title: The long-term impact of a performance improvement continuing medical education intervention on osteoporosis screening.
abstract: BACKGROUND
  The purpose of this study is to determine whether a performance improvement continuing medical education (PI CME) initiative that utilizes quality improvement (QI) principles is effective in producing sustainable change in practice to improve the screening of patients at risk for osteoporosis.
  
  
  METHODS
  A health care center participated in a PI CME program designed to increase appropriate osteoporosis screening. There were eight 1-hour educational sessions for this activity over a 9-month period. Thirteen providers completed all 3 stages of the PI CME program. A variety of other clinicians, in addition to the 13 providers, participated in the educational sessions. Data were collected at the beginning and end of the PI CME activity and at three intervals during the 5 years after the completion of the activity.
  
  
  RESULTS
  The percentage of tests for osteoporosis ordered and performed increased significantly from Stage A to Stage C of the PI CME activity and continued to increase after the completion of the PI CME activity. Follow-up data at 4 and 40 months (for ordering and performing osteoporosis screening) and 49 months (for performing the screening only) reflect the impact of the PI CME activity plus the continuing QI interventions. The percentage of BMD tests ordered continued to increase substantially over the post-PI CME periods: 4 and 40 months (F(3,46) = 4.04, p < .05). Similarly, the percentage of BMD tests performed continued to increase at 4, 40, and 49 months after the conclusion of the PI CME activity (F(4,55) = 12.55, p < .0001).
  
  
  CONCLUSIONS
  The data indicate that PI CME utilizing QI principles can be effective in producing sustainable change in practice to improve the screening of patients at risk for osteoporosis. Further research is needed to determine the extent to which such changes can be directly attributed to this type of intervention.
authors.affiliation: Assistant Director, Continuing Medical Education, Boston University School of Medicine. laraz@bu.edu, cme@bu.edu.
authors.forename: Lara
authors.initials: L
authors.lastname: Zisblatt
authors.forename: John R
authors.initials: JR
authors.lastname: Kues
authors.forename: Nancy
authors.initials: N
authors.lastname: Davis
authors.forename: Charles E
authors.initials: CE
authors.lastname: Willis
mesh_terms: D015502:Absorptiometry, Photon; D000046:Academic Medical Centers; D000368:Aged; D015519:Bone Density / Q000502:physiology; D001900:Boston; D002983:Clinical Competence / Q000592:standards; D003151:Community Health Centers; D004502:Education, Medical, Continuing / Q000592:standards*; D004521:Educational Measurement; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008403:Mass Screening / Q000592:standards* / Q000706:statistics & numerical data; D008499:Medical Records / Q000592:standards; D008503:Medical Staff / Q000193:education*; D006278:Medicare; D010024:Osteoporosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D015397:Program Evaluation; D058996:Quality Improvement / Q000706:statistics & numerical data*; D018570:Risk Assessment; D014481:United States
keywords: continuing medical education; osteoporosis; performance improvement; preventative medicine; quality improvement