Nancy L Davis

Institute for Healthcare Improvement, Cambridge, Massachusetts, United States

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Publications (8)7.79 Total impact

  • Nancy L Davis, Lloyd Myers, Zachary E Myers
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    ABSTRACT: The movement toward improvement in healthcare quality and patient safety has led to greater emphasis on practice performance measurement and physician accountability. Health information technology provides clinical data for quality measurement but hasn't provided the link to practice-based learning and improvement. An electronic portfolio for practice-based learning and improvement (ePortfolio) that combines practice data for identification of competency and performance gaps along with learning and process interventions offers true practice-based learning and performance improvement. Automated reporting can assist in the ever-increasing burden of documentation for maintenance of licensure, maintenance of specialty board certification, credentialing, payer recognition programs, and other physician accountability requirements.
    The American journal of managed care 12/2010; 16(12 Suppl HIT):SP57-61. · 2.12 Impact Factor
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    ABSTRACT: The American Academy of Family Physicians (AAFP) designates enhanced continuing Medical education (CME) credit (evidence based [EB] CME) to activities that meet specific criteria incorporating EB medicine principles. However, little is known about the effect of this innovation on EB-CME faculty or their learners. Subjects were faculty presenters and participants at the 2006 AAFP Annual Scientific Assembly. We compared presenters and participants of sessions with EB-CME approval to those without, assessing faculty preparation and participants' perceptions of CME quality and value. EB-CME faculty preparation was more likely to use evidence-based medicine (EBM) resources and less likely to rely upon books, journals, or personal experiences. There were statistically significant differences in session participants' perceptions with regard to scientific evidence presented, perception of commercial bias, and application of information to practice, with EB CME sessions more favorable in all dimensions. Main faculty barriers to EB- CME application were time constraints and limited understanding of the application and approval process. The AAFP's EB-CME designation is associated with greater faculty use of EBM sources, while EB-CME participants perceive EB-CME as higher in quality and value.
    Family medicine 01/2009; 41(10):735-40. · 1.20 Impact Factor
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    ABSTRACT: There is much in the literature regarding the potential for commercial bias in clinical research and in continuing medical education (CME), but no studies were found regarding the potential for bias in reporting original research in CME venues. This pilot study investigated the presence of perceived bias in oral and print content of research findings presented in certified CME activities. Research presentations at two national primary care CME activities, where authors had self-reported potential conflicts of interest, were peer reviewed and monitored for perceived commercial bias. Blinded and unblinded peer reviewers' and monitors' analyses of bias were compared to assess whether knowledge of potential conflicts of interest affected perceptions of bias. Knowledge of potential conflicts of interest appeared to increase awareness of potential commercial bias with regard to use of a single product in care and assurance that there was reasonable evidence to support the practice recommendation. A perception of the presenter's strong opinion regarding care did not appear to be influenced by knowledge of a potential conflict of interest. While limited, by study design, this research detected subjectivity and variability in perceiving commercial bias within research findings presented in CME venues. Further study of these questions is required to guide the resolution of conflicts of interest in research and CME.
    Journal of Continuing Education in the Health Professions 01/2009; 28(4):220-7. · 1.32 Impact Factor
  • Nancy Davis
    Journal of Continuing Education in the Health Professions 01/2009; 29(1):79-79. · 1.32 Impact Factor
  • Nancy L Davis
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    ABSTRACT: Leaders in the field in academic settings, professional associations, and those who determine criteria for CE credit should discuss implications and work together to establish appropriate processes to promote learning at the point of care. Clinical decision support and point-of-care learning based on evidence-based practice recommendations reduce variability in care, reduce errors, improve safety, and ultimately improve the quality of patient care.
    The journal of evidence-based dental practice 10/2008; 8(3):181-5.
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    Nancy Davis, Executive Director
    02/2008;
  • Nancy Davis, David Davis, Ralph Bloch
