Here’s another case from the session on preventing the appearance of bias.

Case 3: Faculty selection

Dr. Gray Matter has been asked by the American Society of Cardiac Cures to make a presentation regarding a heart gizmo newly released by Fix-It Device Company. Dr. Matter, an excellent presenter and world-renowned interventional cardiologist, is the primary researcher for this new product and spent ore than a decade developing it. He is a major shareholder in Fix-It, and has noted this on his disclosure form. The education coordinator for the society has noted the disclosure information and intends to discuss this during the upcoming Education Advisory Committee meeting.

Seventy-four percent of the audience voted via ARS that this had a high chance of having the perception of bias; 60 percent said it would be most difficult to comply with Standard 2 (resolution of personal conflicts of interest), 20 percent said it would be tough to comply with Standard 5 (content and format without commercial bias). The vast majority said they would exclude him altogether.

He still could be doable, some said, if he was limited to talking about the development of the product, not patient recommendations. Other possible mitigators people suggested included rigorous peer review, fact checking, making sure his results had been published in reputable journals, and add in competing devices. Or just offer the event as uncertified CME. One person pointed out that, if it was the only treatment for that disease, he could make an argument for Dr. Gray Matter being OK to use.

I missed some of the beginning stuff in this session, like the definition of speakers bureau and the regulations that affect speakers bureaus (I came in just as Debra Gist, consultant, was finishing up on the regs part and was recommending that people check out my article on the Phase II rules of the Stark Law—thanks, Deb!) . I’ll post more when the presenters e-mail those slides to me. Here’s the part I caught.

Maureen Doyle-Scharff, Abbott Laboratories, outlined some of the realities pharma companies are dealing with that impact their speakers bureaus:

* Budgets are being cut across the board, not just for CME but everywhere.

* The firewalls between marketing and medical affairs can create confusion when it comes to key opinion leader services.

* Pharma is trending away from “road shows” (i.e., visiting professor programs).

* Investment in single, standalone events is viewed as less risky.

* Some companies are beginning to differentiate between promotinal and independent speakers.

“It’s turning into a ‘read our minds’ situation,” she said. “We don’t want to have anything to do with speaker selection. Don’t ask us.”

The good news, she said, is that we all are beginning to recognize that faculty need training on what is and is not appropriate. In fact, industry is “champing at the bit for this”—”this” being a formalized training program that will walk faculty through what they can do in each setting. She said that one component of a training program that should be rolled out later this year (I’m not sure who, exactly, is developing it, but from what she said, it sounds like a cooperative effort between industry and some of the major players on the CME side), will be a certification that the faculty member has gone through the training and has agreed to follow the rules.

Every major pharma company that was at the table plans to rquire any individual who serves as faculty to go through this training, she said. “Many of the CME providers also said they won’t use faculty who haven’t gone through this training. It could come down to pharma companies not being willing to support any activity whose faculty haven’t gone through this training.”

Nathalie Harden, with Health Science Communications Health Science Center for CME, then spoke about how to partner effectively in joint or co-sponsorships in today’s “overly regulated environment.” Why partner? “We need to to survive. We’re all vying for the same funds. Partners can request grants together and share the pot.” Partnering also can help match one company’s strengths with another’s weaknesses.

The biggest obstacles, she said, were ineffective early communication, misunderstandings about what roles each partner will play, and a lack of documentation to cement the deal. She recommended talking with partners early and often, exchanging written policies, and creating realistic timelines that meet each partner’s needs. Know who’s in charge of what, and whose resources are best suited for each aspect. Create a process for resolving issues that come up, and don’t rely on verbal agreements. Have each provider sign a collaborative agreement and share it among all the stakeholders.

