attitudes regarding quality measures and evidence-based guidelines for ulcerative colitis (UC)

American Gastroenterological Association. Adult inflammatory bowel disease physician performance measures set. http://www.gastro.org/practice/quality-initiatives/IBD_Measures.pdf © 2013 PRIME Education, Inc. (PRIME®). All Rights Reserved.

CMS Physician Quality Reporting p g System y  Reporting program with incentive payments for eligible li ibl physicians h i i  Quality measures developed by provider associations, i ti quality lit groups, and d CMS  Facilitates self-assessment and comparison with i h peers  2015: Payment reduction (1.5%) for providers who h do d not report measures in i 2013

CMS. PQRS. http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/pqrs/index.html © 2013 PRIME Education, Inc. (PRIME®). All Rights Reserved.

PQRS Quality Measures for Inflammatory y Bowel Disease  Assessment of IBD type, anatomic location, and activity  U Use off corticosteroid-sparing ti t id i therapy th among patients ti t documented d t d to t be b receiving a corticosteroid  Assessment of bone loss among patients on corticosteroid therapy  Receipt of influenza immunization  Receipt of pneumococcal immunization  Testing for latent tuberculosis before initiating anti-TNF anti TNF therapy  Assessment of hepatitis B virus status before initiating anti-TNF therapy  Receipt of tobacco use screening and cessation intervention

TNF = Tumor necrosis factor American Gastroenterological Association. The physician quality reporting system (PQRS). http://www.gastro.org.

© 2013 PRIME Education, Inc. (PRIME®). All Rights Reserved.

Overview of Study Methods p 1: Group GI physicians participating in QI study (n = 30)

Live activity: IBD quality measures and EBM

Pre-post differences in rates of adherence to quality measures

p 2: Group GI treaters participating in PRIME CME/CE activities (n = 542 12/16/2013)

Enduring activities: IBD quality measures and EBM

Pre-post differences in knowledge, competence, and attitudes

Post-control differences in knowledge, competence, and attitudes

© 2013 PRIME Education, Inc. (PRIME®). All Rights Reserved.

Chart Audit Methods  Identification of GI practices with high clusters of UC patients  We used the AMA Physician Masterfile to rank states with largest numbers of GI p practices to achieve geographic g g p representation p

 Screening of gastroenterologists for eligibility criteria  Final selection and contracting of 30 GI practices  300 charts were abstracted at baseline for PQRS measures and practice trends linked to evidence-based guidelines

© 2013 PRIME Education, Inc. (PRIME®). All Rights Reserved.

Study Timeline

© 2013 PRIME Education, Inc. (PRIME®). All Rights Reserved.

QI Study: Baseline Findings and a d Observations Obse at o s  Low rates of adherence to PQRS measures and practice guidelines  For 7 of 8 PQRS measures: 1% to 59% (mean = 36%)  Remarkable collegial interaction between participants and expert faculty  Gastroenterologists actively reflected on gaps and strategies for improving quality measures  Chart review data and pre/post learner assessment data provide id early l validation lid i off the h need d for f education d i in i quality improvement

© 2013 PRIME Education, Inc. (PRIME®). All Rights Reserved.

Documentation of UC Type (Severity), and Location, ocat o , a d Activity ct ty 60% 50%

50%

Adhe erence Rate e

40% 32%

30% 24%

20%

10%

0% Type ype (Mild, Moderate, Severe)

Location 1 Category (Distal, Extensive)

Activity (Active, Remission)

© 2013 PRIME Education, Inc. (PRIME®). All Rights Reserved.

Educational Impact of Enduring du g Activities ct t es Preto PostP t P t Activity Δ (%)

Outcome Domain Declarative Knowledge • Disease classification systems

37

Self-reported Understanding • Comparative efficacy and safety of UC medications • Quality measures for the management of patients with UC

15

Expected Improvement in Ability • Applying evidence in counseling patients about treatment options • Identifying patients at risk for nonadherence to UC medications

62

Clinical Competence • Treatment and management decisions based on case vignettes

21

N = 542 on 12/16/2013

© 2013 PRIME Education, Inc. (PRIME®). All Rights Reserved.

Challenges for QI Projects  Staying updated with rapid, ongoing changes in quality measures and initiatives  Collaborating with numerous partners  Accessing, abstracting, and analyzing quality measures  Addressing potentially negative attitudes about the value of documenting and reporting ti quality lit measures

© 2013 PRIME Education, Inc. (PRIME®). All Rights Reserved.

Next Steps  Follow-up chart audits 6 months after educational d ti l activities ti iti  Patient data analysis and individual benchmark reporting to gastroenterologists  Completion of learner survey and control analyses  Continued C ti d dissemination di i ti and d promotion ti off the th enduring activities to the greater community p of GI practices  Sharing results of the QI project in a mainstream GI journal with a goal to assist gastroenterologists newly engaged in required reporting © 2013 PRIME Education, Inc. (PRIME®). All Rights Reserved.

Questions?

© 2013 PRIME Education, Inc. (PRIME®). All Rights Reserved.