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Improvement in Medical Practice

Improvement in Medical Practice (IMP) contributes to improved patient care through ongoing assessment and improvement in the quality of care in practices, hospitals, health systems, and/or community settings.

 

This can include activities that result in:

  • Improved patient or population health outcomes
  • Improved access to health care
  • Improved patient experience (including patient satisfaction)
  • Increased value in the health care system

 

 

Improvement in Medical Practice Activity Options

 

There is now more flexibility in meeting this MOC standard, as you can choose the activity most relevant to your own practice and practice setting. It is required that you participate in one of the available Improvement in Medical Practice activities yearly in MOC Years 1-5.

 

ABOG Improvement in Medical Practice Modules can be accessed through the ABOG website via your personal page in the physician portal. You may choose a topic that is appropriate to your practice from the list of available modules.


There are two phases to each module:

  • Phase 1 of the module typically involves review of up to 10 of your patient records and answering pertinent questions. Some topics involve policy review instead of patient records.
  • Phase 2 of the module process occurs one month later. You'll receive an email from ABOG and must complete follow-up questions to complete the module.



REQUIREMENTS

  • If you choose modules, you are required to open and complete Phase 1 of a module each year for the first five years (MOC Years 1-5) in each six-year MOC cycle. Phase 2 will be available after one month.
  • You must complete all modules before the end of MOC Year 6.

ABOG will consider structured quality improvement (QI) projects in obstetrics and gynecology for MOC credit. These projects must demonstrate improvement in care and be based on accepted improvement science and methodology. Newly developed QI projects from organizations with a history of successful QI projects are also eligible for approval.


How to apply for ABOG approval:

  1. Submit a QI application before December 1, 2019, to the MOC department with information about the activity and the sponsor organization. The application can be accessed on your Personal Page on the Part IV section.
  2. ABOG staff will review the application. During the review period, you may be asked to clarify information about your activity. Please allow up to four weeks for review.
  3. You'll be responsible for submitting a list of participants each year by Monday, December 9, 2019, to ensure processing before the MOC deadline on December 15, 2019.



QI efforts in obstetrics and gynecology that qualify for MOC credit must meet the following standards:

  1. Have leadership and management at the project level capable of ensuring adherence to participation criteria. This means that the project must track who is participating, their dates of participation, and their role with respect to the definition of meaningful participation.
  2. Address care you can influence in one or more of the six Institute of Medicine quality dimensions (safety, effectiveness, timeliness, equity, efficiency, and/or patient-centeredness).
  3. Have a specific, measurable, specialty-relevant, and time-appropriate aim for improvement.
  4. Use appropriate, relevant, and evidence-based performance measures that include measurement related to patient care at the appropriate unit of analysis (physician, clinic, care team, etc.).
  5. Include appropriate interventions to be tested for improvement.
  6. Include appropriate prospective and repetitive data collection and reporting of performance data to support effective assessment of the impact of the interventions over two or more improvement cycles.
  7. Represent an attempt at translation or implementation of an improvement into routine care or the dissemination or spread of an existing improvement into practice.
  8. Possess sufficient and appropriate resources to support the successful conclusion of the activity without introducing a conflict of interest.



In order to earn MOC credit for participating in approved QI efforts, you must:

  1. Attest that you have meaningfully participated in the approved QI effort
  2. Have your attestation cosigned or reported to ABOG by the project leader
  3. Reflect on the QI effort



Your participation in an approved QI effort is considered meaningful when:

  1. The QI effort is intended to provide clear benefit to your patients and is directly related to your clinical practice of obstetrics and gynecology.
  2. You're actively involved in the QI effort, including, at a minimum, working with care team members to plan and implement interventions, interpreting performance data to assess the impact of the interventions, and making appropriate course corrections in the improvement effort.
  3. You're able to personally reflect on the activity, describing the change that was performed in your practice and how it affected the way care is delivered.


You can claim MOC credit each time you meet meaningful participating requirements as long as you're implementing new interventions.

Many physicians already participate in quality improvement (QI) efforts in their local practice. The Multi-Specialty MOC Portfolio Approval Program (Portfolio Program) is an alternative pathway for healthcare organizations that support physician involvement in QI and MOC to allow their physicians' QI efforts to be approved for ABOG MOC Part IV credit.