The Q&A mostly revolved around the faculty training program Doyle-Scharff talked about. I asked if there would be any consequences for not living up to the agreement to live by what they learn, and there aren’t any built into the program itself. But Doyle-Scharff said that CME providers hopefully wouldn’t use faculty who haven’t gone through the training, or who violate what they learned. Mark Schaffer, EdM, Thomson Professional Postgraduate Services, also a presenter, said that the purpose really is to educate the faculty, because a lot of them really don’t understand the difference between promotional and educational events. He believes that they want to behave correctly, and will once they understand where the lines are drawn.

The topic of whether companies are cutting back on promotional meetings also came up. Schaffer said that physicians tend to like certified education better than promotional meetings, and that companies are cutting back on promotional meetings because they’re recognizing that fact. Doyle-Scharff said that some companies are in fact cutting back on promotional meetings, something that doesn’t break her heart. “I believe educational meetings have more value than a commercial. But doctors do like the promotional meetings.” Another pharma person in the audience pointed out that the amount spent on promotional versus educational events really depends on where a specific product is in its life cycle. If it’s close to being launched or newly launched, the budget will increase for promotional events, and decrease over time.

Van Harrison, who was in the audience, piped up with a question about policies on paying for training for educational speakers. Do they get honoraria? Schaffer replied that his company doesn’t pay for them to attend, but it does pay their airfare and living expenses, just not lavishly, so it’s a budget-neutral thing for them to attend.

There also was some back-and-forth about the value of national versus local speakers. Is it really worth it to bring in a big name, big money speaker to do a hit-and-run lecture, or is it better to rely on local experts who are better known to the audience and will be around to answer questions after the event is over? Schaeffer pointed out the obvious: It depends on your audience.

This free-for-all, no-holds-barred CME provider/industry dialogue, led by Maureen Doyle-Scharff of Abbott Laboratories and Mike Saxton with Wyeth Pharmaceuticals was pretty lively, to say the least. It was pretty much all a back-and-forth between the pharma and CME people in the audience, so I’ll just do my notes up as a Q&A (there sometimes were several A’s to each Q). Here goes:

Q: As companies move to online systems, some have also gone to an online contract. According to the Standards, we need an actual signed contract, not a virtual one. Is pharma working with ACCME on this?

A: The short answer is “no.” You’ll get a different answer from every company in this room. The dialogue is only happening on an individual basis, and at this meeting.

A: The closest thing to it is the Task Force (on CME collaboration), which has asked if we can be on the same page with some of the basic documents. Keep in mind that these online systems were built based on compliance [with OIG and PhRMA] compliance only, not ACCME regs.

Q: What can a CME provider do to make their application stand apart from all the other proposals in the Web-based system?

A: Quality, basically. Outcomes, needs assessment, objectives, methods. Another fundamental is that it’s aligned with our research interests.

A: We expect to get between 10,000 and 24,000 proposals this year. Short is good. Needs assessments are very important, too. The main reason we turn grants down are that they just present a need for a lump sum and don’t break it down into what will be spent for each faculty, for example. Also, we don’t give grants if meals are over $100 per person.

A: Don’t ask for meals, just educational expenses.

Q: The online forms are mainly geared toward live meetings, which makes it next to impossible to find the right fields for enduring materials or Internet activities.

A: Every week we have meetings on what we need to change. Give us some time; we’re still working it out.

Q: Are there limits on grant size that can go through an online system?

A: Our Web site is for smaller proposals; anything over $50,000 is given to managers to handle.

A: For us, it’s anything over $10,000.

Q: Is there any value in putting in a $9,999 request, then, to keep it under the threshold?

A: We see more of the opposite: If you have a proposal for $12,000, we may ask you to push it down to $10,000 to get it through faster. If it has to go to a manager, then to a committee, it will take longer.

Q: A lot of times we ask for $10,000, and they come back with, “we’ll give you $5,000.” Also, it’s hard to find the right Web site. Is there some way to find the right place to go?

A: Both the Alliance and the Task Fore are talking about developing common letters of agreement, which I don’t see happening. More likely, they’ll publish a guide to the right place to go. It’s one way to help you sort through the clutter. Cojmjpanies will have to wade through a lot of red tape, but I’m dedicated to making it happen this year. But it won’t be comprehensive, because some companies won’t agree to do it.

