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Outcomes Methodologies in the Changing
Landscape of CME
Chitra Subramaniam, Ph.D
Assistant Dean and Director, Continuing M...
All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event i...
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Outcomes Methodologies in the Changing Landscape of CME

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Outcomes Methodologies in the Changing Landscape of CME
Presenter Chitra Subramaniam, Ph. D
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Outcomes Methodologies in the Changing Landscape of CME

  1. 1. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online Events Just like your CME, technology delivery is ever-evolving. Pair your CME with BeaconLive’s cutting edge delivery methods. BeaconLive | Webinars | Webcasts | Online Events Learn More: BeaconLive.com/Healthcare
  2. 2. Outcomes Methodologies in the Changing Landscape of CME Chitra Subramaniam, Ph.D Assistant Dean and Director, Continuing Medical Education Assistant Director, Center for Educational Excellence This webinar is brought to you by BeaconLive Webinars | Webcasts | Online Events
  3. 3. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive About Me Education: • Ph.D in Curriculum and Instruction with a focus on Instructional Technology; Cognate: Measurement and Evaluation • 10X10 AMIA training in Biomedical Informatics • MS Clinical Biochemistry Areas of Expertise and its Application: Basic :Curriculum and Instruction Education Evaluation and Measurement Information Processing/The learning process Knowledge Repositories and Instructional Design Systems Data Visualization Information/Interaction design; Usability Applied: Design of Knowledge Systems for Outcomes based Education Measurement and Evaluation methods; Impact of Learning Instructional Design Systems; Instructional design strategies, teaching Integration of Technology in Education Information Design
  4. 4. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive Those who have been influenced! • AO Foundation • American College of Cardiology • American Society for Clinical Pathology • American College of Radiology • CDC, Ministry of Health, Tanzania • National Quality Laboratory Training Center, Tanzania • Pearson Custom Solutions, Pearson Publishing • McGraw Hill • Cengage Learning • Thomson/Delmar Publications • Center for Medicare and Medicaid Services • Council for Exceptional Children, Washington D.C • University of South Florida • University of Central Florida • Lincoln Technical Schools • US Education Corp • City College • Kaiser University • Hernando County School Board • Hillsborough County School Board • IBM, AT&T • Learning Mate, India • Chartered Institute for Professionals in Financial Accounting, U.K • American Society for Clinical Pathology
  5. 5. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive Polling Question Rank the # 1 challenge in measurement and evaluation you face today 1. Concepts are too abstract and cannot be operationalized 2. Data has too much variability 3. Results are mostly subjective. Objective measurements are a challenge 4. The system does not allow for a streamlined approach to measurement 5. None to very few tools available for implementation 6. Accountability is too high- cannot meet expectation 7. Have little or no access to data; not within a health system
  6. 6. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive My Perspectives • Outcomes is an afterthought in most organizations both for education and training. • Strategic and tactical frameworks for achieving outcomes in most organization is lacking • Lack of clear mapping and alignment of the outcomes methodology with the instructional design and delivery strategies and learner engagement approaches. • At a macro-level, the educational program goals do not align with institutional goals. • The process of learning and factors influencing the learning (individual, group and system level) are not being considered. • Protocols for programs that include QI/PI, research, collaborative team based learning are not clearly defined.
  7. 7. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive A Paradigm Shift in Healthcare From Here To Here Individualistic Collaboration Autonomous Integrated Scholarly Practical Expert Centered Focus Patient/Service Team Hierarchical Distributed
  8. 8. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive Healthcare Environment….. Patient Centered Personalized Care Diagnosis, treatment, and management- the process Behavioral, cognitive, social, economic and cultural factors that impact the physical, mental and social well being of a patient Integrated system- Its about the experience Micro and Macro level issues Accountability/Standardization/health outcomes Health care costs- Sustainability Motivated, disciplined patient Life Long Learners
  9. 9. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive The Challenge Influencing Factors Research Quality Education
  10. 10. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive Performance Needs Learning Needs Business Needs Learning Objectives Application Objectives Impact Objectives Impact and Consequences Application Implementation Learning and Confidence Begin with the End In Mind!
  11. 11. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online Events Business Needs Job Performance Needs Learning Needs Design Analyze DevelopEvaluation Assessment Needs Assessments, Evaluations and survey results, Market Research New developments And trends, Teaching philosophy, goals and vision, situated learning Objectives/learning outcomes, content, instructional design, assessment measures, supplemental materials, resources, modalities and technology Formative/ Summative evaluations, resources, support services, supplemental materials Implement What does that mean?
