Patient Care Practice Improvement (PI) Activity
Clinically active diplomates must complete and attest to two PI activities, one in years one through five of their certification, and one in years six through ten. During the requirement phase-in period (2010 through 2017), the requirement may be fewer. Diplomates’ can view their individual requirements and attest to completion by signing in to their ABEM MOC Personal Page.
The PI process is based on the steps found in most practice improvement programs. Physicians who are not engaged in a PI program at work will need to identify one available through various national and state organizations, design one with their EM colleagues, or create their own.
A PI activity must include the following four steps:
- Diplomates must review patient clinical care data related to a single presentation, disease, or clinical care process that is part of the Model of the Clinical Practice of Emergency Medicine (EM Model), for example, clinical care processes, feedback from patients that relates to the clinical care given, outcomes of clinical care, or access to care such as time for through-put, left without being seen, etc.
Group data and data collected through a national, regional, or local practice improvement program in which diplomates participate is acceptable. The PI activity should include ten of the diplomate’s own patients. Inclusion of fewer patients is acceptable for activities involving important clinical issues of lower prevalence and higher acuity (e.g., sepsis, AMI door-to-balloon times).
- Compare the data to evidence-based guidelines. Evidence-based guidelines are based on published research subject to peer-review. If such guidelines are not available, diplomates may use guidelines set by expert consensus or comparable peer data. Guidelines set by expert consensus are published, accepted, national standards, and guidelines set by peer data are set by individuals who practice in like or similar circumstances.
- Develop and implement a plan to improve the practice issue measured in Step 1. Diplomates may plan for an individual or group improvement.
- After implementing the improvement plan, review patient clinical care data that includes at least ten of the diplomate’s additional patients with the same presentation, disease, or clinical process as the first patient data review. Fewer than ten of the diplomate’s patients may be included if the activity involves an important clinical issue of lower prevalence and higher acuity. Use this data to evaluate whether clinical performance has been improved or maintained.
Requirements for Verification
Diplomates are required to specify an independent verifier of each PI activity. The verifier must be someone with oversight or knowledge of practice performance and would likely be one of the following:
- Hospital board chair or other member of the board
- Department chair
- Chief of staff
- Medical Director
- Practice administrator in non-hospital settings
Five percent (5%) of activities will be randomly selected for verification. Verifiers will be asked to affirm that all of ABEM’s requirements have been met.