  • Most Portfolio Program QI activities are sponsored by the institution or hospital QI departments.
  • QI projects may be multidisciplinary or specialty-specific in obstetrics and gynecology.
  • The projects must meet Portfolio Program standards and be approved by ABOG through the program.
  • If you meaningfully participate in the QI efforts, you'll meet MOC requirements for a year.
  • An individual project participation and MOC credit may extend for up to two MOC years.
  • Longitudinal projects may be renewed for longer QI activities.


To find out more about the Portfolio Program, visit their website.

ABOG recognizes simulation training an as innovative approach to assess your technical, clinical, and teamwork skills in obstetrics, gynecology, and office practice. You may participate in CME that involves simulation activities provided that the CME is approved in advance by the MOC Division of ABOG. After reviewing the CME content and simulation activity, ABOG will approve CME that meets MOC standards (has relevant and meaningful simulation and self-assessment).


The simulation activity must provide advance, hands-on, clinical education experiences for participants from a wide scope of practices. It may integrate task-trainers, low- and high-fidelity simulators, computer-based simulations, and actual medical devices to provide optimal learning opportunities.



How to apply for ABOG approval:

  1. Submit a Simulation application before December 1, 2019, to the MOC Division with information about the activity and the sponsor organization. The application can be accessed via your personal page in the Part IV section.
  2. ABOG staff will review the application. During the review period, you may be asked to clarify information about your activity. Please allow for up to four weeks for review.
  3. You'll be responsible for submitting a list of participants each year by Monday, December 9, 2019, to ensure processing before the MOC deadline on December 16, 2019.



Simulation Course Standards


To ensure high-quality learning experiences, ABOG has established guidelines for simulation and will approve activities for MOC Part IV credit which meet those standards.


The following core curriculum components for simulation courses must be present:

  • A minimum of four hours of total course instruction
  • Active participation in realistic simulation procedures or scenarios
  • Management of relevant patient-care scenarios with an emphasis on teamwork and communication, if appropriate
  • Assessment of technical skills, if appropriate
  • Feedback or post-scenario debriefing, if appropriate
  • One instructor must be an ABOG Diplomate
  • The instructor-to-student ratio must be no greater than 1:5



MOC and CME Credit


To receive MOC credit, you must actively participate in the entire simulation course and complete a course evaluation. After the activity, you will receive email instructions to reflect on the simulation and to answer web-based questions about the impact on your practice.


ABOG MOC credit is independent of CME credit. Some activities and courses may provide CME credit. Contact the site or sponsor for specific CME information about their course.

ABOG awards MOC credit for authorship or co-authorship of published articles relating to quality improvement (QI) activities in health care. To be considered for MOC credit, articles must:


  1. Be published in a peer-reviewed journal
  2. Adhere to SQUIRE guidelines for published QI articles
  3. Be published during your current MOC cycle
  4. Be approved by ABOG

ABOG also recognizes authorship and co-authorship of peer-reviewed oral presentations and posters presented at national scientific meetings that describe the implementation and outcomes of a QI project. The project's ultimate success will not affect the credit, but it should address a recognized gap in care, generally be prospective, and involve more than one QI cycle.



To be considered for MOC credit, abstracts or posters must include:

  1. The specific aim of the QI project
  2. The process for improvement
  3. The progress toward or results of achieving the specific aim
  4. A discussion of whether the aim was achieved, factors that affected success, and next steps
  5. Be approved by ABOG



How to Apply for ABOG Approval

  1. Submit the publication, abstract, or poster to the MOC Division by mail or email.
  2. Provide the date of the publication or presentation.
  3. Staff will review and approve completed submissions. You may be asked to clarify information during the review process.
  4. Please allow up to four weeks for the review and notification.

Clinical research is valuable but different from QI. Typically, the following will not each MOC credit:

  • Research publications, including comparative trials, before-and-after studies, and other studies intended to answer a clinical or scientific question.
  • Descriptions of studies to assess whether an intervention is effective.
  • Quality-measure development.
  • Retrospective studies of administrative claims data.