Lead Author
David M. Nash, MD, MBA

Overview
Concerns about the quality of health care stem from research on variations in practice, the performance gap between what we know and what we do, and awareness of high numbers of medical errors. A key to improving quality is adopting a systems perspective that recognizes the interrelationships among structure, process and outcomes. The goal is improvements in all dimensions of quality, including population health and functional health status. By achieving gains in quality, physicians can regain professional control and autonomy. This online module defines the elements of quality in health care and uses discussions and cases to teach how to adopt strategies to improve quality in practice.

Learning Objectives
After completing this module, you will be able to:

• Define the elements of quality in health care
• Evaluate methods to measure and improve quality to enhance physicians' performance and professional satisfaction
• Identify reasons why improvements in quality of care are still needed
• Assess strategies to improve quality of care in practice

Related ACGME Competencies
Systems-based Practice
Practice-based Learning & Improvement

Accreditation Status
This module's CME / CE accreditation status expires in October 2012.
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Lead Author
Mark Bloomberg, MD, MBA, FACPE

Overview
Physicians are committed to providing high quality care to their patients. Their training in diagnosis and treatment is designed to produce the best possible clinical outcomes. Still, beyond any individual clinician's sole control, serious flaws exist in our clinical care system and its performance. This module presents an overview of the processes, tools, and techniques of quality improvement in the clinical setting.

Learning Objectives
After completing this module, you will be able to:

• Indicate reasons why quality improvement is pertinent and important to practicing physicians
• Identify appropriate areas in clinical care and service where quality improvement techniques can be applied
• Identify examples of common quality improvement tools and technique

Related ACGME Competencies
Systems-based Practice
Practice-based Learning & Improvement
Interpersonal & Communication Skills

Accreditation Status
This module's CME / CE accreditation status expires in October 2012.
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Lead Author
David Nash, MD, MBA

Overview
Public accountability in health care is a strong and growing force shaping the practice of medicine today. All physicians, especially those contracting or interacting with managed care organizations, must know who is monitoring their practice, what these reviewers are evaluating, and how performance measurement efforts are likely to evolve in the future. This online module describes the methods used to evaluate and accredit managed health care plans and the organizations performing these reviews. It explores these and other major national quality improvement efforts currently under way and how they are likely to impact physicians and their medical practice.

Learning Objectives
After completing this module, you will be able to:

• Cite the major groups and agencies who monitor the health care system and how they do it
• Identify major ongoing quality improvement efforts at the state and national levels
• Recognize how performance review activities are likely to evolve and impact you and your practice

Related ACGME Competencies
Systems-based Practice

Accreditation Status
This module's CME / CE accreditation status expires in October 2012.
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Lead Authors
Joseph Lau, MD and Deborah Zucker, MD, PhD

Overview
EBM has gained increasing support in the 1990s as an approach to making clinical decisions based on validated information. What is the process for identifying and evaluating clinical evidence? And how can practicing physicians integrate elements of EBM into daily clinical practice? This online module explores these questions and guides learners in how to find and appraise clinical evidence for patient care.

Learning Objectives
After completing this module, you will be able to:

• Acknowledge the value of evidence-based medicine in clinical decision making
• Describe the steps involved in practicing evidence-based medicine
• Integrate evidence-based medicine into daily clinical practice

Related ACGME Competencies
Practice-based Learning & Improvement
Systems-based Practice
Medical Knowledge
Patient Care

Accreditation Status
This module's CME / CE accreditation status expires in December 2012.
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Clinical Guidelines

Lead Authors
Neal M. Friedman, MD and David M. Nash, MD, MBA

Overview
Clinical guidelines are evidence-based statements outlining appropriate health care for specific circumstances. They are an accepted tool for reducing unexplained clinical variation, improving quality and outcomes, and controlling costs. Numerous groups are engaged in developing guidelines, yet physician acceptance and adherence remain barriers, for a variety of reasons. In response, strategies have been developed to encourage adherence and make guidelines readily accessible at the point of care. This online module presents physicians and other practitioners with background information and uses cases to illustrate how guidelines are developed, how they can benefit patient care, and how they can be integrated in delivery systems and practice settings.

