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Group PQI Projects

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Group PQI Projects

Participating as a Group of Diplomates:
Part 4 Standards for Group PQI

In response to requests from a number of practices to complete quality improvement initiatives as a group or groups of diplomates within a practice, the ABR created a special category of MOC Part 4 participation. Group participation in PQI is an important option because its scale is well suited to address systems-based problems. Thus, it holds tremendous potential as a multiplier of MOC’s power to advance healthcare quality and safety. Group participation can also be more convenient and manageable for administrative purposes. Practices engaged in ABR’s Administrative Model for Group MOC participation (“streamlining”) may choose this pathway as an efficient mechanism to satisfy Part 4 requirements for their diplomate members. In addition, individual diplomates whose practices are not engaged in Group MOC participation are still entitled to use Group PQI to satisfy their Part 4 obligations.

 

What Constitutes a Group?

The ABR understands that a wide variety of group practice settings must be recognized and accommodated. Thus, for purposes of Group PQI project participation, the ABR has defined “group” as follows:

“Two or more diagnostic radiologists, radiation oncologists, or medical physicists of the same or different disciplines, sharing a common central organizational structure, who work together to provide patient care, regardless of individual contractual affiliations or relationships. These diagnostic radiologists, radiation oncologists, or medical physicists may provide services at single or multiple facilities or locations in a variety of clinical settings, including hospitals, offices, or patient imaging centers.”

Because Group PQI may inadvertently distance some participants from an intimate, hands-on experience, certain project-level and diplomate-level standards must be applied to ensure meaningful participation.

 

Group PQI Process Standards

A group participation quality improvement project shared among diagnostic radiologists, radiation oncologists, or medical physicists should have the potential to impact their individual practice behavior and/or system environments within the confines of their group practice. If a group of radiologists decides to participate in a systems-based PQI initiative, the following guidelines must be followed for all participants to receive PQI credit. These standards are intended to ensure meaningful participation of diplomates in group PQI.

  1. One radiologist, radiation oncologist, or medical physicist who is participating in MOC must be identified as the project or team leader for the group project. This will facilitate organizing meetings; taking attendance and keeping minutes of meetings; and coordinating data collection, analysis, and review, as well as improvement planning and implementation.
  2. Each participating radiologist’s name must be documented along with project title, project description, and the start and end dates for the project.
  3. Credit for individual participation in a Group PQI project requires attendance at three or more group meetings (as described below for “Group-Designed Project Criteria”), with minutes taken and attendance documented for each participant. Such meetings are mandatory regardless of whether a society-sponsored project, registry, or group-designed project is employed.
  4. Each participant must have access to all project documentation, including meeting minutes and any additional relevant data, which will facilitate reporting to the ABR in the event of an audit.
  5. Each participant must fulfill meaningful participation requirements and, when a PQI project is completed, prepare a short paragraph of self-reflection, stating the way(s) in which the project positively impacted his or her practice and/or patients.
  6. The project leader must sign off on the project before ABR MOC Part 4 credit is issued.
  7. Each radiologist participating in and completing the project will receive individual PQI credit from the ABR once the participant completes an attestation through his or her Personal Database (myABR).

 

Group PQI Project Standards

As with Individual PQI projects, Group PQI projects may be self-designed by the diplomates or selected from a variety of existing projects sponsored by national organizations and societies. However, for Group PQI, nationally endorsed projects that include measures directly related to patient care (outcome or process) are preferred. The goals and measures of any project should be relevant to each diplomate’s practice, with the potential to improve care.

  1. Society-Sponsored, pre-approved PQI projects, including registries, as listed on the ABR website, may be appropriate if the group feels the project is relevant to its practice. The goals and metrics of these projects are specified in detail for each project. It is also acceptable to use such projects as a basis for designing a Group PQI initiative that is more pertinent to a particular group’s clinical practice.
  2. Group-Designed PQI projects are conceived and formatted by the group to address a quality or safety gap in the group’s practice. Such projects do not require approval for use. However, certain constructs in the design and execution of the project must be observed, and the development process must be documented. The “Plan-Do-Study-Act” cycle, as described for Individual PQI and as modified below for use by Group PQI efforts, must be followed. A major distinguishing feature of Group PQI, as compared with Individual PQI, is the requirement of group meetings to ensure meaningful engagement of participants in the process. Group meetings also promote productive interactions among the participants in performing quality measurements and assessments and implementing practice-improvement actions relevant to the system in which they practice.

     

Group-Designed Project Criteria

BASELINE PDSA CYCLE (Cycle #1)

  1. PLAN.   Identify project, metrics, and target (Group PQI Meeting #1)
  1. Select a topic area in which your practice group would like to see your practice improve, and within it, decide on a systems-based challenge that is relevant to your practice. The purpose of PQI is to address and improve real issues in your practice, so performance topics that do not present challenges or perceived gaps in practice are not appropriate as subjects for PQI projects.
  2. Decide specifically what your practice group will measure to assess current performance and future improvement and create a data collection form to record the measurements (if one does not already exist).
  3. Determine an appropriate desired project target that will help in your evaluation once the project has been completed.
  4. Determine a prediction of what the baseline measurement result will be to help align perception with reality during data analysis.

 

  1. DO.  Data collection

 

  1. Make a baseline measurement in an appropriate number of cases drawn in an unbiased manner.
     
  1. STUDY.  Data Analysis (Group PQI Meeting #2)

 

  1. The practice group should come together to review and analyze the baseline data collected to date, discuss the implications of the results for the practice, and determine the perceived root causes for not meeting the performance measurement target/goal. Compare the results with the predicted measurement results.
     
  1. ACT.  Action Plan (Group PQI Meeting #3)

 

  1. If you have not met your measure target, devise an improvement plan addressing the root causes, as well as a process for plan implementation. Proceed to PDSA Cycle #2.
  2.  If you have met your measure target, terminate this project, select another topic, and proceed with a new project.

 

POST-IMPROVEMENT PLAN PDSA CYCLE (Cycle #2)

After establishing baseline results, conduct a second PDSA cycle to assess the impact of the plan on the baseline measurement.

  1. PLAN.  Implement the improvement plan and confirm your data collection process.
  2. DO.  Collect re-measurement data.
  3. STUDY.  Analyze re-measurement data.
  4. ACT.  Project Decision Point (Group PQI Meeting #4)

Analyze the post-improvement plan re-measurement data and determine whether your group has met its performance goal.

If so, select another project to start as appropriate, while maintaining the gains made in the initial project.

If not, continue with the initial project and repeat PDSA cycle(s) as necessary to reach the desired goal, or otherwise determine an end-point.

  1. SELF-REFLECTION. When the project is completed, each participant must prepare a short paragraph of self-reflection, stating the way(s) in which the project positively impacted his or her practice and/or patients.

 

ABR GROUP PQI PROJECT TEMPLATE

To assist group participants in following and documenting the required process, the ABR has developed an optional  template (Group PQI Participant Checklist and Summary Record), which may be used in completing PQI projects. Society-sponsored PQI projects generally provide templates to be used in completing the projects. If not, the ABR template may be used as appropriate.

Fulfilling the MOC Cycle PQI Requirements

Each Group PQI participant must complete one PQI project every three years. Don’t forget that each group participant must attest on his or her ABR Personal Database (myABR) that he or she has completed a PQI project.

Please click to access your myABR.