Small N, Big Impact

Thoughtfully designed interactive education can prompt, support, and foster change in clinical practice. However, single-session, point-in-time educational activities focused solely on knowledge and competence gaps are rarely sufficient to drive and sustain practice change because they do not address systemic barriers in a targeted way. Quality improvement (QI) shifts the focus from individual performance to examine and address the systemic and process-based barriers hindering improved performance and desired patient outcomes. As defined by the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) “Quality improvement (QI) consists of systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups.” QI projects focus on the team, the system, the data, and ultimately, the patients.
In the CPD community of practice, continuing medical education providers, academic medical centers, federally qualified health centers (FQHCs), and medical education companies can form strategic and compliant partnerships with support from industry to improve patient outcomes and pilot novel educational strategies to enact practice changes. Boston University Chobanian & Avedisian School of Medicine Continuing Medical Education (BUSM CME) Office, Clinical Education Alliance entities Clinical Care Options and Practicing Clinicians Exchange, RealCME and Eli Lilly will present a case study of a QI program on the topic of Type 2 diabetes and weight management. The program—supported via an unrestricted educational grant from Eli Lilly—seeks to evaluate the following in improving patient outcomes:
1. The effectiveness of a “traditional” QI model exploring facilitators and barriers where CPD staff provides direct project management support, and
2. The effectiveness of a mentored QI program delivered through a digital environment to facilitate peer and expert engagement

The presenters will report on interim outcomes and discuss the essential components of the QI methodology to achieve improved diabetes and weight management outcomes. While grant funding for QI projects may be viewed as speculative given the substantially higher upfront investment, smaller clinician reach, and lack of guaranteed impact to practice, it is the presenters’ contention that QI medical education grants have the potential for a greater return on dollars funded compared to single session educational activities through their ability to enact change through the delivery of improved practice and evidence-based medicine by participating healthcare professionals within systems.

Important take-home lessons will include considerations for both supporters and education providers, such as best practices for compliant interactions during the course of the QI project, aligning all stakeholders with realistic and measurable goals, and planning for scalability.
Outline of

Discussion:
• Intent of RFP
• Program Design
• Outcomes to Date
• Lessons Learned and Best Practices for Consideration

Innovation
Grant funding for this program provided an opportunity to expand the QI project beyond the ‘boots-on-the-ground’ model of QI embedded within an academic medical center into two FQHCs that lacked traditional QI support. The ability to scale this QI project into other clinic settings was a concurrent goal with the patient-centered aims. Leveraging a digital platform, clinicians and other members of the healthcare team at the two FQHCs are being virtually mentored through the development, execution, and evaluation of their QI projects. The methodology allows for testing of the effectiveness of interventions at these disparate sites as well as readiness to scale-up to additional clinic settings or in different therapeutic areas.