A: Call PACME members directly. They’ll help you if they can.

Q: Is there any hope for a topic that’s not product-related to get funded? Like medical ethics? If so, who would fund that?

A: Merck. There’s a list of “other” topics they’re willing to support on their Web site.

A: Does industry view this as a charitable contribution or as a return on education? We fund a lot of charitable contributions, and that might be one of them. But keep in mind that charitable contributions are only maybe 3 percent of our budget. The bulk of the money will always be evidence-based medicine areas related to our product areas.

A: We stick to areas of educational interest. There are broad interests, sometimes, like multicultural disparities, that we can support. What trips us up are topics related to practice management—we’re uncomfortable going in that arena.

A: Nontraditional topics may still have value to us. But you need to do more primary research during the needs assessment.

Q from pharma: We don’t have an online grant process yet, but we will by the end of the year. Could you give us the five things we need to keep in mind as we build that system?

A: Logical budget item entry.

A: Entries that allow enough characters in the field, or the ability to upload.

A: Flexibility in allowing providers to propose programs other than live events.

A: Make it stable (BIG applause on this one).

A: Make it saveable, and don’t let it time out on you.

A: List the company’s main research areas that are open to funding at the present time.

A: Ability to upload budget, agenda, needs assessment, etc., so we don’t have to re-input it all.

A: Save some of the basic information in the template so I don’t have to re-input it every time. Also, give us some idea of whether it actually went through and where it is in the process. Also, why a grant was rejected (pharma replied that that’s not going to happen, due to the sheer volume of requests they get).

A: A phone number to call for troubleshooting (one pharma person said, “I didn’t understand when I was a provider how much money it costs us to give away money. I would have to hire five more people to answer all those calls if we installed an 800 number).

Q: We have heard that some field-based personnel are coaching some providers on how to get a few steps up on the online process. Is this going to continue?

A: This shows there’s still a need for compliance training. Alert the company when something like this happens.

A: We would want to know if there was any coaching going on.

Q: I want to know about location. One of our hospitals is in the Florida keys, and they want to have the CME in their own backyards, not to have to travel to the mainland for it. It’s totally unfair that I get penalized for living in a beautiful place.

A: I would document your reality, in detail, in your grant request.

A: The tendency is to see “resort” and “Keys” and turn it down. Show how it’s an appropriate exception.

A: If you were in Iowa (not to pick on Iowa) and wanted it to be in the Keys, we would get nervous. For people in that circumstance, I would suggest restructuring your meeting so instead of having a five-day, four-hour/day meeting, have a two-day intensive on Thursday and Friday, and let them do the weekend on their own.

Q: We go to a nice place, but we go off-season, and we go all day long, every day.

A: Remember that it’s about perception, not actual costs. That’s why any application with “resort” in it will be kicked out. I don’t care if you got a $59 room rate and you went 24/7. All that would get printed in the paper is that you went to a resort. Some brand hotels are off-limits, period. It’s all about perception.

Q from pharma: We’ve been talking for almost an hour now, and it’s all been about money. We get tired of being your money pit. Isn’t there anything else you want to ask us about?

Q from CME: What market research can pharma give us that we can use for our needs assessment?

A: We couldn’t provide any.

A: As a provider, I remember drooling over that data. But our lawyers won’t let you have 95 percent of it. But ask anyway, because we want to show our lawyers that it’s important to share it, as long as it’s done right.

A: The amount of time it would take to go through all the data would prohibit this, since we can’t share anything that’s product-related, which most of it is, and rightfully so.

A: Find the info that’s published in clinical trials. You’re supposed to come up with an independent needs assessment.

We ran out of time at this point, but tomorrow (Saturday) there’s another three-plus-hour session on this kind of stuff that I plan to attend, so more is on the way (I feel like the pharma queen at this conference—for some reason, I’m going to all the pharma-focused sessions. But that’s OK, because they get pretty rowdy.)