Learning Objectives
After completing this module, you will be able to:

• Understand the rationale of using systematic reviews to develop guidelines
• Work with patients to share decisions through guidelines
• Quickly access existing guidelines, evaluate them and apply them to your local situation
• Use guidelines to build or participate in care management programs

Related ACGME Competencies
Practice-based Learning & Improvement
Systems-based Practice
Patient Care

Accreditation Status
This module is not currently certified for CME credit.
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Lead Authors
Mark Bloomberg, MD, MBA and Harry Leider, MD

Overview
This online module focuses on disease management (DM) as a way to provide enhanced health care services to groups of patients who share a common disease. It explores DM programs as a cost-effective means to improve the quality of clinical care received by these patients, as evidenced by real outcomes, such as a reduction in disease exacerbation and complications, enhanced functional status, and higher patient satisfaction with care. This module presents practitioners with information, strategies and tools to manage and provide high quality and cost-effective care for patients.

Learning Objectives
After completing this module, you will be able to:

• Describe disease management and how it is being applied across single practices and extended health care systems
• Discuss how specific DM programs can address the needs of your patients or a population of patients who share a common disease
• Identify how you can use DM programs to improve the health of your patients

Related ACGME Competencies
Systems-based Practice
Patient Care

Accreditation Status
This module is not currently certified for CME credit.
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Lead Authors
Thomas Mayer, MD, MBA and Elaine Enright, RN, CCM

Overview
In this online module we present cases and content to explore the essential components of case management, the core competencies of a registered nurse or other health care professional performing this function, and the application of case management within physician practices. Case management not only improves the experience and the outcomes of care for patients, but it also benefits physicians by assisting them in their day-to-day practice. In the sections that follow, discussions of case management are complemented with case scenarios that are used to illustrate the practical and operational elements of case management and to improve the learner's decision-making. The goal of this module is to present physicians, nurses, and other practitioners with information, strategies, and tools to manage and provide high quality and cost-effective care for patients.

Learning Objectives
After completing this module, you will be able to:

• State why and how case management can benefit all stakeholders in the continuum of care.
• Describe the processes of case management and the respective responsibilities of case managers and physicians.
• Identify the critical aspects of how physicians work with case managers from different settings in their daily practice.
• Describe components necessary to implement a case management program.

Related ACGME Competencies
Systems-based Practice
Interpersonal & Communication Skills
Patient Care

Accreditation Status
This module is not currently certified for CME credit.
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Lead Author
Philip Boulter, MD

Overview
Referrals are an essential element in managing care. Appropriate referral of the patient from primary care physician (PCP) to specialist and ongoing communication and coordination are critical to achieving optimal clinical outcomes, patient satisfaction, and cost-effective care. While only a small percentage of primary care visits result in a referral, each referral can generate several specialist visits and related services. This online module offers learners insight into the importance of active referral management. It provides information about what referral patterns are and how they are measured and techniques for positively influencing the referral process to improve quality of care.

Learning Objectives
After completing this module, you will be able to:

• Identify referral patterns, and evaluate them against national benchmarks
• Identify factors that influence referral patterns
• List opportunities to influence and change referral processes in order to improve care

Related ACGME Competencies
Systems-based Practice
Interpersonal & Communication Skills
Patient Care

Accreditation Status
This module's CME / CE accreditation status expires in April 2013.
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Managing Pharmacy in the Hospital Setting

Lead Author
Joseph L. Raduazzo, MD

Overview
Pharmacy costs have become a concern in the hospital setting, as in health care generally. Some issues are especially important in the hospital setting, where drug costs are absorbed within the reimbursement for the overall admission. The hospital pharmacist is a key player in managing this area, but comprehensive strategies also require participation by administrators, physicians, nurses, and even patients. This online module presents practitioners with information, strategies and tools to manage and provide high quality and cost-effective pharmaceutical care for patients.

