The Impact of a Preventive Cardiology Quality Improvement Intervention on Residents and Clinics: A Qualitative Exploration

Elizabeth C. Bernabeo, MPH, Lisa N. Conforti, MPH, Eric S. Holmboe, MD

Am J Med Qual 2009;24: 99-107

Dr Teirstein Comments

This work was sponsored by ABIM and the authors include highly paid employees of the ABIM. This study explored the impact of the Preventive Cardiology Practice Improvement Module (PC- PIM) on residency clinics. Residents did Practice Improvement modules that are part of MOC. The authors then interviewed the residents and training program directors, asking them questions about how they felt about the module. There is no data provided. The results section is a series of anecdotes. They state, “results from 22 clinic interviews indicated merit in using the PC-PIM to teach QI during residency. Many residents reported increased knowledge and confidence, particularly regarding the value of QI. The majority recognized that QI often leads to improved patient care and outcomes, even in resource poor environments.” This paper is written by conflicted authors who interviewed conflicted subjects. The results section is simply a description of what the subjects thought and felt about the experience. An analogy might be if your boss called you on the telephone and asked if you thought you worked for a good company or a bad company. It would not be a surprise if everyone reported they worked for a good company.

Dr Cohen Comments

This is a qualitative research study, meaning it was based on structured but open ended interviews and is largely descriptive—looking for themes. Whether the residents who were interviewed were conflicted is difficult to know, but it appears that a number of the interviews were conducted jointly with both a resident and a supervising faculty member, who was often a champion for the quality-improvement project. Therefore, it would not be surprising that some degree of bias was induced by the joint interview process.

Dr Ajay Kirtane Comments

This study explored the impact of the Preventive Cardiology Practice Improvement Module (PC- PIM) on residency clinics through interview methodology. Outcomes or process changes were not reported here. The overall study included 720 participating internal medicine residents at 23 ambulatory sites; the results in this publication include that from 22 interviews at 15 training sites with faculty and resident “champions” (in 7 cases both together). Descriptive terminology is used and in general “most clinics reported a successful experience and results demonstrated multiple aspects of positive impact from implementing the PC-PIM”. Another summary description states “Overall, the themes that emerged to describe the value of doing the PC-PIM at the resident level were the following:

 

  1. learning the value of a QI team, as well as how to form one
  2. recognizing that QI often leads to improved patient care and outcomes, even in resource poor environments
  3. increased knowledge and confidence regarding performing QI activities.” Whether these were influenced by the inherent selection bias among interviewees who participated is not known.