Improving Physician Attendance At Educational Seminars ...

1 SEPTEMBER 2004 / MANAGED CARE49courage Attendance . The faculty in-cluded a local Physician -leader and aregional asthma expert. The sessionswere scheduled by the MCO, but weregiven by the study group using a pre-viously developed curriculum thatemphasized material endorsed by theNational Heart Lung and Blood In-stitute. Direct costs were findings:Overall, 53 of299 (18 percent) providers partici-pated in the two-part asthma CMEsessions. Recruitment was signifi-cantly more successful when a physi-cian leader participated in solicita-tion of providers (P<.01). Successfulrecruitment generally necessitatedtwo points of contact, and phonecontact appeared to yield greater suc-cess than e-mail.

2 Scheduling conflictsand inconvenient location were themost common reasons given for notattending the Seminars . Ninety per-cent of providers who attended thefirst session completed the average direct cost per providerwas $ :Even when offeringprimary care providers a multifacetedinteractive asthma-teaching pro-gram, Physician recruitment necessi-tates personal and multiple contacts,and careful planning in terms of sem-inar location, time, and content. In-teractive Physician education semi-nars necessitate a large investment ofresources but may be cost-effective ifcare is Seminars for healthcare providers are a popular compo-nent of quality-improvement initia-tives for managed care Educational strate-gies to influence Physician practicesuccessfully include using interactiveformats, incorporating influentialphysicians as faculty, and schedulingsessions so that new information canbe integrated into practice and thenreinforced through supplementaleducation (Thomson-O Brien 2003,Mazmanian 2002, Davis 1997).

3 Nev-ertheless, providing repeated, inten-sive Educational sessions for physi-cians can be expensive as well aschallenging. Because time and re-sources must be invested to carry outsuch continuing medical educationevents, provider Attendance is centralto the success and cost-effectivenessof these partnership with five differentMCOs, our team recently facilitatedthe presentation of an asthma edu-cation seminar for primary careproviders on six separate occasions(two sessions per event). We specifi-cally selected this program becauseit had been previously evaluated andwas shown to improve pediatricasthma care and patient outcomes(Clark 1998).Asthma is a common pediatricchallenge that many MCOs children, particularlyABSTRACTP urpose:To enhance primary careprovider participation in a multi-faceted interactive asthma teachingprogram sponsored by managed :Case series of six MCO-sponsored continuing medical edu-cation (CME) :MCOs were pro-vided with a standard set of recruit-ment materials.

4 The MCO diseasemanagement divisions invited pedi-atric primary care providers of severaltypes to attend the asthma teachingsessions and tracked the type of con-tacts employed and the success were awarded CME andwere provided with a meal to en-Author correspondence:Michael D. Cabana, MD, MPHD ivision of General PediatricsUniversity of Michigan Health System6-D-19 NIB, Box 0456300 North Ingalls StreetAnn Arbor, MI 48109-0456E-mail: (734) 615-3508 Fax: (734) 764-2599 This paper has undergone peer review by appropriate members of MANAGEDCARE SEditorial Advisory Physician Attendance At Educational Seminars Sponsored By Managed Care OrganizationsMICHAELD. CABANA, MD, MPH1;RANDALLBROWN, MD, MPH1;NOREENM.

5 CLARK,PHD2;DIANEF. WHITE,RRT1;JUANITALYONS,PHD1;SYLVIAWANNE RLANG,PHD1;SUSANL. BRATTON, MD, MPH11 Department of Pediatrics, University of Michigan Health System, and 2 Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, interactive Educational Seminars that target physicians require a large investment of resources, they can be cost-effective if medical careis improved as a with Medicaid insurance, aremore likely to have asthma but lesslikely to receive appropriate care(Finkelstein 2000, Lieu 2002, Ortega2002, Halterman 2002, Clark 2002).In addition, significant gaps in physi-cian adherence to national asthmaguidelines are well documented (Ca-bana 2001, Diette 2001, Scarfone2001).

6 As a result, we targeted physi-cians who provided care for asth-matic children enrolled in qualifiedMedicaid managed care MCO employed varyingstrategies to improve Physician at-tendance. This case-series report de-scribes our experience and observa-tions about the success of thesetechniques in promoting physicianattendance at the Educational semi-nar and includes the reasons forphysician nonattendance and esti-mates of program costs relative to programThe interactive seminar focuses onenhancing physicians therapeuticskills in treating childhood asthmaand developing physicians ability toeducate and counsel families aboutasthma self-management. The pro-gram has been evaluated in a ran-domized controlled trial and wasshown to improve patient outcomes(Clark 1998, 2000).

7 The program includes brief lec-tures from a local asthma expert, avideo showing effective clinicianteaching and communication behav-ior, case studies regarding clinical is-sues, a protocol for physicians to as-sess their communication behavior, areview of important messages tocommunicate, and materials to dis-tribute to families (Clark 1997, 1998).The program, named MichiganPhysician Asthma Care Education(MiPACE), was augmented by twocase studies emphasizing barriers toasthma care relative to Medicaid pa-tients. These case studies were devel-oped from themes identified by focusgroups with the caregivers of asth-matic children insured by Medicaid,and they were structured in aproblem-based format (Zeitz 1999).

8 The Seminars have been designedto be delivered in two 2- to 3-hoursessions, over the course of 2 to 3weeks. Typically, the Seminars areheld during the evening in a centrallylocated venue selected by the MCO,and a meal is provided to partnersAfter approval by the University ofMichigan Institutional Review Board,we contacted managed care organi-zations in Michigan that providemedical care for a large Medicaidpopulation (Michigan Community Health 2004). Becausethe purpose of the Educational sem-inar was to improve asthma care andoutcomes, we reasoned that thesecompanies would be motivated tosupport the program and promote itto network practices. We approachedMCOs serially, based on the numberof Medicaid patients enrolled in theirprogram, until five had agreed to also approached local asthmacoalitions to form a cooperative part-nership with the MCOs to recruit pe-diatric primary care providers for theasthma teaching session.

9 The namesof asthma coalitions came from theState Health Department and fromthe incentivesThere was no cost to attend the ed-ucational seminar. The seminar wasapproved for CME credit of 5 hoursfor participants who completed theprogram. A meal was provided dur-ing each received a completetoolkit of asthma Educational mate-rials including patient handouts,asthma action plans, asthma placebodevices,* Educational posters, andWeb site information. The educa-tional materials were prepared andprinted professionally. These in-cluded a copy ofPediatric Asthma:Promoting Best Practices(AAAAI1999) and the Michigan Departmentof Community Health s Asthma BluePrint for Action, which contains in-formation regarding asthma care aswell as asthma resources in the state(Michigan Department of Commu-nity Health 2001).

10 The kit also included asthma ac-tion plans in English, Arabic, andSpanish, samples of medication de-livery devices, and peak flow meters,as well as a poster from the AmericanLung Association s Open Airways forSchool Program (2003).Lastly, copies of the program slidesfor the cases were included. The com-plete set of Educational materials wasworth approximately $100. The studyteam provided the seminar faculty,staff, supplies, room rental, and par-ticipant meals for the educationalprogram. Physicians received no hon-oraria, but the MCO provided a newstethoscope to each participant inseminars 2 and strategiesOur goals were to recruit 10 to 12pediatric providers per seminar andfor participants to complete both ses-sions.