Physician Perceptions of Performance Feedback in a Quality Improvement Activity.

Physician performance and peer comparison feedback can affect physician care quality and patient outcomes. This study aimed to understand family physician perspectives of the value of performance feedback in quality improvement (QI) activities. This study analyzed American Board of Family Medicine open-ended survey data collected between 2004 and 2014 from physicians who completed a QI module that provided pre- and post-QI project individual performance data and peer comparisons.

Improving quality of care and guideline adherence for asthma through a group self-assessment module.

Background: The quality of care for asthma remains suboptimal. Compliance with guidelines remains low, but improved adherence to guidelines may increase the quality of care. but.

Methods for Performing Survival Curve Quality-of-Life Assessments.

Background: Many medical decisions involve an implied choice between alternative survival curves, typically with differing quality of life. Common preference assessment methods neglect this structure, creating some risk of distortions.

Methods: Survival curve quality-of-life assessments (SQLA) were developed from Gompertz survival curves fitting the general population's survival.

Adding flexible temporal constraints to identify chronic comorbid conditions in ambulatory claims data.

Chronic comorbid conditions are important predictors of primary care outcomes, provide context for clinical decisions, and are potential complications of diseases and treatments. Comorbidity indices and multimorbidity categorization strategies based on administrative claims data enumerate diagnostic codes in easily modifiable lists, but usually have inflexible temporal requirements, such as requiring two claims greater than 30 days apart, or three claims in three quarters. Table structures and claims data search algorithms were developed to support flexible temporal constraints.

Diuretic of choice in ABFM hypertension self-assessment module simulations.

Background: Evidence suggests that chlorthalidone has therapeutic advantages over hydrochlorothiazide, perhaps because of a longer antihypertensive effect. Although guidelines such as the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure treat diuretics as a class, some experts believe chlorthalidone is the diuretic of choice in hypertension management. We evaluated diplomates' use of chlorthalidone and hydrochlorothiazide as first-choice diuretics in virtual patient simulations of hypertension in the American Board of Family Medicine Maintenance of Certification for Family Physicians self-assessment modules.

Family physicians' completion of scoring criteria in Virtual Patient encounters.

The American Board of Family Medicine (ABFM) has used a 60-item Multiple Choice Question (MCQ) section followed by a Virtual Patient (VP) exercise in Maintenance Of Certification (MOC) since 2004, and has had an asthma module since 2005. The original asthma VP criteria anticipated some Expert Panel Report-3 recommendations, such as home peak flow monitoring and a written plan, that were added to the MCQ section only when the guideline was updated in 2007. VP completion rates for these criteria improved markedly with the MCQ update, while other criteria completion rates were stable.

Variation over time in preventable hospitalization rates across counties.

Background: The Agency for Health Care Research and Quality developed 14 prevention quality indicators (PQIs), including four PQIs related to preventable hospitalizations for diabetes and one to asthma. Quality indicators vary across counties, but variation over time has not been described.

Methods: The Kentucky Cabinet for Health and Family Services published PQI data for each county in Kentucky in each of the 3 years from 2006 to 2008.

Using county-level public health data to prioritize medical education topics.

Introduction: Medical education topics might be locally prioritized using public health data on health outcomes and risk factors unrelated to quality of care.

Methods: The Missouri Information for Community Assessment (MICA) supplied preventable hospitalization rates (PHRs) for asthma, chronic obstructive pulmonary disease (COPD), diabetes, heart failure, and hypertension in 114 counties from 1998 to 2002. For each disease, a linear regression model predicted PHR from behavior, access, and disease prevalence data from MICA and other public data sources.

Value of information in virtual patients portraying pharyngitis.

The American Board of Family Medicine (ABFM) uses virtual patients (VP) in Maintenance of Certification. Theoretically, the ABFM could score users on the value of information (VOI) in their queries. Pharyngitis, a prototypical primary care topic, appears practically intractable to VOI scoring.

Value of information in virtual patient performance evaluations.

The American Board of Family Medicine (ABFM) uses virtual patients (VP) in Maintenance of Certification. User queries might be evaluated by calculating diagnostic value of information (VOI). Typical primary care queries address concerns far beyond efficient diagnosis.

Modeling relief.

The American Board of Family Medicine deployed virtual patient simulations in 2004 to evaluate Diplomates' diagnostic and management skills. A previously reported dynamic process generates general symptom histories from time series data representing baseline values and reactions to medications. The simulator also must answer queries about details such as palliation and provocation.

Maintenance of certification for family physicians (MC-FP) self assessment modules (SAMs): the first year.

Introduction: In 2000, the American Board of Medical Specialties adopted Maintenance of Certification (MOC) to replace intermittent, periodic recertification. MOC consists of 4 components: demonstration of professionalism (part I); commitment to life-long learning (part II); demonstration of cognitive expertise (part III); and evaluation of performance in practice (part IV). The American Board of Family Medicine (ABFM) implemented Maintenance of Certification for Family Physicians (MC-FP) in 2004, with its MC-FP part II self-assessment modules (SAMs) as the focus of the first year's activities.

Computer-based testing in family practice certification and recertification.

Background: The member boards of the American Board of Medical Specialties have agreed to expand the scope of certification to include assessment of medical knowledge, practice-based learning and improvement, patient care, interpersonal and communication skills, systems-based practice, and professionalism. Multiple-choice examinations provide limited ability to assess these dimensions.

Methods: The American Board of Family Practice (ABFP) has developed a computer simulation system to facilitate more comprehensive candidate evaluation.