Sharing collaborative designs of tobacco cessation performance improvement CME projects.

INTRODUCTION: Performance Improvement Continuing Medical Education (PI CME) provides an important opportunity for CME providers to combine educational and quality health care improvement methodologies. Very few CME providers take on the challenges of planning this type of intervention because it is still a new practice and there are limited examples from which to model. This article offers case examples of educational design, results, and lessons learned from 4 tobacco cessation PI CME activities. PURPOSE: To share with the CME community different cases of PI CME educational design and results so that CME providers may have examples to draw from and develop more PI CME activities. METHODS: This is a case report. RESULTS: Four of 9 partners of the Cease Smoking Today (CS2day) initiative developed the 4 tobacco cessation PI CME activities. Each project was designed and implemented using a common planning framework and clinical performance measures but with varying operational and educational design components depending on the strengths and resources of the leading partner. Three projects that are completed show improvements in aggregated practitioner performance and smoking quit rates. One project is currently under way. DISCUSSION: These cases highlight the value of collaboration, identify influences of operational and educational designs on variation in compliance with performance measures, and lead to a discussion of similarities in barriers, successes, and lessons for future practice.

Learning to collaborate: a case study of performance improvement CME.

INTRODUCTION: Performance Improvement Continuing Medical Education (PI CME) is a mechanism for joining quality improvement (QI) in health care to continuing medical education (CME) systems together. Although QI practices and CME approaches have been recognized for years, what emerges from their integration is largely unfamiliar, because it requires the collaboration of CME providers and stakeholders within the health care systems who traditionally have not worked together and may not have the same understanding of QI issues to close performance gaps. This study describes how an academic institution and a community-based primary care practice collaborated to enhance patient care in the area of hypertension. It offers lessons learned from a PI CME activity in the area of hypertension. METHODS: This was an observational case study. Data were collected through interviews, observations of educational events, and review of documents such as learning logs, which were designed to: (1) help physicians learn and change, (2) satisfy requirements for CME credit, (3) serve as the basis for reimbursement, and (4) provide data for the case study. RESULTS: Nine clinicians from one clinic completed the PI CME activity, achieved measurable improvements in their practice, and contributed to systems change. The study highlighted (1) the value of shared goals and agreement on the process among the participants, planners, and others involved; (2) the advantage of a multidisciplinary approach; (3) the importance of supporting clinicians' continuing motivation to participate; and (4) the need to allow sufficient time to enable the initiative to evolve. DISCUSSION: PI CME required unprecedented collaboration between CME planners and QI stakeholders to enable change in clinical practice.