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 and Objectives
Systems-based Practice:
    Work effectively in various health care delivery settings and systems relevant to their clinical specialty.
    Advocate for quality patient care and optimal patient care systems.
    Participate in identifying system errors and implementing potential systems solutions.

Practice-based Learning & Improvement:
    Systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement.

Accreditation Status
This module's CME / CE accreditation status expires in September 2009.
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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 and Objectives
Systems-based Practice:
    Work effectively in various health care delivery settings and systems relevant to their clinical specialty.
    Advocate for quality patient care and optimal patient care systems.
    Work in interprofessional teams to enhance patient safety and improve patient care quality.
    Participate in identifying system errors and implementing potential systems solutions.

Practice-based Learning & Improvement:
    Set learning and improvement goals.
    Systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement.

Interpersonal & Communication Skills:
    Work effectively as a member or leader of a health care team or other professional group.

Accreditation Status
This module's CME / CE accreditation status expires in September 2009.
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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 and Objectives
Systems-based Practice:
    Work effectively in various health care delivery settings and systems relevant to their clinical specialty.
    Advocate for quality patient care and optimal patient care systems.

Accreditation Status
This module's CME / CE accreditation status expires in September 2009.
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Lead Author and Adapter
Mark A. Bloomberg, MD, MBA, FACPE and Susan M. Murray, RN, ANP, MPH

Overview
Advanced Practice Nurses (APNs) have broad based training and education in health assessment, health maintenance, disease prevention and disease management. Nonetheless, problems in the delivery of care prevent all patients from achieving the best clinical outcomes. Beyond any individual practitioner's control, serious flaws exist in the clinical care system and its performance. This online module presents an overview of the processes, tools, and techniques of quality improvement that APNs can apply to their patient care settings, using examples from the scenarios described above.

The goal of this module is to present Advanced Practice Nurses 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 why quality improvement is pertinent and important to the Advanced Practice Nurse.
• Identify appropriate areas in clinical care and service where quality improvement techniques can be applied.
• Identify examples of common quality improvement tools and techniques.

Accreditation Status
This module's CME / CE accreditation status expires in April 2010.
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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 and Objectives
Practice-based Learning & Improvement:
    Identify strengths, deficiencies, and limits in one’s knowledge and expertise.
    Locate, appraise, and assimilate evidence from scientific studies related to their patients' health problems.
    Use information technology to optimize learning.

Systems-based Practice:
    Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care as appropriate.

Medical Knowledge:
    Demonstrate an investigatory and analytic thinking approach to clinical situations.

Patient Care:
    Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment.

Accreditation Status
This module's CME / CE accreditation status expires in September 2009.
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Clinical Guidelines
Launch Module

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 and Objectives
Practice-based Learning & Improvement:
    Locate, appraise, and assimilate evidence from scientific studies related to their patients' health problems.
    Use information technology to optimize learning.

Systems-based Practice:
    Coordinate patient care within the health care system relevant to their clinical specialty.
    Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care as appropriate.

Patient Care:
    Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment.
    Develop and carry out patient management plans.

Accreditation Status
This module's CME / CE accreditation status expires in May 2010.
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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 and Objectives
Systems-based Practice:
    Coordinate patient care within the health care system relevant to their clinical specialty.
    Work in interprofessional teams to enhance patient safety and improve patient care quality.

Patient Care:
    Develop and carry out patient management plans.
    Provide health care services aimed at preventing health problems or maintaining health.

Accreditation Status
This module's CME / CE accreditation status expires in January 2010.
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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 and Objectives
Systems-based Practice:
    Work effectively in various health care delivery settings and systems relevant to their clinical specialty.
    Coordinate patient care within the health care system relevant to their clinical specialty.
    Work in interprofessional teams to enhance patient safety and improve patient care quality.

Interpersonal & Communication Skills:
    Communicate effectively with physicians, other health professionals, and health related agencies.
    Work effectively as a member or leader of a health care team or other professional group.

Patient Care:
    Develop and carry out patient management plans.
    Provide health care services aimed at preventing health problems or maintaining health.
    Work with health care professionals, including those from other disciplines, to provide patient-focused care.

Accreditation Status
This module's CME / CE accreditation status expires in April 2010.
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Lead Author
Thomas Mayer, MD, MBA

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 and Objectives
Systems-based Practice:
    Work effectively in various health care delivery settings and systems relevant to their clinical specialty.
    Coordinate patient care within the health care system relevant to their clinical specialty.
    Work in interprofessional teams to enhance patient safety and improve patient care quality.

Interpersonal & Communication Skills:
    Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds.
    Communicate effectively with physicians, other health professionals, and health related agencies.
    Work effectively as a member or leader of a health care team or other professional group.
    Act in a consultative role to other physicians and health professionals.

Patient Care:
    Work with health care professionals, including those from other disciplines, to provide patient-focused care.

Accreditation Status
This module's CME / CE accreditation status expires in September 2009.
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Managing Pharmacy in the Hospital Setting
Launch Module

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:
    Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care as appropriate.
    Work in interprofessional teams to enhance patient safety and improve patient care quality.

Interpersonal & Communication Skills:
    Work effectively as a member or leader of a health care team or other professional group.

Patient Care:
    Work with health care professionals, including those from other disciplines, to provide patient-focused care.

Accreditation Status
This module's CME / CE accreditation status expires in February 2010.
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The Emerging Roles of Pharmacists in Collaborative Care Delivery
Launch Module

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 and Objectives
Systems-based Practice:
    Coordinate patient care within the health care system relevant to their clinical specialty.
    Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care as appropriate.
    Work in interprofessional teams to enhance patient safety and improve patient care quality.

Interpersonal & Communication Skills:
    Communicate effectively with physicians, other health professionals, and health related agencies.
    Work effectively as a member or leader of a health care team or other professional group.

Patient Care:
    Work with health care professionals, including those from other disciplines, to provide patient-focused care.

Accreditation Status
This module's CME / CE accreditation status expires in April 2010.
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Health Literacy in the Clinical Encounter
Launch Module

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 and Objectives
Interpersonal & Communication Skills:
    Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds.

Professionalism:
    Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.

Systems-based Practice:
    Advocate for quality patient care and optimal patient care systems.

Patient Care:
    Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families.
    Counsel and educate patients and their families.

Accreditation Status
This module's CME / CE accreditation status expires in October 2010.
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Cultural Competence and Disparities in Health Care
Launch Module

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 an essential component 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 and Objectives
Professionalism:
    Demonstrate compassion, integrity, and respect for others.
    Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.

Interpersonal & Communication Skills:
    Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds.

Patient Care:
    Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families.
    Counsel and educate patients and their families.

Accreditation Status
This module's CME / CE accreditation status expires in March 2011.
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