  12. 12. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive SYSTEM NEEDS Evidence Based Medicine Quality Improvement Performance Metrics Business practices Delivery Models Clinical Research HEALTHCARE DELIVERY Healthcare Teams Coordination of Care Healthcare Disparities Health Information Technology Pay for Performance Life Long Management of Diseases CPD/CE Healthcare Disparities, Episodic to life long treatment, Patient expectations and demands are different, Patients are a part of the team Learner Centered Education/System Driven Training Quality Research Education
  13. 13. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive Display knowledge, comp etence, performa nce at predefined level/benchmarks Develop contextual competence, adap t to change, recognize patterns in problems within a context Adapt to change, find, validate and apply new knowledge Develop competence further through habits of mind, behavior, and wisdom Continuously add to knowledge, compet ence and performance through practice and reflection on experience Assess “the habitual and judicious use of • Communication • Knowledge • Technical skills • Clinical reasoning • Emotions • Values • Reflection in daily practice”. Epstein, MR., Assessment in Medical Education, N. Engl. J Med Jan 25, 2007. 356;4 Teacher/Instructor Facilitator Coach/Curator
  14. 14. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive Polling Questions Of the 5 stages discussed at which level do you think your CE activities are designed and measured? 1. Display knowledge, competence, performance at predefined level/benchmarks 2. Develop contextual competence, adapt to change, recognize patterns in problems within a context 3. Adapt to change, find, validate and apply new knowledge 4. Develop competence further through habits of mind, behavior, and wisdom 5. Continuously add to knowledge, competence and performance through practice and reflection on experience
  15. 15. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online Events Performance Knowledge Competence Moore’s Outcomes Levels Bloom’s levels Participation, Satisfaction Performance Learning- Declarative Procedural Patient Health Community Health Competence Populatio n Health KNOWLEDGE APPLICATION ANALYSIS CREA TE EVALUATIONLearner Needs UNDERSTANDING Learning Formats Instructional Strategies M & E methods and tools Constructive Alignment
  16. 16. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online Events Pre-structural Uni-structural Multicultural Relational Extended Abstract Quantitative Phase Qualitative Phase Identify So simple procedures Enumerate Describe List Combine Do Algorithms Compare Contrast Explain Relate Analyze Theorize Generalize Hypothesize Reflect The Hierarchy of Verbs Deep Learning
  17. 17. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive Motivation, stress, time constraints, cognitive overload Metacognition, critical thinking/reasoning, problem recognition System/Business Healthcare Consumers
  18. 18. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online Events
  19. 19. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online Events In case there was a story to tell…. Member Engagement • At the basic level, any product or service that meets customer needs can derive growth in sales, participation, brand identity and word of mouth. • Consumption is a form of participation or engagement • Can be measured in money, satisfaction, participation, idea generation, retention, money invested by customers, number of spin off products. • Directly links to the professional advancement of the member. • Product/service level engagement Educational Value Activities’ influence on performance, habits and perhaps even outcomes. Activity integrates into professional practice Activity-satisfaction Activity addresses needs Activity allows for knowledge and skills transfer Format of the activity suitable, convenient and easy to follow Content relevant to practice and the needs Return On Investment A traditional financial measure based on historic data. Trends from financial performance Rate of increase/decrease in revenues Marketing ROI Retention and Acquisition rates Strategic Effectiveness Organizational strategy the association chooses to deploy (product leader, most advanced, price leader, cheapest, most customized) based on o Strategic organizational goals o Member value proposition
  20. 20. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive A systems approach to desired results Framework for Program planning and Evaluation
  21. 21. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive How do you measure quality? Improvement Tools • Continuous quality improvement (CQI) – opportunity for improvement exists in every process on every occasion. • CQI model emphasizes view healthcare as a process and focuses on the system rather than the individual when considering improvement opportunities.
  22. 22. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive How do you measure quality?  The FADE Model  FOCUS: Define and verify the process to be improved  ANALYZE: Collect and analyze data to establish baselines, identify root causes and point toward possible solutions  DEVELOP: Based on the data, develop action plans for improvement, including implementation, communication, and measuring/monitoring  EXECUTE: Implement the action plans, on a pilot basis as indicated, and  EVALUATE: Install an ongoing measuring/monitoring (process control) system to ensure success.
  23. 23. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive How do you measure quality? PDSA PLAN: Plan a change or test of how something works. DO: Carry out the plan. STUDY: Look at the results. What did you find out? ACT: Decide what actions should be taken to improve. Repeat as needed until the desired goal is achieved
  24. 24. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive How do you measure quality? Six Sigma • Statistical measurement methodology designed to reduce cost, decrease process variation, and eliminate defects • Sigma is a statistical unit reflecting the number of SDs a given process is from perfection • Steps • 1. Define – creation of project charter which defines the customer’s needs, project scope, goals • 2. Measurement – data collection plan • 3. Analyze – data analysis occurs, deviation from standards is identified • 4. Improve – create solutions and implementation plans • 5. Control – process is controlled by implementing policies, guidelines, and error-proofing strategies to make reverting to old process impossible.
  25. 25. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive Things to consider • Quality Improvement versus research • QI objective address need of local situation • Research seeks to address problems that will provide generalizable results • QI can be considered research if: • the tested intervention involves a deviation from established practices • individual patients are subject • randomization or blinding is conducted • Participants are subjected to additional risks/burdens beyond usual practice.