Here’s another avoiding the appearance of commercial bias case, from the session on Thursday:

Case 2: Design and role of commercial supporter

Burton Transplant is newly appointed executive director of the Foundation for Healthy Hearts. When interviewing for the position, he promised the board of directors a 50 percent increase in revenue generated from the next annual conference. The annual conference is scheduled in 10 months so there is ample time to achieve this goal. Mr. Transplant is excited about his new position, and in particular is thrilled by the aspect of receiving a $10,000 bonus if the goal is met. In keeping with the established organizational culture, he writes letters to the list of commercial interests asking them to pledge funds to the Red, White, or Blue levels of support. Each support level has defined benefits for participant exposure, including corporate logos on coffee mugs, conference bags, and bookmarks.

When asked via ARS how high the potential is for the perception of commercial bias in this scenario, the biggest response (40 percent) was that there was a high chance, though about a quarter each said there was a low or moderate chance. When asked which of the Standards for Commercial Support would be most difficult to comply with in this situation, 39 percent said it was #4 (appropriate management of associated commercial promotion); the next highest percentage went for #1, independence.

Is it appropriate to display corporate (not product) logos on this kind of stuff? The response was mixed, but most said while technically OK since a corporate logo is not considered advertising, it’s not a good idea. One attendee added that in Canada, you can’t even give a pen with a logo on it. In the U.S., the presenters said, there’s no rule saying that you can or can’t give a token gift like a pen; it’s up to the provider to decide if they’re comfortable with it, and to talk with the commercial supporter about expectations ahead of time.

Update: Apologies to all who come here from the MM Extra e-newsletter! The link to the first case is here.

I just got an e-mail from someone with a question I can’t answer about California Senate Bill 1765. Does this legislation apply to medical conventions held outside of the state of California where California healthcare professionals attend, or is just intended for when a pharma is in California doing business with a California healthcare professional?

If you know the answer, please drop me an e-mail or leave a comment below. Thanks!

Update: Thanks to Debra Gist, MPH, who recently opened a CME consulting business, for hunting down this advisory on SB 1765. According to attorney John Krave, who wrote the advisory, this is still a gray area:

Unclear Geographical Limits. SB 1765 applies to pharmaceutical companies that operate within California, but fails to describe the impact of foreign state operations. Does SB 1765 require a company with a California presence to comply with PhRMA marketing limits in its Florida operations? The question is especially difficult if the company operates outside the OIG/PhRMA Guidelines but does not violate any laws in the process. Can the company truthfully post the required declaration if it has engaged in legal violations or has a flawed compliance program in a foreign state or country.

I missed the beginning of this one, but what I experienced of the rest was terrific. Led by Carol Havens, MD, and Philip Bellman, MPH, both with Kaiser Permanente Northern California, they went through why good outcomes begin with good needs assessment (if you don’t know where you’re going, how do you know when you’ve arrived?), and the need to link objectives to outcomes, use multiple interventions, measure outcomes in multiple ways over time, and use outcomes to identify future needs. CME can help “move the big dots,” they said, including quality, functional outcomes, mortality rates, patient safety, and a host of other things that everyone has their eyes on when it comes to improving patient population health. Outcome measurement not only leads to better education, demonstrates the value of the CME office, and helps determine future education—practically speaking, it also is mandated by ACCME, and positive outcomes can lead to exemplary accreditation.

Level 1 outcomes, what they called the “smile sheet,” just rates the quality, usefulness, objectives, presentation, faculty, and coffee quality of the activity. It doesn’t provide much on meaningful outcomes, though. They gave an example of a monthly one-hour videoconference where quality and usefulness were pretty consistently in the 90 percent to 95 percent range. But when they measured Level 2 outcomes (changes in knowledge, attitudes, or skills) for the same program, using pre- and post-tests, skill observation, and commitment to change agreements, 48 percent to 74 percent said they either will change or considering changing, while 15 percent to 31 perent said they already practice this, and 3 percent to 23 percent said it didn’t apply to what they do. They also asked those who said they were going to change to list two things they intend to do differently as a result of the program.

