| Summary: | Thesis (Ed.D.)--Boston University === Background: The American Board of Medical Specialties (ABMS) developed a requirement that uses the process of board certification to have physicians complete improvement cycles to help them increase their compliance with basic standards of practice. To meet this requirement, called Part IV Practice Performance Assessment, some organizations have developed self-directed, web-based modules that bring providers through each stage of improvement. The purpose of this study is to determine the impact of these web-based Part IV modules, to see what, if any, improvements they effect in practice, and to see if they encourage participants to engage in practices that are proven to bolster and sustain improvement.
Methods: There are two parts to this study. In the first part, the data from three web- based Part IV modules were analyzed using a matched-pair t-test to compare baseline and follow-updatacollectedaspartofthemodules. Inthesecondpartofthestudy,afocused ethnography was used to investigate the views of physicians about this new requirement. Participant views were collected through a semi-structured interview process and data were analyzed through thematic analysis.
Results: Data were analyzed for 770 clinicians who participated in one ofthree web- based Part IV modules. Participants demonstrated significant improvements in 27 of 31 measures assessed through the modules. Thirty-two physicians who participated in one of three modules were interviewed. Data from the interviews show that while a majority of physicians did not want to participate in such modules, some found value in participating and improved their practice. Some used quality improvement strategies and made
improvements that impacted their performance and the performance of other physicians in their practice. Others focused on their own practice and worked to change habits. Some participants reported no change in practice and considered participation a waste of time.
Conclusions: The data from the modules suggest that they are able to help physicians improve practice. The data from the interviews can help the creators develop modules that enhance the factors that inspire physicians to make changes in their practice and not
just fulfill the requirement.
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