Here is an update on some recent research activity. We contributed to grants submitted to AHRQ as part of the iADAPT RFP. Both have returned with reasonable scores and we are in the process of participating with the grant team in answering the questions raised by the reviewers. We have also recently submitted a grant request for financial support for a project that will utilize crew resource management as a facilitation tool for the improvement of care for patients with acute coronary syndromes presenting to the emergency ward.
Archive for May, 2010
Recent Research Activity
Monday, May 24th, 2010Long-Standing Activities in CME
Monday, May 17th, 2010It is a real pleasure and honor to offer long-standing educational activities.
Just this past week one of our activities celebrated its 69th year (Ophthalmology). This week we have an activity celebrating its 20th year (HIV) . In the first weeks of June we have activities celebrating their 6th (Rheumatology), 22nd (Asthma and Allergy) and 11th (Pediatric Endocrine) years.
For more information on these outstanding activities check out the list at the bottom of the Home page as well as our fully searchable calendar.
It’s Time for Watchful Waiting
Monday, May 10th, 2010Healthcare is an ever evolving system. New information enters the system daily, knowledge shifts and expands. What works today sometimes doesn’t work tomorrow based on new and evolving evidence. Simply stated it is not a static being.
Thus it should not be a surprise to anyone that the issues of ethics and healthcare are also evolving. What was held as truisms yesterday get reshaped by changing societal, religious and personal moral and perspective shifts. This is no more evident than in the discussion of relationships and conflict of interest.
Physicians and health system have always been concerned by these issues but clearly more attention is being paid to these issues today. Unfortunately, advances are not being recognized and continued calls for change persist. We need to all step back, take a deep breath and assess what is happening and has happened in this domain. To call for new changes when we do not yet understand what has already changed and its impact may be dangerous and could induce more harm than good. It is time for a period of watchful waiting.
What is especially damaging is the continued use of outdated information. Quoting studies prior to 1998 simply does not take into account massive shifts in both regulation and in the moral perspectives. Using this older data may even be irresponsible if it pushes us to changes that are either not needed, not beneficial or to those that carry unexpected harm.
Yet this is what keeps happening. Opinion pieces in leading journals and in the media continue to use data that is simply outdated. Yes prior to the millennia change a pharmaceutical company could be an accredited provider and yes prior to 2004 there could be influence by the commercial industry into certified CME activities. Yes, historically, many activities were about the travel or the meal. Yes CME was mostly about knowledge transfer and even then its effectiveness was poorly assessed. Yes, attending CME for some was more about the piece of paper than the knowledge or the ability to advance care. These are all unfortunate and yes they are in part our past, but our past does not predict our future.
Certified CME in 2010 is about outcomes. If knowledge is the barrier to change then changing knowledge is appropriate and importantly documenting that change is equally important. CME activities are being created that impact the highest levels of Moore’s outcomes. Commercial funding is down. Transparency has significantly increased and the cleansing effects of sunlight are being realized. The standards of commercial support are in place and new regulations are applied as the system learns from has worked and what has not.
These shifts are occurring in related domains as well. Take for instance the recently reported fall in pharmaceutical sales representatives visits to physicians as physicians look elsewhere for evidence-based information regarding pharmaceuticals. This fall is mirrored by a fall in the numbers of representatives in the industry. There are now even grants for advancing evidence-based prescribing.
If ever there was a time for watchful waiting it is now.
The sunshine act has arrived. Companies are publishing their payments. Disclosure and transparency are part of everyday life for physicians now as policies advance at almost every health center and system. Professional societies are considering a newly published code of conduct. Gifts and trinkets are indeed being squeezed out of the system. Ghostwriting and ghost presenting are being identified and banned. These individual are each significant changes, taken collectively they are massive shifts.
The use of past, outdated data must simply stop. New data is needed, but the changes are so massive, pervasive and new that they have not yet been assessed. Thus, it is time to do what scientists do, sit back, take a deep breath, collect and analyze the data and then make strategic moves forward to advance care, advance professionalism and advance the health of the system and of the population.
It’s time for watchful waiting.
OIG’s view of CME
Monday, May 3rd, 2010Last December, the New England Journal of Medicine published an article on “The Agenda for Continuing Medical Education—Limiting Industry’s Influence,” by Lewis Morris, general counsel, and Julie Taitsman, chief medical officer, for the HHS Office of Inspector General (OIG). The article stated that “the medical profession will one day eschew commercial support for continuing medical education (CME).” Until that day comes, the authors suggested that a mechanism be developed to allow the medical profession to subsidize CME programs designed to improve patient care. The AAMC viewed this article as an invitation to open a dialogue with the OIG about CME and related issues. As a result, Dave Davis, AAMC senior director for continuing education and performance improvement, and Ivy Baer, director and regulatory counsel in our health care affairs unit, sat down with Lew Morris and Julie Taitsman last week. Their wide-ranging discussion touched on the OIG’s concerns about who sets the educational agenda for all CME providers, and the use of CME for “kickbacks.” There was also much give and take during the conversation on how accredited, academic CME differs qualitatively from that of other CME providers. It was agreed that a broader representation of the academic community would benefit from more discussion on these issues. The AAMC is exploring ways to make this happen in the future.