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    ABSTRACT: This guide is designed to provide a foundation for developing effective continuing medical education (CME) for practicing physicians. For the purposes of this work, continuing medical education is defined as any activity which serves to maintain, develop, or increase the knowledge, skills and professional performance and relationships that a physician uses to provide services for patients, the public, or the profession (American Medical Association 2007; Accreditation Council for CME 2007). The term continuing professional development (CPD) is broader and has become more popular in many areas of the world. As defined by Stanton and Grant, CPD includes educational methods beyond the didactic, embodies concepts of self-directed learning and personal development and considers organizational and systemic factors (Stanton & Grant 1997). In fact, this guide describes many modalities that may be defined as CME or CPD. In the interest of simplicity, we will use the term continuing medical education (CME) throughout, with the understanding that the same strategies may be applied to non-clinical continuing professional education. For those who do not work exclusively in CME, many terms and processes may be unfamiliar. This guide is intended to provide a broad overview of the discipline of CME as well as a pragmatic approach to the practice of CME. The format provides an overview of CME including history and rationale for the discipline, followed by a practical approach to developing CME activities, the management of the overall CME programme and finally, future trends. At the end of the guide you will find resources including readings, websites and professional associations to assist in the development and management of CME programmes.
    Medical Teacher 01/2008; 30(7):652-66. · 1.82 Impact Factor
  • Nancy L Davis
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    ABSTRACT: INTRODUCTION There are many drivers of improvement in healthcare quality. At the turn of this century, there were many calls for improvement of health-care delivery and patient safety. In 2001, the Institute of Medicine's Crossing the Quality Chasm reported that as many as 98,000 deaths per year were caused by medical errors [1]. The Midwest Business Group on Health cited the healthcare dollars wasted and an annual cost of poor quality of $2000 per covered employee [2]. McGlynn and colleagues at RAND discovered that only 55% of evidence-based recommended care was actually delivered [3]. During the same period, continuing medical education (CME) researchers were looking closely at the effectiveness of CME in actually changing physicians' practices. Davis et al discovered that traditional CME alone was not effective in improving practice, but they did find that it could lead to desired changes when connected with other modalities [4]. Yet, CME was not changing. CME pro-viders continued to produce the type of programming they were comfortable with and that their physician learners demanded. Online CME continued to grow as technology improved and phy-sicians found it more difficult to leave their practice to attend CME activities at remote venues. Between 1998 and 2003, the number of Internet-based CME activities increased more than 700%, com-pared with the 38% growth in total CME activities [5], and the number continued to climb through 2008 [6]. Internet technol-ogy provided a new delivery format, but the content and design remained largely the same as live CME, with little linkage to a specific practice. In 2005, the American Medical Association Physicians Recognition Award (AMA PRA) introduced criteria for performance-improvement CME [7]. Based on basic quality-improvement con-cepts, this new CME format provides a CME credit reward for phy-sicians who are participating in practice-based quality improvement. Credit is awarded by a CME provider according to the physician's documentation of the completion of 3 stages. Stage A is the assess-ment of practice against evidence-based performance measures. Stage B is the implementation of intervention(s) for improvement. Stage C is remeasurement of practice following intervention. Five CME credits are awarded for completion of each stage, with 5 addi-tional credits awarded if the whole cycle is completed, for a total of 20 credits. This process is consistent across all 3 CME credit sys-tems in the United States (AMA PRA, American Academy of Family Physicians, American Osteopathic Association) [8,9]. This new type of CME requires a new skill set on the part of CME providers and their learners. Most of these individuals have no formal training in quality-improvement concepts, processes, and tools. Although measuring outcomes has become more impor-tant in CME in recent years, the level of practice-change measure-ment required for performance-improvement CME is uncommon. Evidence-based performance measures are typically not part of CME needs assessment, content, or outcomes measurement. Along with a new focus on practice improvement, the Accreditation Council for Continuing Medical Education (ACCME) Updated Criteria for Accreditation offers CME providers the opportunity to attain a higher level of accreditation if they work in collabora-tion outside the CME unit. Providers mastering criteria 16 to 22 are rewarded with level 3 accreditation [10]. These criteria include the integration of CME into processes for improving practice, including the use of noneducational strategies, overcoming barriers to change, collaboration with other stakeholders, and positioning CME within the organization to influence the scope and content of improvement interventions. Whether the provider aspires to level 3 accreditation or not, there are challenges in meeting new expectations with regard to practice-specific goals and gap analyses. Clearly, there is a need for new processes for continuing professional development to advance beyond CME, but many CME providers are not in a position to meet these demands.