MOC Participation Plan
This participation plan must be completed by physicians seeking MOC Part 4 credit for board certification from one or more of the ABMS Member Boards participating in this program. The physician must state plans to participate in an approved QI effort and meet all of the participation requirements of that QI effort.
This participation plan must be co-signed by the MOC project leader and turned into the MOC office () within 2 weeks of the “kickoff meeting.” If the plan involves aspects of a Clinical Standard Work (CSW) project, it must be co-signed by CSW leadership and the CSW consultant for that project.
Note that participating ABMS Member Board MOC fees, if applicable, must be current for the physician to receive MOC Part 4 credit. Participant should verify that the current project fulfills personal timelines and member board requirements.
Respond to each question in a clear and concise manner.
Section 1: Participant Information
Provide the following details:
1. Date of Submission
2. Portfolio Sponsor What is the name of the sponsoring organization providing the QI effort?
Seattle Children’s Hospital
3. Title of quality improvement effort
4. Name
5. Email Address
6. Birth date
7. NPI Number
8. Certification Information Indicate your certifying Board or Boards and your unique Board identification number
9. Participation Indicate the beginning and ending date of your participation in the QI effort
Section 2: Review checklist for meaningful participation
To receive Part 4 MOC credit (25 points) from Seattle Children’s MOC Program, all physicians must complete the following:
Work with team members to plan and implement a minimum of one project intervention.
We suggest that interventions be supported with:
· Previous success in another setting
· Use systematic analysis of systems or processes of care (e.g., a process map, root cause analysis to identify possible interventions, or use of a logic diagram or key driver diagram to explain the rationale for the change)
· Evidence from published literature
Submit Participation Plan to SCH Portfolio Manager. Verify that the current project fulfills personal timelines and member board requirements.http://www.seattlechildrens.org/healthcare-professionals/education/maintenance-of-certification-MOC/forms-and-documents/
Use an annotated run chart to monitor data and assess the impact of the intervention.
We suggest data collection and usage include:
· Use of relevant outcome, process, and balancing measures to effectively assess impact of interventions and potential unintended consequences
· Sufficient sample size to support effective assessment of the impact of the intervention. The frequency of the data collection should be appropriate to the measures for the QI effort
· Timely feedback reports at the appropriate unit of analysis to allow frequent, rapid improvement cycles.
· Evidence that data are of sufficient quality to provide accurate guidance to the project team
· Use of appropriate charting or reporting tools to document performance over time (e.g., annotated run charts, control charts, etc.)
· Activities should be of sufficient duration to allow for physician participation in at least one full cycle of assessment, intervention, and re-measurement (“PDCA Cycle”)
· Participation in more than one full PDCA cycle is strongly encouraged and will be a requirement in the future
Attend at least 3 team meetings to review the run chart and to identify and mitigate barriers to the intervention. One of these team meetings must be the Attestation Meeting (see below).
Complete quality-improvement training such as Continuous Process Improvement courses, IHI Open School, or self-directed reading. http://www.seattlechildrens.org/healthcare-professionals/education/maintenance-of-certification-MOC/opportunities-learn-quality-improvement/#
Attend Attestation Meeting and complete Attestation Form upon completion of the activity and submit to the SCH Portfolio Manager.
http://www.seattlechildrens.org/healthcare-professionals/education/maintenance-of-certification-MOC/forms-and-documents/
Section 3: Description of the Quality Improvement Effort
Describe the quality improvement effort by providing the following details:
1. Global Aim What is the overall goal of this improvement project? (For example, to implement local and national recommendations for the hospital management of Croup)
2. Intervention What change do you plan that you think will lead to improvement? (In general, a MOC project implements and monitors only one intervention. For example, modification of an order within an order set to improve adherence to a specific pathway recommendation.)
3. Specific Aim What is the specific aim of the QI intervention? (Hint: Be specific! For example, to decrease readmission rates for patients on the Croup Pathway from 8% to 4% by January 1, 2014)[[see link to Setting Aims]]
4. Current State Describe how this condition is currently managed and the barriers to improving care.(Hint: A process map is an efficient way to describe the complexity of healthcare delivery in large systems)
5. Data Source What is the source of the data used to measure performance in the QI effort? (Hint: We advise that you use previously collected (i.e., billing or administrative) data. Although helpful, chart reviews can be extremely time consuming!)
6. Data Collection Who will be responsible for data collect? What methods will be used for data collection?
7. Improvement Explain why you think this intervention or change will lead to better care for your patients?
8. Process and/or Outcome Measures How do you know a change will result in an improvement? Describe how the measure is derived or calculated. Be specific and list the numerator and denominator. (For example, the numerator is the number of patients with an order for medication over the denominator of number of patients discharged with the condition)
Numerator =
Denominator =
9. Balance Measures Explain how you will use data to monitor unintended consequences of the proposed change for your patients?
Numerator =
Denominator =
10. Role What is your role in the QI effort? (For example, project leader, consultant, specialist, hospitalist, primary care, etc)
11. Activity Describe your planned activity in the QI effort.
12. Team Involvement Are other members of your care team involved in the QI effort? If so, explain how.
Section 4: Signature
I attest I plan to participate in this QI effort as described above.Physician Signature
Printed name / Date
I have reviewed and approve this plan for the above signed to meet MOC Part 4 credit. I am designated by the Portfolio Manager to review and approve attestations of participation for this QI effort.
Project Leader Signature
Printed name / Date
I have reviewed and approve the elements of this plan that involve Clinical Standard Work for the above signed to meet MOC Part 4 credit. [if applicable to this project]
Clinical Standard Work
Leadership Signature
Printed name / Date
I have reviewed and approve the elements of this plan that involve Clinical Standard Work for the above signed to meet MOC Part 4 credit. [if applicable to this project]
Clinical Standard Work
Consultant Signature
Printed name / Date
Seattle Children’s Multi-Specialty MOC Portfolio Approval Program | Project Plan / 2
SCH.MOC.PARTICIPATIONPLAN.400 v.1.5 [Feb 2014]