For level 1, you’ll usually get a 3.5 on a 4-point scale, and a 4.5 on a 5-point scale, said Bellman. “I can pretty much predict exactly the results you’ll get before the activity even takes place.” So, that’s not very useful. While level 1 “usefulness” ratings are somewhat useful, they aren’t predictive of what people will actually use. The level 2 question that measures their intent to change, though, is both useful and predictive, since intent to change correlates highly with actual change, Bellman said.

Level 3 (self-reported behavior change) involves a followup assessment of implemented practice change. This provides both intended and unintended consequences of CME, and can document impact of CME on practice behavior, though it does tend to be subjective since it’s self-reported. “We ask them if they changed something, and what they changed,” said Bellman. This can be done via Web or mailed surveys, and phone interviews. (More on increasing response rates to come later.)

For one CME program on managing obesity, 54 percent had said they intended to make a change in their practice (level 2). After one month, 45 percent said they measured BMI “more frequently.”

Level 4 kicks it up a notch by objectively measuring change in practice using quality measures, utilization measures, HEDIS, JCAHO, NCQA measures, screening, diagnostic, and screening rates, patient satisfaction measures, community public health data, and any other objective measures you can get your hands on. While level 4 measures can help assess needs and chart post-activity progress, they may not capture the breadth or complexity of new behaviors, and it can be hard to pick out individual data from that of a large practice group. Level 4 can measure things like increased chlamydia screening and appropriate prescribing of asthma medication, for example.

In an in-person and Web-based CME intervention to improve patient-provider communication and increase the use of electronic patient care records, the presenters found that 80 percent said they would increase the use of DV screening tools in the level 2 measure, and DV diagnosis rose 5.4 percent after three months.

The esoteric and elusive level 5 outcomes measure, which objectively measures change in treatment outcomes or population health status, tracks the net effect of practice change on patients and target populations. It also can be hard to measure or obscured by co-morbidity or other factors, the presenters said. Using sources like morbidity and mortality rates, incidence of secondary complications, and hospitalization and re-hospitalization rates, level 5 can measure things like a decreased risk of cardiac death, increased survival of HIV patients, and decrease in smoking rates. You can use level 5 outcomes to summarize change for key stakeholders, examine the intended and unintended impacts of the activities, and use the data to assess the need for future activities. “Don’t just document and put it in the CME files,” they warned. “Find out who the outcome data is important to, and let them know what the data is.”

Levels 1 and2 are immediate measures, 3 goes in 1-3 months, and levels 4 and 5 measure impact six to 12 months later, they said.

The presenters recognized that doing high-level measurements for all programs just isn’t practical, or even possible, for most providers. “We’d like all our programs to be level three or above, but we do the best we can,” they said. To find the time and resources to do outcomes measurement, prioritize your resources, and use the measures on high-impact programs that address organizational needs. They even suggested that the way CME providers have been proving their worth by holding more and more activities isn’t working to their benefit. Do fewer programs, and make sure the ones you do are high impact, they suggested. “If you only do 10 a year, but they have a big impact on patient health, you’ll prove your worth.”

Barriers: A big one is that docs don’t respond to surveys. The presenters had a few suggestions to increase response rates. While they do both electronic and paper surveys, they say not to rely on electronic because most docs still don’t respond very well to them. Don’t survey every program, either, just the ones that matter, so they don’t get survey fatigue. Also, when they come to the next activity and are a captive audience, ask what they did with the last month’s information. Another tip: Ask your physicians to send the request for info, because other docs are more likely to respond to someone they know. Keep the survey short, too. “It shouldn’t take more than two to five minutes,” and test it on colleagues first to make sure the wording is clear. Publicize the data, too, so they know what they’re doing matters, which makes for an incentive to respond.