  26. 26. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online Events Quality of Care Measurement  Costly to implement Quality Improvement programs  Requires good data and evaluation of costs Method Purpose Data Requirements Cost-effectiveness analysis Comparison of costs and health effects of a QI program vs. usual care Utilization data for healthcare providers Long-term health benefits to patients Cost-minimization analysis Comparison of costs of two programs with identical health benefits Same as above Cost-benefit analysis Comparison of program costs and benefits Health benefits of program Cost of programs
  27. 27. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive HealthCare Matrix Bingham, J. and Doris, Q et al (2006). Using an Healthcare Matrix to assess patient care in terms of aims for improvement of core competencies. Journal of Quality and Patient Safety, Vol 31 (2).
  28. 28. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive The Duke Outcomes Matrix • Practice gap matrix • This is where we started……. • Everything in between…… • This is where we are now…….
  29. 29. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive Polling Question Do you use tools to design, develop, implement and measure CE activities? Yes No
  30. 30. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive Outcome- Increase pneumococcal vaccination rates in patients at high risk (18- 64) and those 65 and greater Physicians
  31. 31. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive Health Educators from the County Just for us • Reach out to all seniors and high risk groups through educational sessions within Durham, Wake and Orange Counties • Communicate the importance of pneumococcal vaccines and the consequences of not obtaining one. Outcome- Increase pneumococcal vaccination rates in patients at high risk (18- 64) and those 65 and greater • During home visits for seniors, screen for pneumococcal vaccinations. • Document the screening • Ensure vaccination of seniors who need one and document it.
  32. 32. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive Outcome- Improve Quality of Life for HIV patients by empowering them and their care givers Physicians, researchers, social workers/counselors, nurses and patients Role Goals Measures Physicians, Specialists Effectively communicate the need to maintain the treatment regimens. Emphasize the need for mental, emotional and physical well being and empower the patient to pursue the best treatment that addresses their individual needs. Work with the care giver team members to support the emotional well being of the patient Implement evidence based strategies to communicate and build trust and connect with patient During every patient encounter evaluate patient’s adherence to medication plans. Assess the emotional, physical, and mental well being of the patient. Document the assessment Using coaching techniques, offer suggestions and strategies to enable patient self confidence Present all available options based on the results of the assessment and discuss their advantages and disadvantages.
  33. 33. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive Roles Goals Measures/Indicators Social Workers Guide HIV patients regarding their legal rights following disclosure of their status. Serve as an advocate for the patient. Work with the care giver team members to support the emotional well being of the patient Implement evidence based strategies to communicate and build trust and connect with patients. Upon disclosure, inform and document patient’s legal rights using case examples. List and share all community, state and other resources available to the patient. Communicate to the physician and other care givers if any changes in the emotional, mental or socio- economic condition is observed. Follow up with patients on a regular basis to ensure that the support through resources are made available.
  34. 34. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive Roles Goals Measures/Indicators Nurses Follow all protocols during patient encounters Provide guidance and support related to treatment regiments and their management Work with the care giver team members to support the emotional well being of the patient Implement evidence based strategies to communicate and build trust and connect with patients. Document all patient vital signs, HIV health factors that are evaluated. Assess medication adherence and communicate to the care team appropriately. Share with the care team any changes observed in the emotional, and physical well being of the patient. Communicate with patients, physicians and specialists to ensure proper coordination of care.
  35. 35. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive Roles Goals Measures/Indicators Patients Be well informed about the disease, its diagnosis, treatment and management Contribute to, engage and learn from the broader community Ask questions of all care givers and communicate concerns and challenges. Stay motivated and empowered to pursue the best treatment that addresses their individual needs Participate in educational opportunities offered by the care givers. Engage in online communities and share/exchange knowledge, experiences and resources. During visits, clarify concerns and understanding of treatment options. Participate in activities that lead to empowerment and motivation of oneself to lead a quality life.
  36. 36. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive Performance Dashboard
  37. 37. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive Questions and Next Steps View these on-demand webinars at BeaconLive.com/healthcare-webinar-series Involve Me! Reflection of Adult Learning Principals Healthcare Reform 2.0: What it Means for CME and Medical Communication Professionals Automating your CME Enterprise with Learning Management Technologies BeaconLive’s Healthcare Webinar Series On-Demand Webinars
  38. 38. All Rights Reserved, Duke Medicine 2007This event is powered by BeaconLive Webinars | Webcasts | Online EventsThis event is powered by BeaconLive Questions and Next Steps ➔ Full Service Webinars ➔ Onsite and Remote Webcasts ➔ On-Demand Solutions ➔ Continuing Education Platform ➔ Integrated Registration Contact BeaconLive today to learn how we work with the healthcare industry John Craine | National Sales Manager, Healthcare Services Division jcraine@beaconlive.com | 434.927.4122 BeaconLive’s Healthcare Webinar Series

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