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Pediatricians’ Participation in Quality Improvement at the Time of Enrollment in MOC

Pediatrics, Volume 142, Number 5, November 2018

Quality Improvement has become a priority for the training and accreditation of health professionals and the facilities in which they work. Survey respondents reported the extrinsic requirement to maintain board certification as the dominant motivator for QI involvement, followed by 2 intrinsic factors:  identifying gaps in practice/implementing change and an opportunity to collaborate with others.

This publication reports the proportion of pediatricians annually participating in QI efforts, the motivations to engage in QI, beliefs about QI, perceptions of workplace support for QI, and self-confidence in QI skills. The document notes that despite almost 2 decades of national attention to the quality of healthcare and efforts to embed continual QI in healthcare delivery activities, ~1 in 5 nonacademic pediatricians and 1 in 10 academic pediatricians did not report participating in any QI activities in the previous year.


Perspectives on Quality Improvement Collaboratives Effectively:  Qualitative Findings from the CHIRPA Quality Demonstration Grant Program

The Joint Commission Journal on Quality and Patient Safety 2018; 44:12-22

The most frequently pursued intervention in the 18-state Children’s Health Insurance Program Reauthorization Act of 2009 (CHIRPA) quality demonstration was quality improvement collaboratives, which 12 states offered to more than 300 primary care practices. A study was conducted to identify which aspects of these collaboratives were viewed by organizers and participants as working well and which were not. In this study, interviewees widely praised offering Maintenance of Certification or Continuing Medical Education credits – which provided “a big hook to bring in physicians” because physicians are required to earn (and usually pay for) such credits at regular intervals.


ABMS, State Medical Societies and Specialty Societies Meet to Address Concerns about MOC

In early December 2017, the American Board of Medical Specialties (ABMS) met with members of the Council of Medical Specialty Societies (CMSS), the Specialty Society CEO Consortium (S2C2), and state medical societies to discuss the Maintenance of Certification (MOC) programs of its Member Boards.  The meeting focused on the critical issues and concerns that physicians have raised about MOC, what the ABMS Member Boards are doing to resolve these concerns, and how these organizations can work together to create a future, continuing Board Certification program that is relevant and valuable to all of our stakeholders, especially to Board Certified physicians and the patients they serve.


A Study of Perceived Effectiveness of Part 4 Maintenance of Certification

Hospital Pediatrics. November 2017 Volume 7, Issue 11

A new physician survey was piloted to determine if Part IV Maintenance of Certification participation improves perceived educational and clinical outcomes.  The online survey, MOC Practice, Engagement, Attitude and Knowledge Survey (MOC-PEAKS) developed by Seattle Children’s Hospital, was administered in 2015 to participating physicians.

The article notes that although many physicians embrace the concept of MOC, the Part IV MOC exercise still draws strong criticism. Critics assert that many of the projects are poor learning exercises, are not relevant to their practice, do not improve outcomes for their patients and are too expensive, time consuming and administratively focused. This study was designed to assess perceived educational and clinical outcomes and specifically measure changes in physicians’ perception of engagement and attitudes about QI and MOC, their ability to apply QI methods and the impact of their Part IV MOC activity on patient care. The results demonstrated that MOC Part IV is meeting some of its major educational goals: physicians reported significant improvement in their engagement and attitude about QI and MOC, their perceived ability to apply QI methods after participating, and the perception that their MOC activity would lead to lasting improvement in patient care. MOC-PEAKS demonstrated that a pediatric hospital-based MOC program can operationalize an effective and rewarding Part IV MOC experience.


ABMS Launches Continuing Board Certification: Vision for the Future

CHICAGO, IL – September 25, 2017 – The American Board of Medical Specialties (ABMS) and its 24 Member Boards have launched a major initiative, “Continuing Board Certification: Vision for the Future” (Commission). A collaborative process, the Commission will bring together multiple partners to vision a system of continuing board certification that is meaningful, relevant and of value, while remaining responsive to the patients, hospitals and others who expect that physicians specialists are maintaining their knowledge and skills to provide quality specialty care.


Attitudes and Experiences of Early and Midcareer Pediatricians With the Maintenance of Certification Process

Acad Pediatr. 2017 Jul; 17(5):487-496.

Pediatricians expressed significant frustration with the MOC process, poor understanding of requirements, and barriers with the process, especially for part 4. Increasing diplomate education on the process and increasing available and relevant activities may be important to optimize physician’s continuous learning.


Maintenance of Certification Part 4: From Trial to Tribute

The Journal of Pediatrics, Volume 185, Pages 4-5.e1, June 2017

Many physicians at the Children’s Hospital of Philadelphia (CHOP) paid fees for online performance improvement modules that were based solely on their own practice and were often considered “busy work” with both financial and time burdens. To meet the growing need for locally meaningful QI activities and the internal requirements for physicians to maintain board certification as a condition of practice, CHOP became a Portfolio Sponsor. By 2016, after being a Portfolio Sponsor for several years, 55% of eligible physicians participated in MOC at CHOP.

The CHOP program has reduced “busy work” through participation in stand-alone online performance improvement modules while filling the need for physician participation in existing local improvement opportunities.


Improving HPV Vaccination Rates Using Maintenance of Certification Requirements

Pediatrics, Volume 137, Number 3, March 2016

Many pediatricians are now required to participate in the American Board of Pediatrics Maintenance of Certification (MOC) Part IV programs focused on improving healthcare quality, but the benefits of participation are unproven. This study focused on primary care pediatricians from 11 primary care practices participating in a 1-year MOC program for human papillomavirus (HPV) vaccine. Participants received education and electronic health record-generated performance feedback reports with their rates of captured HPV immunization opportunities and those of peers. Participating clinicians missed fewer opportunities for HPV vaccination than nonparticipants.
The results of this MOC Part IV program demonstrate the potential of the MOC requirement to foster health, in this case, the prevention of HPV-related disease, including cancer, through better vaccination coverage. Although improvements were modest and system-level changes may be needed to drive greater improvement, results were achieved at a relatively low cost and with high pediatrician satisfaction.


What’s In It For Me? Maintenance of Certification as an Incentive for Faculty Supervision of Resident Quality Improvement Projects

Academic Medicine, Volume 91, No. 1, January 2016

The authors at the University of California at San Francisco wanted to create an authentic benefit for the Pediatric faculty who supervised pediatrics residents’ Quality Improvement projects by offering Maintenance of Certification (MOC) Part 4 (performance in Practice) credit. The authors designed their Portfolio Program to include faculty development, active supervision of residents and QI projects designed to improve care.

The stakeholders (faculty preceptors, educational leaders, QI leaders and learners) all benefit from the program. There were barriers to overcome in the implementation of the portfolio program, but through screening and increased oversight, UCSF has addressed the concerns.