My favorite tip was the “lumpy envelope” one: Put a piece of candy in the envelope along with the survey; they’ll open it just to see what the lump is. Once they open it, they’re somewhat engaged with it, and you have a better shot at them filling it out.

One audience member pointed out that its hard to link outcomes to a specific educational intervention, when there are so many other factors that may have led to the behavior change. The presenters acknowledged that this is a problem, and it’s hard to know the impact of each intervention. But, since what you really care about is improved patient outcomes, it doesn’t really matter all that much. “If you can identify that an educational intervention is needed, you provide that intervention, and change happens, you can rightfully say you were at least part of the solution,” said Havens.

I have to add that both the presenters were excellent, really lively and engaging, and I’m totally not doing them justice here.

I’m going to take a break and go walk around a bit, now that the sun’s out. I’ll try to post some more stuff in a bit. Again, please forgive my typos!

This followup to Wednesday’s section meeting was pretty hot, seeing as it focused mainly on responding to the JAMA article about banning pretty much all industry involvement in academic medical settings. Everyone seemed to agree that some sort of response was needed, and the audience went about thinking about what action steps could be taken to counter the negative press.

One suggestion was to agree to no longer send any commercial support to individual clinical departments, to only work through the CME office, which many pharma companies already do. For those who still work granting through sales reps who rely on their relationships with key opinion leaders and department heads, it might be a little harder to get them to work strictly through the CME department, though.

Another suggestion was to get input from some CME leaders who are well-respected leaders in this area, such as Van Harrison, on their willingness to wade into the fray. Many thought it was time to put together a white paper that outlines the reality of CME, the history of collaboration between industry and CME, and the safeguards that are already in place. Others suggested writing letters to the editor of various newspapers, and getting loud with congressional representatives on the issue.

One person suggested that the information might not seem credible coming from industry folks or PhRMA, and suggested that the Society for Academic CME might be willing to take up the cause instead. “PhRMA feels it already dealt with CME with the PhRMA Code,” one person said. “They’re drowning in Part D right now, and probably wouldn’t want to take this on.”

“We need to pull other entities into this so we’re not standing alone and looking self-serving,” another person said. “We shouldn’t be paying for all of this. Other entities are involved in CME, and should be involved” in defending the way it’s supported commercially.

Another action item was to let CME providers know that not only do commercial supporters not frown on activities that have multiple supporters, but that they view this as a positive. Being the sole supporter these days just adds to the perception of bias, they said.

Playing catchup this afternoon, yesterday’s session by Karen Overstreet, EdD, Indicia Medical Education, and Jacqueline Parochka, EdD, Excellence in Continuing Education, on preventing the appearance of commercial bias, was mainly a series of cases we responded to via audience response system (thanks, Meridia, for providing the ARS!) and discussed. I’ll scatter a few of these in posts as I have time. Thanks to the presenters for the interesting cases. Here’s one:

Case 1: Venue and role of commercial supporter

Ms. Doe Right, the vp and director of education, Renal Dialysis Medical Specialty Society, has just produced a DVD titled, “New Pediatric Treatment Options,” that was funded by an educationala grant from Better Kidneys, USA. The CME unit staff members are strapped for time, given that the annual conference is scheduled in less than two months and the board of directors has been promised that the DVD will be distributed to the membership before the meeting. She frantically calls her contact at Better Kidneys, USA, and begs them to help her distribute enduring material. She indicates that she will write a lettere of intent, prepared the instructions for distribution, and will supply the packaged DVDs and the membership mailing lists.

It was pretty much unanimous that the letter from the accredited provider did not protect the commercial supporter in terms of questions of accreditation, and likewise that commercial supporters cannot distribute enduring materials to participants. Alternate solutions the audience suggested included using BRCs and postcards, fulfillment houses, and the like. A couple of other notes were that it is OK for the sales rep to distribute brochures about the meeting, because they aren’t educational materials, and also that it is OK to use a mailing list from a commercial supporter, as long as you cross-reference it with a list you obtained independently.

