The purpose of this study is to determine whether having physicians evaluate their
management of certain diseases as part of board recertification results in improved patient
In the year 2000, the American Board of Internal Medicine introduced continuous professional
development as part of its board recertification process. The purpose of these changes were
to achieve the following goals:
- To improve the quality of patient care;
- To affirm the high standards expected of a self-regulating, accountable profession;
- To foster continuing scholarship and self-improvement;
- To offer diplomats a portfolio of credentials attesting to competence; and
- To add value to the health care system.
The most notable change in the new recertification process was the addition of practice
improvement modules (PIMs). These modules require physicians to review how well they manage
a particular chronic disease within their practice and to develop an improvement plan for
their practice. In April 2005, it became a requirement that all internists complete a PIM
as part of board recertification.
Currently, it not known whether having physicians evaluate their management of certain
diseases as part of board recertification will achieve its intended goal of improving
patient care. Therefore, the purpose of this trial is to assess whether practice
improvement modules result in improved clinical performance.
The PIM selected for this study will focus on asthma. As PIMs seek to improve the quality
of care within a practice, the unit of randomization in this study will be clinics (i.e.,
practices) within the Henry Ford Health System. We will enroll practicing, board-certified
internists within the Henry Ford Medical Group (~40 internists or 20 per arm). Clinics (~16
or 8 per arm) will then be randomized to either complete the PIM or not complete the PIM.
Participating internists at a site randomized to complete the PIM will be encouraged to work
together to complete the asthma PIM. Participating internists at control sites will
continue usual care and will not be asked to complete an asthma PIM.
Comparisons: We will assess differences in asthma care by prospectively surveying patients
seen by physicians in the intervention group and control group following the intervention
period. These analyses will be adjusted by the baseline characteristics of asthma patients
seen by participating physicians.
- Previously board-certified in internal medicine
- Practicing general internist within the Henry Ford Medical Group
L. Keoki Williams, MD, MPH
Center for Health Services Research, Henry Ford Health System