Metric: New AAFP Performance Measurement Program Will Meet Multiple Goals
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* Cindy Borgmeyer

Attendees at the American Academy of Family Physicians Scientific Assembly in October got a sneak preview of a new AAFP program: METRIC—Measuring, Evaluating and Translating Research Into Care. The program will launch in 2005.

Designed to fulfill the criteria for Part IV of the American Board of Family Practice Maintenance of Certification Program for Family Physicians, or MC-FP, METRIC also will provide physicians CME credit for completing practice-based performance measurement projects.

But Bruce Bagley, MD, AAFP Medical Director of Quality Improvement, hopes the program will have more lasting effects.

“We see it as a way to get family physicians interested in doing quality improvement work in their practices,” Bagley explains. “METRIC is really a ‘low hurdle’ in terms of the amount of work that the physician will have to do. Our hope is that we can teach family physicians how to do these kinds of interventions on an ongoing basis.”

According to the ABFP, each Diplomate is required to complete 1 “Performance in Practice Module” during the 7-year recertification cycle. This part of the MC-FP process harkens back to the office record review requirement ABFP Diplomates previously were required to complete. Rather than focusing simply on record-keeping practices, however, the new process will focus on improving practice performance and, ultimately, patient outcomes.

## Hands-On Demo

Participants at the AAFP meeting previewed an abbreviated version of METRIC’s diabetes module, the first of 2 modules developed for the program. The diabetes module is scheduled to launch in January; a module on coronary artery disease will go live in July. The plan is to continue to launch 2 modules each year, with each module being accessed through the Academy’s Web site.

The demo at the Scientific Assembly served 2 purposes, says Christine Pullman, manager of the AAFP METRIC program. First, it gave family physicians attending the meeting a chance to test-drive the new online program before it launches next year. Second, it allowed interested individuals to sign up to perform beta testing of the full diabetes module beginning in November. Those individuals will work through the program module and give input on it.

An added plus: Physicians beta-testing METRIC can earn free CME credit—20 Prescribed credits—for completing the entire module. Although not finalized at press time, the expected cost for AAFP members to use one of the METRIC modules to complete their MC-FP Part IV requirement is $25. Nonmember Diplomates will likely pay $50.

In awarding CME credit for this activity, the Academy is moving down an educational path similar to that laid out in a recently completed AMA pilot project allowing physicians to earn Physician’s Recognition Award Category 1 credit for performance improvement activities.

## Nuts and Bolts

Here’s how METRIC will work when it launches. Participants will first complete a brief practice assessment questionnaire online. The questionnaire is designed to gather information about the physician’s practice environment. Is it a large multispecialty practice located in an academic institution or a smaller family medicine group—even a solo practice—located in a rural community? How many patients call the practice their medical home? Of those patients, how many are actively involved in their own care? Does the practice use a team approach to patient care? If so, how does that team function? What protocols and tools are used in the practice to track patients’ clinical outcomes?

On completion of the practice assessment, the physician will be asked to select 10 patient records from his or her practice based on specific diagnostic codes. The physician will enter data on various clinical and practice performance measures from each of those records into a Web-based data abstraction tool.

After the data abstraction component is completed, participants will receive immediate feedback on how their practice assessment responses compared with those of their family medicine peers. They can also view their baseline performance measurement data. By clicking on each measure, physicians can access relevant evidence-based guidelines.

Based on participants’ selection of practice assessment areas and performance measures needing improvement, the program will suggest interventions shown to affect clinical outcomes and will provide tools to facilitate process improvement. METRIC participants will then develop individualized action plans using the interventions they’ve selected, along with appropriate tools and instructions on their use.

It’s here that Bagley sees the program giving physicians a chance to see the value of using these interventions as part of their ongoing quality enhancement efforts.

“For instance, if an FP puts a registry system in place as one of the interventions chosen as part of his or her METRIC action plan, it is our hope that the physician will realize the value of that system and apply the same principles to registries for multiple chronic conditions,” Bagley says.

Several months later, the METRIC program will send participants a reminder that it’s time to remeasure. Physicians will again record data from 10 patient records on the same performance measures. Those follow-up data will then be displayed alongside their baseline data so participants can gauge how their performance has changed. In addition, both performance assessment report screens—baseline and follow-up—allow physicians to instantly create graphs using their own data.

When the entire exercise is completed, the METRIC program will notify the ABFP that the physician has fulfilled his or her MC-FP Part IV requirement, and CME credit will be awarded. For AAFP members, that credit will automatically be added to their computerized CME records.

## Program Support

The overall METRIC program is supported by multiple educational grants. Specifically, the diabetes module was funded through an educational grant from Merck & Co, Inc; the coronary artery disease module is being supported by Merck/Schering-Plough Pharmaceuticals. CECity.com, Inc, an award-winning online technology provider based in Pittsburgh, Pa, developed the software supporting the METRIC modules.

A Physician Advisory Committee—composed of family physicians whose expertise spans various areas of clinical content, performance measurement, and quality improvement—will guide development of module objectives, performance measures, and interventions. Each of these components will be supported by evidence-based clinical content. Bagley chairs the advisory committee.

The topics will be drawn from several sources. Among them are the Institute of Medicine’s list of the top 20 health conditions in the United States and the results of AAFP surveys on members’ perceived CME needs. “So we’re not going to have obscure diagnoses; we’re going to have disease topics that are significant to the family physician and to the public,” Pullman explains.

Launched modules will remain active for 3 years and will be periodically updated by the advisory committee. After that time, each module will be evaluated to determine whether it should be continued.

## Future Attractions

Data submitted to the METRIC program represent a valuable resource, Pullman notes, and the program’s developers plan to retain those data for use in future practice-based research. “Once the physician completes the program, the data would be kept in aggregate form—after having been completely disassociated from the physician’s information,” she says.

“This is a baby step,” says Pullman, referring to METRIC in the context of full-fledged quality enhancement efforts. And yet programs such as METRIC are key to developing a sustainable culture of quality improvement, she adds.

“Keep in mind that the current requirement for MC-FP Part IV is to do 1 practice improvement project in every recertification cycle—that is, once every 7 years,” Bagley emphasizes. “This would not be adequate to fulfill our goal of getting family physicians involved in ongoing quality improvement and office redesign efforts.

“The Academy’s Quality Enhancement Program will also teach FPs the needed skills to implement the new model of care (described in the Future of Family Medicine report). Many of the interventions that we will recommend in the METRIC program will be the same as those recommended in QEP, so there is some synergy.”

*   © 2004 Annals of Family Medicine, Inc.