Improving Foot Examinations in Patients With Diabetes: A Performance Improvement Continuing Medical Education (PI-CME) Project.

PURPOSE: The purpose of this project was to determine if a Performance-Improvement Continuing Medical Education (PI-CME) project, using the American Medical Association's methodology, would help improve the timeliness and comprehensiveness of foot examinations in patients with diabetes.

METHODS

A PI-CME project was conducted with the Internal Medicine faculty staff physicians (n = 8) and residents (n = 45). Following the 3 steps of PI-CME, participants received baseline reports about their performance defined by the American Diabetes Association's guidelines for foot examinations (stage A). Each group received an educational intervention (stage B) and a reminder tool for use in the practice. Participants received individualized reports about their performance post intervention (stage C) for comparison with preintervention data and reflection on any changes in compliance.

RESULTS

In the faculty and resident clinics, the percentage of patients who received an annual foot examination when due increased significantly. Both clinics also showed improvements in the percentage of patients who received all 3 components of the exam, with the greatest improvement in the resident clinic.

CONCLUSIONS

The PI-CME approach can be successfully used both with faculty staff physicians (who receive CME credits) and residents (who do not receive credits) to improve performance on diabetes quality measures.