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HomePerformance Improvement
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This activity will provide participants with a self-assessment opportunity for improving the management of outcomes of adult patients with depression. Click below to Enroll!
This activity will provide participants with a self-assessment opportunity for improving the management of outcomes of adult patients with Schizophrenia. Click below to Enroll!
Performance Improvement - Depression
Major depressive disorder (MDD) is a common and greatly debilitating illness that affects as much as 13% of the U.S. population, with each depressive episode lasting approximately 16 weeks. It imposes a substantial burden on society as a leading cause of disability, lost work productivity, morbidity, mortality, and increased use of health services.
Until recently, response, defined as a 50% or greater reduction on objective measures of improvement such as HAM-D or CGI-I, was the focus of treatment. Now, however, treatment success in the management of MDD is determined by meeting two goals: 1) complete relief from all signs and symptoms of depression, including the restoration of psychosocial and occupational functioning to premorbid levels; and 2) complete symptomatic remission or prevention of recurrence.
Patients treated for MDD who still have residual symptoms have more than twice the risk of relapse and experience a recurrence more than 3 times faster than asymptomatic patients. This highlights the need for MDD to be adequately treated and monitored over time to ensure that patients achieve and maintain remission of all symptoms. Subsequently, in order to achieve remission and long-term functional recovery in patients with MDD, it is critical to have the skills to develop and implement effective treatment plans.
Program Detail
References:
- Hasin DS, Goodwin RD, Stinson FS, Grant BF. Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on Alcoholism and Related Conditions. Arch Gen Psychiatry. 2005;62(10):1097-1106.
- Kessler RC, Berglund P, Demler O, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289(23):3095-3105.
- Rush AJ, Trivedi MH. Treating depression to remission. Psychiatr Annals. 1995;25:704-705.
- Panzarino PJ, Jr. The costs of depression: direct and indirect; treatment versus nontreatment. J Clin Psychiatry. 1998;59 (suppl 20):11-14.
- Thase ME. Therapeutic alternatives for difficult-to-treat depression: a narrative review of the state of the evidence. CNS Spectr. 2004;9(11):808-816, 818-821.
- Miller IW, Keitner GI, Schatzberg AF, et al. The treatment of chronic depression, part 3: psychosocial functioning before and after treatment with sertraline or imipramine. J Clin Psychiatry. 1998;59(11):608-619.
- Halfin A. Depression: the benefits of early and appropriate treatment. Am J Manag Care. 2007;13:S92-S97
- Trivedi MH. Treatment-resistant depression: new therapies on the horizon. Ann Clin Psychiatry. 2003;15(1):59-70
- Rush AJ, Trivedi MH, Wisniewski SR et al. Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression. N Engl J Med. 2006;354 (12):1231-1242
- Rush AJ, Trivedi MH, Wisniewski SR, Nierenberg AA et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006;163(11):1905-1917
Performance Improvement - Schizophrenia
Schizophrenia is a highly prevalent disorder that continues to challenge physicians with respect to diagnosis and treatment. It has been reported that, on average, individuals diagnosed with schizophrenia suffered with the condition for more than 2 years before a correct diagnosis and intervention was made. Numerous factors lead to misdiagnosis including symptom overlap between the different syndromes, challenges with diagnostic criteria, and comorbid medical and psychiatric conditions.
Early onset and a course of chronic and recurrent relapses and hospitalizations are central features of schizophrenia. The age of onset of the disorder is widely accepted as carrying considerable clinical and prognostic significance. Patients with early age of onset are likely to have worse premorbid functioning, a significantly longer duration of untreated psychosis, more severe illness, and a greater likelihood of biological abnormalities. Proponents of early intervention argue that outcome may be improved if more therapeutic efforts were focused on the early stages of schizophrenia. Moreover, as approximately half of patients with schizophrenia have at least one comorbid psychiatric or medical condition, prognosis is worsened and morbidity and mortality is increased. Many patients with comorbid conditions experience limited functionality, and the presence of comorbidity leads to poorer short- and long-term outcomes in schizophrenia, and complicates the treatment of both schizophrenia and co-occurring conditions.
Long-term therapy is a necessary requirement for most patients with schizophrenia, however, effective treatments that maintain efficacy with minimal adverse effects can be a difficult balance to achieve. Subsequently, in order to mitigate the effects of the chronic, debilitating nature of schizophrenia, clinicians must be able to recognize the disorder in its prodromal phase and develop strategies to implement aggressive, appropriate care unique to each patient’s dynamics.
Program Detail
References
- Perkins DO, Leserman J, Jarskog LF, et al. Characterizing and dating the onset of symptoms in psychotic illness: the Symptom Onset in Schizophrenia (SOS) inventory. Schizophr Res. 2000; 44(1):1-10.
- Yung AR, McGorry PD. The initial prodrome in psychosis: descriptive and qualitative aspects. Aust NZJ Psychiatry. 1996;30(5):587-599.
- Ziedonis DM, Smelson D, Rosenthal RN et al. Improving the care of individuals with schizophrenia and substance use disorders: consensus recommendations. J Psychiatr Pract. 2005 Sep;11(5):315-39
- Colton CW, Manderscheid RW. Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prev Chronic Dis. 2006;3:A42.
