opinion

PCPI: Physician-led effort improving quality of care

A message to all physicians from Ardis Dee Hoven, MD, chair of the AMA Board of Trustees.

By Ardis Dee Hoven, MD , an internal medicine and infectious disease specialist in Lexington, Ky., is president of the AMA. She served as chair of the AMA Board of Trustees during 2010-11 Posted July 19, 2010.

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Whether it is the time we spend talking with patients, the clinical data we use in decision making, or the tests and procedures we recommend, physicians strive to provide the best care possible for patients. We want to see more effective and coordinated patient care, improved clinical and patient-reported outcomes, more reliable performance and more cost-effective practices. But improving performance is not easy.

More than a decade ago, under the assumption that to improve something you must be able to measure it, the American Medical Association convened a group of doctors, in collaboration with several specialty and state societies, to develop measures to treat diabetes that we could use -- and count on -- to improve the quality and efficiency of care.

This initial collaboration showed that a physician-led, jointly developed, quantifiable approach to performance improvement offered benefits not only to physicians and patients, but also to the American health care system. And so the Physician Consortium for Performance Improvement was born.

Since then, the PCPI has become a recognized leader in the field of quality measure development.

Today, the PCPI has more than 170 members -- nearly all national medical specialty and state medical societies, health professional organizations, the Council of Medical Specialty Societies, the American Board of Medical Specialties and member boards, the Agency for Healthcare Research and Quality, the Centers for Medicare & Medicaid Services, private health plans, and experts in methodology and data collection. The PCPI also receives input from a purchaser/consumer advisory panel.

Because of the diversity of its members, the medical community has come to see the PCPI as a valuable resource -- a place to identify areas for improvement; develop clinically relevant, patient-centered measures; test measures in practice; provide coding and measure specifications for electronic medical record systems; and continually evaluate progress toward national goals.

More than 90 PCPI measures are endorsed by the National Quality Forum, an organization that sets and promotes attainment of national performance goals and endorses measures for public reporting. In addition, 68% of measures adopted by CMS for use in its demonstration projects and programs are PCPI measures. The PCPI also is working with the ABMS and specific member boards to facilitate measure development for board maintenance of certification programs.

Over the years, PCPI work groups have developed more than 270 measures across 43 different topics ranging from heart care to transitions in care. Now, so that physicians can play a lead role in reducing the rate of growth in health costs, we also are taking a close look at overutilization of services.

We are seeing large-scale quality improvement initiatives implementing PCPI measures and innovative strategies resulting in improved clinical processes and outcomes. As part of each measure set and through a forthcoming webinar series, the PCPI will share successful approaches to patient-centered performance improvement to spread this knowledge across the U.S. The next "Quality Improvement in Action" webinar is planned for late August on HIV/AIDS.

The PCPI recently completed several measure-testing projects. Among them was an HIV/AIDS project conducted under the auspices of the Alliances of Chicago Community Health Services LLC. The American Academy of Ophthalmology, Wisconsin Medical Society, University of Wisconsin Medical Foundation and MetaStar coordinated an eye care measures study. Another study to evaluate stroke and stroke rehabilitation measures was overseen by the American Academy of Neurology. The American Geriatrics Society, the Georgia Medical Care Foundation and the National Committee for Quality Assurance tested performance measures related to geriatric care.

Over the past decade, the PCPI has led in developing language and protocols that will integrate PCPI-developed measures into EMR systems. Today, with support from the NQF and the federal government, others are using this PCPI work as a foundation for developing a common electronic format for use by all measure developers.

Continuing medical education is another area that looks to the PCPI. When health care organizations and academic institutions offer CME programs with a performance improvement focus, they often include PCPI-developed measures. In fact, a 2008 survey of more than 250 such programs showed that nearly a third used PCPI measures.

For all its success, it is important to remember that the work of the PCPI is a constant challenge. Joining together to identify gaps in health care quality, develop and test measures, and facilitate broad adoption by the health care community is neither simple nor short term. However, it has been embraced by PCPI Chair Bernard Rosof, MD, and the consortium's members.

Since I have been involved with the PCPI, I am amazed at the expertise and commitment of individuals serving on the executive committee and work groups. PCPI is a shining example of what happens when physicians come together to improve outcomes for their patients and U.S. health care. The more I see and learn about PCPI, the more impressed I am.

In this, my first column as chair of the AMA Board of Trustees, I wanted to discuss something that is important, useful and of interest to all physicians. The PCPI is all of these things. If you are not involved in the PCPI, I urge you to get acquainted.

An AMA website offers many resources, including a list of the 270 PCPI performance measures available for implementation (link).

You, your practice and your patients will benefit.

Ardis Dee Hoven, MD , an internal medicine and infectious disease specialist in Lexington, Ky., is president of the AMA. She served as chair of the AMA Board of Trustees during 2010-11

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