E-venting has a great post about the various different types of blogs people are doing to support their meetings. For our Pharmaceutical Meeting Planners Forum in March, I plan to do kind of a hybrid of all four types that he mentions—on-the-scene posting from the conference (like I’m attempting to do here from the Alliance conference), some back-end stuff about the operational aspects (of interest, since the attendees are meeting planners), some pre-event programming commentary, and links to stuff of general interest to pharma planners. Ambitious, I know, but I think it’d be the right mix for this particular group of participants. Of course, no one will ever comment, the pharma industry being pretty circumspect these days, but it’s worth a try. It’s what I’d find most interesting, anyway.

What would you find most useful in a blog about a conference you’re going to? If you have any ideas, please drop me a line or leave a comment here.

And to the folks here in San Francisco who have mentioned that they enjoy these ramblings, a heartfelt thank you for tuning in! Sometimes I feel like I’m shouting into the void, and it’s great to know that someone’s actually reading this thing.

So much for good intentions. I ended up eating lunch at lunch, and not getting back to my room at breaks to catch up. So here I am, after a great dinner with even greater company at Finos, a nice Italian restaurant right around the corner from the hotel.

Anyway, to continue the post about this morning’s plenary session on putting CME in a systems framework: Barbara Barnes, MD, with the University of Pittsburgh, said that while academia has the clinical care, research, and education components, the three have become more like separate systems than part of one organic whole over time. CME in particular has become marginalized from the rest of the research and care systems. She sees regularly scheduled conferences as one of the greatest opportunities for making change, and stressed the need for performing a more active role in quality improvement committees.

The session ended on a high note with Barbara Huffman, MEd, Carle Foundation Hospital, who was a hoot of a speaker. “The easy thing about hospitals is that we have the three Ds: Docs, diseases, and data,” she said. “The problem is that patient care comes first, and everyone else takes a number—for CME, that number is usually in the double digits.” And, she added, if your administration changes, your processes and culture change along with it. “Your system will always have an effect on you,” she said.

In 2004, she was tasked with coming up with seven patient safety goals—things like making sure the right body parts are removed from the right body, and that one person’s ID badge doesn’t show up on someone else’s meds.

In doing the needs assessment, they found that they had the 80/20 rule going: 80 percent of the admissions came from 20 percent of the doctors. “So we decided to concentrate on the big admitters. We designed our program for the high users by using them as instructors—what better way to get them to change than to put them on the spot?” she said. They did all kinds of interventions, including putting the seven patient safety goals on mouse pads. “But we didn’t give them to the doctors, because they’d just take them home to give to their kids,” she said, laughing. Instead, they gave the message mouse pads to those who check the patients in and out, so they could be sure the protocols were being followed. (Which is pretty smart, I may add.)

I’m losing steam for the night, seeing as it’s about 1 a.m. where I come from and I have a very full belly that’s making me sleepy. But I promise to write up some of the other sessions from today asap: The PACME followup session was pretty good, and the two sessions on preventing the appearance of commercial bias were terrific (basically, lots of cases we got to dissect). The session I went to on practical strategies for better outcomes also was really good—one person said it was the best session they went to all day, by far. And, of course, the free-for-all session where CME providers and pharma folks got to grill each other was really, really hot. They even gave out Web sites for grant proposals (I’m not sure if they want me to share those publicly, so I guess you probably had to be there for that part).

On my agenda tomorrow are sessions on the viability of speakers bureaus these days, the 2005 AMA PRA credit system update, and another as yet to be determined. If it didn’t conflict with the AMA session, I’d love to go to the one on creating win-win joint/co-sponsorship relationships. I had the pleasure of meeting two of the three session leaders, Nathalie Harden and Ann Lichti, both with the Health Science Center for CME, last night, and they are just amazing. It will be one of the most dynamic and funniest sessions of the day, I guarantee it. Oh, and very educational.

So long for now, and please forgive any typos.