PBLI ("The Mirror"), SBP ("The Village")
meets
CAP, CHF, and AMI
1. Introduction (What is PBLI and SBP?)
Sometimes you wonder about the ACGME/ABMS concepts of
Practice-based Learning and Improvement (PBLI) and
Systems-based Practice (SBP). Why do you need to learn
this seemingly extraneous material? How does it fit in
with your care of patients?
Let me respond:
PBLI has been likened to a mirror that allows the
individual physician to reflect upon the quality of
the care they personally provide (using
evidence-based medicine as a guide, of course).
As an example, in the ambulatory setting, your analysis
of your population of patients with diabetes for
documentation of monitoring of urine microalbumin, HbA1c,
etc would be a PBLI activity . If you were assigned to
the ER, a PBLI activity could involve reviewing patients
you saw who presented with community acquired pneumonia to
determine if blood cultures were obtained and
antibiotics given within a specified period of time.
How is SBP different?
"It Takes a Village" is a book about how it requires
more than one individual to raise a child. And
SBP has been likened to the village of system resources
(and system monitors) needed to provide quality care to
patients. Programs that provide funding for the
health care of the older patient (Medicare) and
the care of patients who can not afford
insurance (Medicaid) are part of this system.
Understanding what these system resources provide for
your patients, your hospital, and you is part of
SBP. (Note: Medicare and Medicaid are now part of
"CMS".)
2. Background on national quality improvement activities
The public has an interest in knowing that it is receiving
"high quality" health care. Employers and those who provide
health insurance (e.g., Medicare & Medicaid) have an interest
making certain that that patients receive high quality health care.
Thus, both JCAHO and CMS are cooperating to document and improve
the quality of care provided to patients.
To start with, JCAHO and CMS have decided to look at the
quality of care provided to patients admitted with the following
diagnoses:
Community Acquired Pneumonia (CAP),
Congestive Heart Failure (CHF),
Acute Myocardial Infarction (AMI),.
Since JCAHO and CMS are very busy, the actual montitoring
of our hospital for compliance with the quality of care
"core measures" is actually performed by IPRO.
And the results of IPRO findings are reported to the public
and are used by CMS to determine reimbursement to the
Hospital. Fortunately, we have the assistance of our
own QA and UM departments to provide feedback to us
about our progress in documenting quality of care as
"reflected" by the core measures.
3. What-you-talkin'-'bout, Willis?
But I hear you say: "What is CMS, JCAHO and IPRO and what is a 'core measure'?
Check the following links for the answers:
Who is JCAHO? (And what are "Core Measures" and what does JCAHO have
to do with them?
Who is CMS and what is the Hospital Quality Alliance?
What are the CMS Hospital Quality Measures?
What are IPRO's core measures for AMI?
What does IPRO expect you to teach your patients about CHF?
What does IPRO use as core measures of quality for treatment of community acquired pneumonia?
How are WE doing? (You will need to do a search.)
Now aren't you glad you have our own QA Department to help us!
Please complete sections of the chart that apply to the core indicators
of quality, including:
'The Patient Plan For Post Hospital Care'
and take advantage of our own:
*****
In summary, competency in PBLI means that residents can
use a "mirror" to reflect upon their own provision of
evidence-based quality care. Organizations that comprise
part of our health care system (such as JCAHO and CMS)
are now challenging us to show that we are up to the task
of showing we can do this for CAP, CHF, and AMI.
care. If we do well, they will shower us with rewards
and announce our success to the world.