Learning Objectives
After completing this module, you will be able to:

• Describe the principal drivers of the increases in pharmaceutical costs
• Identify challenges and solutions for managing pharmacy expenses in the hospital setting
• Describe the processes for determining what medications are used in a given hospital

Related ACGME Competencies and Objectives
Systems-based Practice
Interpersonal & Communication Skills
Patient Care

Accreditation Status
This module is not currently certified for CME credit.
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The Emerging Roles of Pharmacists in Collaborative Care Delivery

Lead Authors
Joseph L. Raduazzo, MD and Paul Abourjaily, PharmD, BCPS

Overview
The health care system faces major challenges in providing high quality and cost-effective care to patients and populations. To be successful, it is important to make the best use of all professionals and to establish collaborative arrangements within which they perform their various functions. For pharmacists, a new era has begun in which they are expanding their services beyond traditional roles in managing and dispensing medications. Through collaboration with physicians, they can participate more fully in pharmaceutical care and in promoting health and wellness. They can assume these roles in inpatient facilities, ambulatory care settings, and community pharmacies. The goal of this module is to present practitioners with information, strategies, and tools to manage and provide high quality and cost-effective care for patients.

Learning Objectives
After completing this module, you will be able to:

• Describe the need for and the challenges of managing the quality and costs of pharmaceutical care, for individuals and patient populations.
• Identify the current and emerging roles and contributions of pharmacists in collaborating with physicians and others to manage pharmaceutical care in inpatient and outpatient settings.
• Identify new functions and services that pharmacists in community settings are beginning to demonstrate that can improve patient care.
• Cite the operational and professional barriers to expanding community pharmacists' patient care roles and their collaboration with physicians, and the opportunities to overcome these barriers.

Related ACGME Competencies
Systems-based Practice
Interpersonal & Communication Skills:
Patient Care:

Accreditation Status
This module is not currently certified for CME credit.
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Health Literacy in the Clinical Encounter

Lead Authors
James Hyde, MA, SM and Marc Edelstein, MD, PhD

Overview
Health literacy refers to the capacities of patients to obtain, process, and understand basic information needed to make appropriate health decisions—whether this information is conveyed through written, verbal, or nonverbal means. Studies show that many adults have limited literacy skills and that health care materials tend to be written at higher reading levels than suitable for average Americans. Patients with limited health literacy are more likely to experience adversities associated with their interface with the health care delivery system, and as a consequence have poorer quality of care and health outcomes, lower patient satisfaction and higher health care costs. The goal of this module is to help physicians and other heath care professionals recognize and overcome barriers to effective communication and care coordination, both during the clinical encounter and in the informed consent process.

Learning Objectives
After completing this module, you will be able to:

• Define health literacy and explain how spoken words, written text, and nonverbal messages can impede effective communication.
• Describe the nature and magnitude of limited health literacy in the United States.
• Describe the adverse consequences of limited health literacy on health care quality and patient outcomes.
• Demonstrate both systems-based and practice-based solutions and strategies for clinicians to improve effective communication with patients, with particular focus on the informed consent process.

Related ACGME Competencies
Interpersonal & Communication Skills
Professionalism
Systems-based Practice
Patient Care

Accreditation Status
This module is not currently certified for CME credit.
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Cultural Competence and Disparities in Health Care

Lead Authors
Helen M. Manson, MBChB, MRCGP and Amy L. Lee, MD

Overview
There is much value to be gained from learning how to provide culturally competent care, now recognized as a standard of good medical practice in the United States by professional, governmental, and accreditation organizations. Sensitivity to the myriad health beliefs and values that each patient brings to the clinical encounter, and expert communication skills, are essential components of patient-centered care. Health professionals who are competent in this aspect of professionalism will enrich the clinician-patient relationship and patient experience, diminish the likelihood of miscommunication and medical errors, improve the quality of service to patients, help eliminate disparities in health outcomes for people with diverse racial, ethnic and cultural backgrounds, and save health care dollars.