- Ongur D, http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Ong%C3%BCr%20D%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlusLin L, Cohen BM. Clinical characteristics influencing age at onset in psychotic disorders. Compr Psychiatry. 2009;50:13–19.
- Joa I, Johannessen JO, Langeveld , et al. Baseline profiles of adolescent vs. adult-onset first-episode psychosis in an early detection program. Acta Psychiatr Scand. 2009;119:494–500.
- Marshall M, Rathbone J. Early intervention for psychosis. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD004718.
- Nasrallah HA, Keshavan MS, Benes FM, et al. Proceedings and data from The Schizophrenia Summit: a critical appraisal to improve the management of Schizophrenia. J Clin Psychiatry. 2009;70 Suppl 1:4-46.
- Chwastiak L, Rosenheck R, McEvoy JP et al. Interrelationships of Psychiatric Symptom Severity, Medical Comorbidity, and Functioning in Schizophrenia. Psychiatr. Serv. 2006. 57(8):1102-1109
- Batki SL, Meszaros ZS, Strutynski K et al. Medical comorbidity in patients with schizophrenia and alcohol dependence. Schizophr Res. 2009 Feb;107(2-3):139-46.
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Performance Improvement (PI)
Overview of PI CME:
PI CME, or performance improvement continuing medical education, is an individualized long-term online tool that provides physicians with the opportunity to perform self-assessments of the current clinical care they provide to their patients, compare their current practice to established evidence-based guidelines and performance measures, and ultimately improve their professional practice and patient care outcomes by implementing changes based on performance gaps found from the self-assessment process. Our PI CME activities are based on the American Medical Association’s three-stage learning model for long-term performance improvement.
Our PI CME program guides physicians through all 3 stages and enables them to easily collect and enter data from their own practices using chart reviews and self-assessment surveys. A member of our QI staff will be available throughout the program to assist with any questions. For each stage completed, 5 AMA PRA Category 1 Credits™ can be earned, with a total of 20 AMA PRA Category 1 Credits™ awarded if all 3 stages of PI CME are completed.
PI CME has 3 stages:
- Stage A: Self-assessment of current practice
- Stage B: Development and implementation of improvement plan
- Stage C: Re-evaluation and reflection of practice changes
Our PI CME activities not only enable physicians to improve their own practices and patient health outcomes while earning CME credit, but they also meet the new requirements for maintenance of board certification.
Frequently Asked Questions (FAQs):
- What is performance improvement CME?
Performance improvement CME, or PI CME, is an individualized long-term process that provides physicians with the opportunity and tools to perform self-assessments of the current clinical care they provide to their patients, compare their current practice to established evidence-based guidelines and performance measures, and ultimately improve their professional practice and patient care outcomes by implementing changes based on performance gaps found from the self-assessment process.
- How does our PI CME work?
Our PI CME program guides physicians through all 3 stages and enables them to easily collect and enter data from their own practices using chart reviews and self-assessment surveys. A member of our QI staff will be available throughout the program to assist with any questions. For each stage completed, 5 AMA PRA Category 1 Credits™ can be earned, with a total of 20 AMA PRA Category 1 Credits™ awarded if all 3 stages of PI CME are completed.
PI CME has 3 stages:
- Stage A: Self-assessment of current practice
- Stage B: Development and implementation of improvement plan
- Stage C: Re-evaluation and reflection of practice changes
- Why should I participate in PI CME?
Our PI CME activities will enable you to improve your own individual practice and patient health outcomes, while at the same time allowing you to conveniently earn CME credits from your own office. PI CME is the most relevant type of CME activity for you and your patients and will also help you to meet the new requirements for maintenance of board certification.
- How many CME credits can I earn by participating in PI CME?
Physicians may earn 5 AMA PRA Category 1 Credits™ upon successful completion of each stage. Completion of all 3 stages (Stages A, B, and C) allows a physician to earn a total of 20 AMA PRA Category 1 Credits™
- How much time is involved if I participate in PI CME?
Of course, the time spent on each stage will vary from physician to physician. We are providing the following estimates to help you plan your participation.
- Stage A: 2-4 hours
- Stage B: 1 hour, not including time spent implementing plan
- Stage C: 2-4 hours
- PI CME activities are available for what specific clinical conditions?
The specific clinical conditions for which our PI CME activities are currently available are depression and schizophrenia.
- What are the new maintenance of board certification requirements for psychiatrists?
As of May 6, 2009, the American Board of Psychiatry and Neurology (ABPN) describes 4 components for maintenance of certification (MOC). These are:
- Professional Standing
- Self-Assessment and Lifelong Learning
- Cognitive Expertise
- Performance in Practice
We have designed our PI CME program to be in compliance with the Clinical Modules portion of part 4 of the ABPN MOC. Additional information regarding the ABPN MOC program for psychiatry can be found at http://www.abpn.com/moc_psychiatry.htm
- Is PI CME HIPAA compliant since patient charts are used?
Yes, all patient data collected from chart reviews are anonymous and therefore HIPAA compliant.
If you have any questions about how to get started with PI CME or have questions during any of the PI CME stages, CME LLC’s Quality Improvement staff is available to help you, contact us.
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