Abstract P307: Implementing an Orientation and Training Program for Quality Improvement in the Office-Based Setting: Initial Observations From the American College of Cardiology Improving Continuous Cardiac Care (IC3) Pilot Program

BACKGROUND: Organizational change experts and health care practitioners contend that readiness for change is a critical factor to successful change implementation. With the push to EMR adoption, practice guideline adherence, and systematic collection of standardized clinical data in the office setting, the need for continuous support of medical staff is essential in order to improve quality of care. METHODS: The American College of Cardiology (ACC) launched a prospective QI project targeting physician practices responsible for the care of cardiac patients in the outpatient setting called IC3, now known as the PINNACLE Registry. To provide resources for practices to join and participate in IC3, an Orientation and Training (OT) Program was launched based on the Transtheoretical Model (TTM) for behavior change. Two complementary activities supported the OT strategy: Care Package (CP) Series and Learning Sessions (LS). Independently, these activities were not intended to affect participant behavior. Training was designed as a combination of passive learning methods and practical tools for applying knowledge in daily practice. The CP and LS were delivered quarterly with a theme reflecting major annual events. Each theme targeted a specific role on the office team. IC3 partnering organizations were consulted to determine components and topics. Each CP consisted of printed and online materials. The LS were webinars, on-demand presentations, or referred offerings from other organizations. LS topics were categorized as IC3 Project, hot topics, and professional development. RESULTS: One welcome-themed CP was delivered to 169 practices in June 2009. Twenty LS were offered of which 16 were webinars with an average of 12 practices per webinar. Participant surveys, a practice assessment, and a research project on barriers and facilitators were planned but not implemented due to resource constraints. CONCLUSIONS: Standardized, constant, and relevant activities were essential to keep office teams engaged in a complex program like IC3. In applying the TTM to change behavior, each office team needed continuous and specific resources to move from awareness of IC3, to interest in participating, to engagement in collecting data, and to action in submitting data.