Learning Objectives
After completing this module, you will be able to:

• Define cultural competence and explain how it influences the delivery of high quality, patient-centered health care.
• Describe how the differing values and beliefs of patients and clinicians can impede clear communication and undermine the development and implementation of a mutually acceptable plan of care.
• Explain how the delivery of culturally competent care can lead to improvement in health care at both the individual and population level, with particular focus on the significance for racial and ethnic minority patients.
• Apply practical strategies and techniques to promote culturally competent care at the personal, practice and organizational levels.

Related ACGME Competencies
Professionalism
Interpersonal & Communication Skills
Patient Care

Accreditation Status
This module is not currently certified for CME credit.
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Professionalism in Medicine: The Fundamentals

Lead Authors
Marc Edelstein, MD, PhD and Helen M. Manson, MBChB, MRCGP and Carolyn S. Langer, MD, JD, MPH

Overview
As professionals, physicians are accountable for applying their unique expertise to fulfill expectations of patients and society. In exchange, members of the medical profession, individually and collectively, are granted a high level of status, self-regulation, and trust. Within the context of this "social contract," medical organizations have articulated principles and obligations of physicians—to patients, communities, colleagues, and the profession itself. Professionalism is further characterized as a competency, requiring physicians to adopt attitudes and demonstrate behaviors that serve patients and the public and protect the profession. In a complex environment characterized by rapid change, competing interests, and increased scrutiny, public trust in physicians is jeopardized, with consequences for the healing relationship, clinical outcomes, and the profession’s autonomy.

Learning Objectives
After completing this module, you will be able to:

• Describe the origins of professional principles and values, rooted in moral values, ethical principles, societal expectations and the law.
• Explain what is meant by professionalism in the context of medicine.
• Explain why professionalism is important in the practice of modern-day medicine.
• Describe how physicians' attitudes and behaviors can influence the trust of patients and of society, impacting not only the therapeutic relationship but also the integrity and functioning of both the medical profession and the health care system.

Related ACGME Competencies
Professionalism

Accreditation Status
This module's CME / CE accreditation status expires in December 2012.
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Professionalism in Medicine: Implications for Practice. Part 1-Patient Care

Lead Authors
Marc Edelstein, MD, PhD and Helen M. Manson, MBChB, MRCGP and Carolyn S. Langer, MD, JD, MPH and Brendan P. Kelly, MD

Overview
Professionalism is recognized as a vital component of what it means to be a good physician. Professionalism is present in one’s clinical encounters with patients, as well as in relationships with colleagues, with elements of the broader health care system, and with the community-at-large. Behaving professionally requires a unique set of attitudes, knowledge and skills that guide the physician in his or her interactions and decisions. At the same time, accepting one’s responsibilities as a professional is a prerequisite to integrating the knowledge and skills that make up all the other core competencies. This module, the first of a two-part resource, considers elements of professionalism included in current definitions that pertain to patient care, and provides for each element some background, tools, techniques, resources for further investigation, and related materials.

Learning Objectives
After completing this module, you will be able to:

• Explain how physicians' attitudes and behaviors can influence the trust of patients and of society, impacting not only the therapeutic relationship but also the integrity and functioning of both the medical profession and the health care system.
• Apply tools and techniques that help physicians to act professionally in all aspects of their practice.
• Describe and research formal obligations--determined by the medical profession, by health care organizations and institutions, and by government and the legal system--with which physicians must comply in order to ensure ethical, professional practice.

Related ACGME Competencies
Professionalism

Accreditation Status
This module's CME / CE accreditation status expires in May 2012.
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Professionalism in Medicine: Implications for Practice. Part 2-Practice Management and Professional Identity

Lead Authors
Marc Edelstein, MD, PhD and Helen M. Manson, MBChB, MRCGP and Carolyn S. Langer, MD, JD, MPH and Brendan P. Kelly, MD

Overview
Professionalism is recognized as a vital component of what it means to be a good physician. Professionalism is present in one’s clinical encounters with patients, as well as in relationships with colleagues, with elements of the broader health care system, and with the community-at-large. Behaving professionally requires a unique set of attitudes, knowledge and skills that guide the physician in his or her interactions and decisions. At the same time, accepting one’s responsibilities as a professional is a prerequisite to integrating the knowledge and skills that make up all the other core competencies. This module, the second of a two-part resource, considers elements of professionalism included in current definitions that pertain to practice management and professional identity, and provides for each element some background, tools, techniques, resources for further investigation, and related materials.

Learning Objectives
After completing this module, you will be able to:

• Explain how physicians' attitudes and behaviors can influence the trust of patients and of society, impacting not only the therapeutic relationship but also the integrity and functioning of both the medical profession and the health care system.
• Apply tools and techniques that help physicians to act professionally in all aspects of their practice.
• Describe and research formal obligations--determined by the medical profession, by health care organizations and institutions, and by government and the legal system--with which physicians must comply in order to ensure ethical, professional practice.

Related ACGME Competencies
Professionalism

Accreditation Status
This module's CME / CE accreditation status expires in May 2013.
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Spine Imaging: Timing and Techniques for Lower Back Pain

Lead Authors
Joseph J. Rencic, MD and Kevin Yao, MD

Overview
This module is in the form of a webinar, recorded on November 5, 2009. The educational activity is jointly sponsored by Tufts University School of Medicine, Tufts Health Care Institute, and MedSolutions.

The utilization of imaging in the U.S. health care system has received increasing attention, as costs and volume have risen. The total number of imaging procedures grew by about 40 percent from 2000-2005 and is projected to grow by another 26 percent by 2008, resulting in nearly half a million procedures performed each year. However, estimates suggest that a full third of imaging procedures are inappropriate. The goal of this webinar is to improve primary care physicians’ knowledge and utilization of appropriate high tech imaging studies for patients with lower back pain.

Learning Objectives
After completing this module, you will be able to:

• Evaluate patients with back pain to determine if imaging is required for diagnosis.
• Select the most appropriate imaging modality for the patient’s condition.
• Present the specialist with complete, timely and clinically relevant information when making the referral.

Related ACGME Competencies
Patient Care
Practice-based Learning & Improvement

Accreditation Status
This module's CME / CE accreditation status expires in November 2011.
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Outpatient Abdominal Imaging: Timing and Techniques for Diagnosis

Lead Authors
Joseph J. Rencic, MD and Samson Munn, MD

Overview
This module is in the form of a webinar, recorded on March 9, 2010. The educational activity is jointly sponsored by Tufts University School of Medicine, Tufts Health Care Institute, and MedSolutions.

The utilization of imaging in the U.S. health care system has received increasing attention, as costs and volume have risen. The utilization of MRI, CT and PET scans in the U.S. has tripled from 1996 – 2007, resulting in nearly half a million procedures performed each year. However, estimates suggest that a full third of imaging procedures are inappropriate. The goal of this webinar is to improve primary care physicians’ knowledge and utilization of appropriate high tech imaging studies for patients with abdominal pain.

Learning Objectives
After completing this module, you will be able to:

• Evaluate patients with abdominal pain to determine if and when imaging is required for diagnosis.
• Select the most appropriate imaging modality for the patient’s condition.
• Present the specialist with complete, timely and clinically relevant information when making the referral.

Related ACGME Competencies
Patient Care
Practice-based Learning & Improvement

Accreditation Status
This module's CME / CE accreditation status expires in March 2012.
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